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CITY OF CUPERTINOt
BUILDING DIVYSION PERMIT.
CONTRAGT�It I1V1+]gOIIMAT�I¢N�'-:
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BDIIIfI3pBE9s;A
PERMl I NO.
L JOLLA CT
LOS GATOS ROOFING
08050115
EWS NAME:
PERMIT ISSUE DATE
LEONARD PHYLLIS
P 0 BOX 1725 --
05/13/2008
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECT GINEER:
BUILDING PEJU ITINFO
RE -RF RMV EXSTNG RF& INSTL
BLDG ELECT PLUMBMECH
LICENSED CONTRACTOR'S DECLARATION
Job
I Ictcby affirm that1 w Ihenwd under provis ons of Cbspmr 9 (commencing
^^ ^ ^^_ _..__ �_ ...._ -..- ._ -Description
viN Sauon]0(IU) of Dlvlsim 3 ofthe Businev aW Prafe vam Codc,aW my lc.mc is
I. fail I. sod effort.
_
Liceme Clms Le.
Dale /d - 4r- 60_ CoWdoIaf 00}
ARCHTIFCI'S DECL3RATION
1 usulersund my plans slWl W coast u Public mcurds
Limned ptufcaional
j OWNER -BUILDER DECLARATION
1 Wrathy alum that 1 assn uc.,I from the COnunctors License Law for rhe
i following rcvon. (Section 7031.5. Susi oda, and Pnfcasiov Cade: MY city m manly
which rtquism a p:.I, no cowrun. Ater, improve, dOWILsh, or repair any suuc(uro
! primm its issuanco. also rcquims the applicam for such psmit ro Rk asignW stacmm(
i NaLWisllccncdPorauanlnla, provisions ofmcConuacnr'sLia.Law (CbpW9
Sq. Ft. Floor Area
Valuation
I (commencing with Section 7")of Division 3 or the Business and Prorwsiov Code)or
. dal W is ewopt tbeseftum and the basis for the allegW es raquim Any violadan of
APN Number
Occupancy Type
P Y YP
Sraion 7031.5 by arty appBon( fora permit wbicca ft applicant m a civil Finally of
cot more Nan five huWmd dollars (55018.
❑ 1, u owar of the propesry. m mY wploydv with mgv u Heir role eompention,
wBl Pr Newos; sonde: Thus ComduhlsLics ma.c f cata(Sec.]Dan•Husinw
Lirr tau Law cissa cot appy 10 rt awwa
pod Pnfdvlwu Cade:mpr andso
Required Inspections
is
imputes dh sodwho 6narauhanda himselfmIlumagn boa
improves ,
Ownenywhobuilds provided inn1r mN[erW farthe sain.curd If.
awn employaa, such im art not mrs
ingorthat Is said within of
bilchor. the building or iian ovmrmtisveld within arcyear of
Winonafa.tlunau,O-
WBdar will bate Uc burden of proving; tiro W did rot WLW w improve fav pugox of
ulc.) '
❑ 1, u awnar N she properly, am uelusimly contracting with ocensest mnvaerms in
covtroct rhe project (See. 7064, Basins and Professions Code:) The ConuacnYs U
cave law do not appy w an owner of proprny who Wilds or Improves Merton, hand,
who contnM fm such projects with a conrracmr(s) licence pwuunt no rule Comusetoes
...
.
Licence lase.
..
❑ I am ucmp under Sae ,B&PC fm this masm
or Dam
WORKERS COMPENSATION DECLARATION
I herby affirm under Puvlly of perjury and, of the following declatadov:
]ham and will msinain aCcNOeam of Coven( n ¢If imam fav WorkersComp:n-
Wim, u proNdel fm by Secuun 3700 of rhe labor Code. for the performance of the
work for which this pmol, is ivucrl.
Cl I lout soul will ..loci. Workers Compensation I., u ruquisaul by Scncn
3700 of the labor Cale, fm the pd rmonance of the wort forwhich this permit is ivmd.
My Worlod, C/p-mp/gnaafio}p-Ivuranm canim and Policy nuumberraass: /y G y
C=.._�T a r.A lu/� Policy No.: ln3 I I % poll
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This auction wad nal W cwnplemd 911%, permit is froom wndrW dollen (SIM)
orleu)
1 certify that in rbc perfosmanm of IW wort for which this permit is issued. 1 shall am
amp1q., person in say manncrao as in xc me aubjecl to the Wortrn' Comp:nauoo
laws of Calir.orm Dam
Applicant
NOTICE TO APPLICANT. if. after making Nis Cenificam of Esempuon, ym mould
bassoon subject in the WOrkers COOOPevauon provisipu of tai Labor Code, you must
forthwith comply with such provision or this Permit shall W deemed revoked.
I
CONSTRUCTION LENDING AGENCY
1 WOOJOY affirm this dem is a cownrciion funding appy for rhe purfmmanm of
dau work run which this pa mit is issued (Sec. 3097. Civ. C)
Landers None
,
Landers AWnv
1.1mfy ver I have mad his applicaum sod sure Thu tiau above iNomudmr is
cwrasL I agave m comply with all city cul coany aNinasrn and ruse lots mlaung to
Wilding construction, and hereby autbodae aphosenWims of this coy n caw upon rM
shove-menuarod Propny rot impctlon Pm PQSaL
(WO ago in Yve. h dcmmify and kasp handless the City of Cupnirm again,
liabilities. judgmcnu. cora and esperrws which may in my way accrue almost said City
-
In COn arloac ou of thC gMdng Of this penult.
APPLICANT ERSTANDS ANP-NIILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE R U QOONS.
