06090024 CITY OF CUPERTINO
BUILDING DIVISION PERMIT C�,NCRG"T<)AINpA.'I'.TQ1�� -
BLDINGADDRESS: APACHE ROOFING PERMIT"°'06090024
BUILDING
KENTWOOD A
OWNER'S NAME: PERMIT[SSUEDATE
,OJEFF REILY 5829 EL DORI DR 0
NE: SANITARY NO. CONTROL NO.
(408) . 363-0205
ARCHI'IECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
00 LICENSED CONTRACTOR'S DECLARATION Job Description
r'1 I Mreby affirm dust I an licensed under Provisions or Chapter 9(mmmcnsing
U with Section 7000)ol'Division 3 oldie Business and Professions Cocie,md my license is
in lulls— d 3 1 REMOVE 2 LAYERS OF COMP ROOF. INSTALL NEW GAF 3
,qz LlednmclaS Lm.a TIMBERLINE. INSTALL MODIFIED BITUMEN AT FLAT AR
i Daus ARCHITECTSDECCLARA ION CLASS A
I I undersand my plans Shall W used as public record,
i�
0�n Licensed Pm(cssianal
t 3 OWNER-BUILDER DEthe Com ION
on
)�E I hereby a(nm on I em uempl from the Conmcmrs License Law for the
:H o whichfollowingre mann.(Section](131.3,Business and Profusions Cede:Any oily or county
B$ which requires a permit to rnnswe4 tlmr,hnpmvc demolish,Or Nash my s4udme
prier m its caned pumantt also in resuse Pre inion o for such p mit actor's censerile Lned nammem
• G that he isllccnSedpurwanlmthepmviaVonsofthmCantacmr'SLiansciaw(Chapmr9 Sq.Ft.Floor Area Valuation
3 $ (commencing with Section 7000)of Division 3 ofthat Businmmd Profeusions Code)or $12283
— that M V exempt ihcm(min and the basis fm that alleged esempdan.Any violation of
Section 7031.5 by any appitant for a permit subjects the applicant m a civil penally of APN Number Occupancy Type
rat sums,than five hundred dollar(SIM
❑1,a awns of W propenY•car my emplaym with wages u thew suis cmnpensssian,
ad dadewode andi 7WCortiaot's Lkwhom Lew
ddss a,a(Sm.70 N.oMiws Required Inspections
and arty who
Cade:The ws durrors d who taw dm ret apply lf rt awns of q P
propertywhobudidscarImprovch improvements
thou at in tart himm5f or through his
hown arem,ft WipmNdedthussuch ImPsowmenusaremtinte of aroReredfmsalen-
Wil de, this Wilding or improwmml a mid within Sao
Sear Or mprowf r Cts owm-
buildu w10 have the burden Of proving dal K did sur htiW ar'unprow for puryoSe of
seta.).
❑1.as owner of the wpicny,as emlaiwly camMing with licensed coon ramm m
cansuuu ow project(See.7041.Business ad PofeadOtu Cade:)The CmaaChiel Li-
caselaw thou on,apply,on an owns of Pupdny Mo bodies or improv thdrmn,ad.
who contacts for such projects with a contrscmr(0 licensed pursuant at use Conuacto's
License Law.
❑I at exempt under See ,B&P C for thus reason
Owner Dau
13370WORKER'S COMPENSATION DECLARATION
1 hemby&Mm under penally of Perjury ane of the following dedsmlians:
I have and will maintain a Ccollica sof Consent to selfdnsum for Worker's Compen-
0
rm,a provided for by Section 3700 of the Labor Code,for this per(onnunce of the
rk for whish this permit is doused.
I have and will maintain Waimea Compensation Imam,u required by Section
of the labor Cade,for Ne performance of the work far which this permit is imoed.
y Workers CampensNon Inssom me carrier and Policy number art:
rtier. Policy No.: -
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu Section reed no wconpleud if Ile permit Is formic hundred doom($100)
or less.)
I certify dont in the performance of Me wart far which this permit u issued.)spall nut
employ any person lose'
SUb*L to the Workers,Compensation
Laws of Cslirmohi
Applianl
NOTICE TO APPLICANT:If,jifte,making do 'nam of Esemption,you should
bceame Subject in the Winter's Compensation pmvisiom of the Labor Cade.you most
Q farthwith mit comply wed such provisions or this per "I be deemed mocked.
z tiCONSTRUCTION LENDING AGENCY
[ti I bemby aRm that Nem is a mnstructinn lcnding agency for one perrormsrae of
a> the work for which Nis permit is issued(Sec.3099.Civ,C.)
