08040074 CTTY OF CUPERTINO `x.'IBH4waWsc �Ym
BUILD7AG DIVOON PERNIIT CONTRACTt1R INFORMA dQiV.
eull.glyc y,ggryesLPERMIT NO.
LAKE SPRING CT LOS GATOS ROOFING 08040074
OWNER'S 7NA.Ii; PERMIT ISSUE DAIS
HENRIQUE MARTINS P 0 BOX 1726 04/10/2008
NE: (408) 298-9399 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINBER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
L� O O O
fop LICENSED CONTRACTOR'S DECLARATION IOb Description
1 bmm Wo:uei eby an t 1 Me Uunder pmioru m
viof Chapter 9(comencing
;i withsection70150ofDivWan3mftheBua«usod itfesioruCode.Memylicena4 RE—RF RMV SHK INSTL 30FLT&GAF/ELK CLS A 22SQ
D y m full forte ansa eRanv
ua.Cl Ix.{
Dow... Gnlruwr
e ARCHITECTS ham DECLARATION
G I undenunJ my plw,htll be umd at public rteorJ,
J
g ted
Licensed Professional
OWNER-BUILDER
OWNER- BR DECLARATION
1 iartby a?m Nu I em esatemp anon Me Comm
Liccom law for the
COO ng reasons.(Sudan iW M.Buinoss nd Ram,Conde:Any my m moony
S$ Which iu•permit re mntume,,ices mpma,demolish.fi repair uY avcturt
prior bitssissuance.also requires;thepplicant for such Forfeit u lo ,uammr
that he I.lk.ssJpwenuo is pmviaov If Ne Cnmacure Lioeu Ls-(Chamte9
'
Sq.Ft. Floor Area Valuation
thathentln{withherefrom and
oehassis for Me
cured Pmfeuinv Conde)of $4260
Nuio r camp,therefrom and Ne bur far the subjects
Malleged Wlil.1 W Any vloladun of
mat. 7031.5 by airy hundred
rota permit subjects the epplloan,b•civil Panalty of Number Occupancy Type
not mart Wn Rw hundred dolrn(5500} 36654036
1,a ownv of tiic p^prnY,«my wploym wW w{ea u tietr ulecomPansstion,
win do fework,Co au,wnam4notinI Law
them
act apply
Im H,Booiness
and Aa(odov ldes The Conuume,nd who Law mares nark apply lf m awnor or Required Inspections
own
Property whoes,roviimpmwsch hopreand who do eouchworkhimssdrer f through his
marl employees,to Wilding
Nat arab impmwmau art notIntendedfoo«aka e.the I a,.
Wilderf.
,Ne building or Impmwmmng khaki Wthin oro year or mmpleda^,the ownorf
Wilder will haw tie burden of proving Nu he did not build or Improve for purpose of
ssWJ.
❑I.u manor of the prepen,Ma aclusiwly ccnu min{with licensed mnmumn b
mutmm the prej«t(Sec 70th.Buinm and PmfeWoes Code)The Cmuacute U-
cove law does c«appy to an comer of properly who build,or improm themen,ansa
who contracts for such pmjecte with a mntracur(s)Iiceved monsoon,to Ne Commute,
Lice.Law.
El Iaccoemptmd«See ,BRPCf«thi,rtuon
Owner Data
WORKERS COMPENSATION DECLARATION
I hererc by aflim under purely of perjury aof the following iecWaniom
1 haw and will minW o a Cenifior•ofCmrcn,w felRivurt f«womeea Compco-
Wim,u povided for by Sudan 3700 of the labor Cade,for the performance of de
work for which Nis Pamir is issued.
❑1 ban and will maintain Worker,Gmpnutimn Ivurana,as required by Section
37M of the labor Code,per the pRommm of Ne w«k farwhich this Amit la Issued .
MY Workers C^mpevatdp^Ivmana carrier and Polity num
Griv..tel.elf�MiJrb IFICATE f� PION No Y CERTIFICATE OF EXEMPTION MOM A,N WORKERS
COMPENSATION INSURANCE
(This seNe^nand not W compreJ If the Pami,r foranohunthW deBare($100)
vis .)