S i5 d
Re -roofs
Srg Date
HAZARDOUS
NA2ARDOU MATERIALS
Type of Roof
WIII e (atomDISCLOSURE
, m future Wilding ottupantuoro
b Ned h mamrial
defined y t Lupo ealdom
the Cupertino Municipal Cade. LTepnr 9.11• and rhe Health and Safety
. u
io
.Section 15532(.)7
❑ism Q)No
All roofs shall be inspected prior to any roofing material being installed.
i�
Will Inc applicant or fulum Wilding msupam us, equfPmeal or dcvfas which
If a roof is installed without first obtainingan inspection, I a ren to remove
_ P g
emir lumardous air conaminanu as deftncd by the Bay Ama Air Quality Managemcnr
all new materials for inspection.
Distric(]
❑Yv pNa
IhavenW the barardnmamristsmq immcnuundcr Chapmr6.95ofthe Calif.-
niaHulth&Safcry COdc.ScN=255U5.25533md255M.1 undersand thnirdnc Wilding
do mel curtc Y haw • tmanr, than Il is my mapmmihiliry m roufy Uc aavpan(nT rule
od,i veld m� rmissmwmaraccruftca�ar s.9wu,
Sig a reofApplicant Dae
S /J 0
roof coverings to be Class '1?" or better
g
Owmr onuthorisd gcor —1 pram
Dow
• 2 ITEMS OF 6
•
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN I.......: 35621051.00
DATE ISSUED.......: 05/13/2008
RECEIPT #.........: BS000004766
REFERENCE ID # ...: 08050115
SITE ADDRESS .....: 11236 LA JOLLA CT
SUBDIVISION .......
CITY CUPERTINO
IMPACT AREA .......
OWNER LEONARD PHYLLIS
ADDRESS ..........: 11236 LA JOLLA CT
CITY/STATE/ZIP ...: CUPERTINO, CA 95014
OPERATOR: patg
COPY # : 1
METHOD OF PAYMENT AMOUNT
----------------- ---------------
CHECK 1,081.40
---------------
TOTAL RECEIPT 1,081.40
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
REFERENCE NUMBER
--------------------
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
RECEIVED FROM ....:
LOS GATOS ROOFING
CONTRACTOR .......:
RANDY BROWN LIC
#
23481
COMPANY ..........:
LOS GATOS ROOFING
ADDRESS ..........:
P 0 BOX 1726
CITY/STATE/ZIP ...:
LOS GATOS, CA 95031
TELEPHONE ........:
(408)298-9399
FEE ID
----------
UNIT QUANTITY
-----------------------
AMOUNT PD -TO -DT THIS
REC
NEW BAL
1BSEISMICR
VALUATION 10,935.00
--------------------
1.10
0.00
----------
1.10
----------
0.00
1REROOFRES
SQ FEET 32.00
416.00
0.00
416.00
0.00
TOTAL PERMIT
---------- ----------
417.10
0.00
----------
417.10
----------
0.00
METHOD OF PAYMENT AMOUNT
----------------- ---------------
CHECK 1,081.40
---------------
TOTAL RECEIPT 1,081.40
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
REFERENCE NUMBER
--------------------
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
0'�0 5 oi1s
CITY OF CUPERTINO
d'" REROOF
CITY OF
• CUPERTINO PERMIT APPLICATION
APN #
356,-2/ —os'(, 00
Date:
Building Address:
Owner's Name:
Phone #:
-�
�- Jae Lif0hG/-G/
yah 20-- �Z3 v
Contractor: lOS Cr—C�. � S � U 0 r? Gj
1-..�
Phone #: [1U 8' 9 9 1
2 b>_-,)-3
Fax #: O,? 02 f - 9?3 -71
Cupertino Business License #:/
Contractor License #:
oa 70
Type of Roof Covering:
Existing: Proposed:
❑ Built -Up Roof ❑
Built -Up roof
jL ❑ Asphalt Shingles Asphalt Shingles
❑Wood Shakes ❑
Wood Shakes
❑ Wood Shingles ❑
Other
Wood Shingles
tQ,S
.)( (Specify)6 A 40 (Y) Lt ❑
Other (Specify) %
Number of existing coverings / ❑
Provide I.C.B.O. Report #
To be Removed
Provide Mfgr. Installation Specs.
S 53_2on f (-! /4
Jo Description:
cam.-�-� d'iT
Residential
Commercial ❑
Fire Zone: Yes ❑ No
Confirmed with Planning Dept. if
Valuation:
there are any restrictions: ❑
m) '!�3 S
I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy:
//
M
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) In -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 yu re -roofing.
Homeowner's Name: 91
Job Site Address:
Roofing Company Name:
Applicant's Signature: Date:
•
Greg Casteel
Building Official
Revised 11/2/04
• CUPEI�TINO
CITY OF CUPERTINO
REROOF
FEE SCHEDULE
Number of
Squares
Fee ID
Fee Description
Fee
Group
Permit Type
IREROOFCOM
Re -roof Commercial
B
1COMMLROOF
1BSEISMIC0
Seismic Commercial
B
3n
G/
IREROOFRES
Re -roof Residential
B
1SFDWLROOF
1BSEISMICRE
Seismic Residential
B
1REROOFMRES
Re-roofMulti-FamilyB
1MFDWLR06F
IBSEISMICRE
Seismic Residential
B
IBUSLIC
Business License
B
0
"'ESL'
CITY OF
4 UPEIjTIN0
Community Development
10300 Torte Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:23�
PERMIT #/
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR:
FAX #
I am not using any
- I Signature
Please check aDvlicable subcnnl-rartnrc and rmmnlaha 1 -ha fnllnwina infnr nHnn-
49-
v
Owner Contractor Si e ate
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
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
v
Owner Contractor Si e ate