W Q Lenders Nmc
Landers Add.
U I certify that I haw had Nis application and Suu that tho,bow Mfmmatiun IS
U. correct.I agree to comply with all city and county oMn caws and sou laws relating to
0U building construction,and hereby authorie mpruenutives of this city to anus,upon the
ahow-memiancd property For inspecdon purposes.
(We)agree to law,indemnify and keep harmless the City of Cupertino against
ti(n liabilities,Judgments,costs and expenses which may in any way we=against Said City
U in consuence Or The s rmit,
APPLICANT UNDERSTANDS Aarong of SND WILL COMPLY WITH ALL NON-POINT Issued by: Date 7.r_V'61
SOURCE RE j. ONS,
Re-roofs
Sigalurc ofApplicarmmr
H ARDOUSMATERIALS DISCLOSURE Type of Roof
Will tho applicator future building occupmumro or handle haaardoes material
as denned by the Cupenino Municipal Code.Chapter 9,t2,and the Health and Safety
Cade.Section 35532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes I No
1 If a roof is installed without first obtaining an inspection,l agree to remove
)y W01 the applicant or future building oaup of use equipment or devim which
emit hamb us sir contaminants u dc0md by tie Bay Amo Air Quality Management all new materials for inspection.
D Smicl7
❑Yes CNa
I have read Ne hanNommsmri is mquimments undarClopmrB95 ofd¢Calif-,
nu H.Il &Safety Cad,Smdons25505,25533aed9553J.Iundcrmnd Jmifthe htdlthng iC . J iJ�OV b
his not currently haw a unm4 that It is my responsibility in notify the mupmt of the Z
rtquimmcnu whichm M mel Priorwissumaafa Ccnifeaeof Occupancy. Signature 0 pplicant Date
So All roof coverings to be Class"B"or better
r sulhariud a am
Community Development
10300 Torre Avenue
Cupertino CA 95014
Its Telephone(408)777-3228
tl
CITY OF Fax(408)777-3333
•CUPEI�TINO
Building De artment
JOB ADDRESS: 11V -7 PERMIT #
6,-5 2�(
OWNER'S NAME: PHONE # VIS V40 /2 S
GENERAL CONTRACTOR: RO A 0,e FAX # y °
I am not using any subcontractors: _® -�. i i u 6
*nature D to
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring,. Carpeting
Linoleum/ Wood
• Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
bj Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Co actor Signature Da e
CITY OF CUPERTINO
•em 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35931018 . 00
DATE ISSUED. . . . . . . : 09/05/2006
RECEIPT # . . . . . . . . . : 35909
REFERENCE ID # . . . : 06090024
SITE ADDRESS . . . . . : 1147 KENTWOOD AV
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : JEFF REILY
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : MEL ESCARCEGA
CONTRACTOR . . . . . . . : MEL ESCARCEGA LIC # 00074
COMPANY . . . . . . . . . . : APACHE ROOFING
ADDRESS . . . . . . . . . . : 5829 EL DORI DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95123
TELEPHONE . . . . . . . . : (408) 363-0205
*FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- - --- ----- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 13 , 000 . 00 201 . 96 0 . 00 201 . 96 0 . 00
BSEISMICRE VALUATION 13 , 000 . 00 1 .30 0 . 00 1 . 30 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 308 . 26 0 . 00 308 . 26 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 308 . 26 4641
------------
TOTAL RECEIPT 308 . 26
•
CITY OF CUPERTINO
• �� REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Address: J CIEO l y
ve
Owner's Name: Pho #:
y%r,
contractor: � License�9//��
Contact: r� g y/Yf— Cupertino Business License #:
C � LS CGN'cB A S/o l $S
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
X Asphalt Shingles 0 C& Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shinglesnn'' S a
P. Other(Specify) 1'� _;.�:.a1, 9� Other(Specify)CMo6,* -t_' ON 1�•..1I are"A
Number of existing coverings a- ❑ Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
Residential Con1mercial ❑ 2 .5 t •W>�a:G:.� + ^ �^ a t F
Fire Zone: Yes No ❑ Confirmed with Planning De t. if
there are any restrictions: LJ
ost of Project: Type of Construction: Occupancy{group/:t
l Q_ 6 \�
T3.06
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
•
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
Fax: (408)777-3333 •
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) h1-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed, a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing, •
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4" per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: _44-. e
Job Site Address: VeJWooc}- �u2
Roofing Company Name: P
Applicant's Signature: � � Date: °2OO
Greg Casteel �' / • .
Building Official
Revised 11/2/04