I unify dont in the mil men,or rhe,work for which this Amit is Wood.I,hall not
employ any Parton in any m^nncrm u m become subject m th^Wmjucr'Gmpnssil
Laws of Califomia.Data
Appliare,
NOTICE TO APPLICANT.If.afar making this Cenkrtaa of Exemption,you MmW
become subject to the Wahrh Compensation proviiov of the labor Cc&you mesa
j .,O forthwith comply with such provisions«the permit Mall be domed mated
'
,z-� CONSTRUCTION LENDING AGENCY t,
(•+`y" Ihereby dram dm ft.I..construction for the perfommm of
(� de.,it for which Nr poi,be issued(S«.3097.CI,.C,)
W� Lender's Name
Z Lomdeea Address
U 0 I certify Nu I Mw rtea this application W state than ie.bow i^fomadon 4
cbomilatti^S1eaope¢wmco.mndhMemNiyaamyhai^mamp u
wUi wa^ef NaMis ciiymlaewnmrupnn{th
ata -mamdmrcd Property for inspection purports.(We)almeW saw, m
Indemnify and hop hamlets the City nor cuPanst s gain, Ir
V3liabilities,cmeloudg,of the oouand ea Paves which may In My umue against said City
U igrearling of this permit.
r1- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date G
5 U REGULATIO��qq.
a� eek .VR VU an) WO /0 y Re-roofs
Stimmem of Applian✓Conmubr ' Gage
HAZARDOUS MATERIALS DISCLOSURE Type of Roof _
Will f appnan,or future building m empantaom«handle hauNow materia
as dellmd by the Cupenim Municipal Code.Chapter 9.11.and the Health and Safety
Code.section 25531({)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ya U.Ne
VIII the applicant or future building amrpani ono equipment or deices which If a roof is installed without first obtaining an inspection,.1 agree to remove
t hemamme;it conuminmu u de0rcd by the BayAm Air Quilty Management all new materials for inspection.
❑Yua B -
I hive read the huaNmnmauiab requirements underCMmard.95 ofthe Califor. q / �,,'\
nla Health& and
SafelyCocie,Sonams 25505.25533understand53a.Iunderstandthan lrthc Wilding Z�/�o At
Muwhidos no umnd haw a ananl.than it 4 my memovibility m ndifY ft«cupur of the
rey
chmu,rbpmetpnarmissu afaCeniOcaaof mammy SignaureofApplicant Date
""`�ya� �''""'1�� �f o/� All roof coverings to be Class'%¢"or better
ane dmtharivd agent Dow'
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36654036 . 00
DATE ISSUED. . . . . . . : 04/10/2008
RECEIPT #. . . . . . . . . : BS000004437
REFERENCE ID # . . . : 08040074
SITE ADDRESS . . . . . : 11560 LAKE SPRING CT
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HENRIQUE MARTINS
ADDRESS . . . . . . . . . . : 11560 LAKE SPRING CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5120
RECEIVED FROM . . . . : LOS GATOS ROOFING
CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481
COMPANY . . . . . . . . . . : LOS GATOS ROOFING
ADDRESS . . . . . . . . . . : P O 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 4, 260 . 00 0. 50 0. 00 0 .50 0 . 00
1REROOFRES SQ FEET 22 . 00 286 . 00 0. 00 286. 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 286 .50 0. 00 286 . 50 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 286 . 50 #2610
---------------
TOTAL RECEIPT 286 . 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
605 FINAL REROOF
Doko `{ 007
CITY OF CUPERTINO
Soma& REROOF
OF
*CUPERTINO PERMIT APPLICATION
APN# 0 1) Date:
Building Address-
' ) 1,5&0
ddress: 11.5&0 G EKG r� n
Owner's Name: Phone #:
Contracto . L O S uric �0 5 � U Q y- I r? C{ Phone #: yQ 8'
Fax#:
Cupertino Business License #: Contractor License #:
23y 8 / 0 70
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt ShinglesAsphalt Shingles
Wood Shakes /,:K] Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) Other (Specify ?
Number of existing coverings ❑ Provide I.C.B.O. eport#
❑ To be Removed Provide Mfgr. Installation Specs.
S s 22
Roof a/qss —�-- -
Jo Description• / �0
Residential Commercial
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: ❑
Valuation:
Vbo
I Have
Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
_
Ah v�
�yS• a re
` CITY OF CUPERTINO
REROOF
. CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMIC0 Seismic Commercial B
2 1REROOFRES Re-roof Residential B 1SFDWLR00F
1BSEISMICRE Seismic Residential B
1REROOFMRES Re-roofMulti-Family B 1MFDWLR00F
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
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 Y4" 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:
Job Site Address:
Roofing Company Name:
Applicant's Signature: �//) � G7p/ /-�i Date:
Greg Casteel
Building Official
Revised 11/2/04
n Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
g�UPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
l� D l<Ce C't f 6) F0C-( 00-7`(
OWNER'S NAME: eY1 t wS PHONE # LtOg
GENERAL CONTRACTOR - ..'2 FAXI# - 3�
I am not using any subcontractors: �U�i{�?Cl�1�ih.L�67(J gda Lo g
Signature Date
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
Roofing
Septic Tank
Sheet Metal
rSheet Rock
—:4Tile
Owner/Contractor Signature Date