06080166 CITY OF CUPERTINO
BUILDING DIVISION PERMIT aCgt\ffifi M"Tlt�
BUILDING ADDRESS: PERMIT NO.0 6 0 8 016 6
930 LIBERTY CT
OWNER'S NAME: PERMIT[SUE DATE
LANGSTON NICHOLAS A AND MAZGAR
NE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUTMINO PERMRINFO
BLDG ELECT PLUMB MECH
loo LICENSED CONTRACTOR'S DECLARATION Job Description
U 1 bmeby am.than I am instead under pmvWans of Chapter 9(crnmcnetog P
with Sued..70(10)o'Diviaon 3 of the Business And Pmfcssion+Conn.and my license is
i s in full farce andeff sTEAR OFF WOOD SHAKE, REPLACE PLYWOOD ADD 50 YEA
damn �T�
Carl, ga$ COMP ROOF CLASS A OR B
QQ ARCHITECTS DECLARATION
i y< I understand my plana shall Is,used a public mcmds
myU
tQ Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby,from that I are comp,from me Contractors LIeense law far IW
:00 following moon.(Bastian 703 LS.Business and Professions Code:Any city or county
•
IRK which mr,utrta a Permit to consumer.alter.Improve, mur
deish,m¢pair any structure
�ito prior to its Issuance.also requires the applicant Car such permit to file a signed summer
a< that heis0sutho
licensed Contractor's Sq.Ft.Floor Area Valuation
IHS (commencing with Section?000)of Division 3ofthe Business And Professions Codn)or $$12000
9 that he is eaempl therefrom and the bais for the alleged Aumpdon.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars(8500).
❑I,As owner of the property,or my employees with wages as Nab sok compensation,
will dA the work,,ad wa awmare is not intended A,offered for take(Sec.7014,Buainea ns Required Inspections
de:
and Professions CoTM Com acmes Wourse Law does not apply 0 an owner of 9 P
properly who builds m Ilnpfa Vp dlerCon,Nd who does such Mark htmKlg m through his
awn Amployma,provided that such imp wtuenu meant Intended oroRered farsak.It,
hw•erver.the Wilding or improvement tsuld within Arc year of compktiun,the Awumr-
builder will been dm Women of proving mut he did m,Wild or improve Cm purpose of
ale.).
0 I,as owner of the properly,am exclusively contracting with licensed contractors to
comwct the project CSee.7004.Business and Professions Code:)TW Contractors LI. A'
cense Taw mom not apply to an owner of properly who Wilda m Improves thereon,and i
who cse o for such pro)ects with a conuseux(s)licensed pursuant to the Conuaclar'a ®®®i FMd
ALED
0 I ma Law.
❑lam uempt undo See .Bk PC for Nb mason
Owner Data-WORKERS COMPENSATION DECLARATION
���•
I hereby,frim under pcma ly of perjury one of dm folmwing declamimmm BUILD
m a.,
Ihaw,nd wild (a by Section
37 te of Gmcnta Conn.
rte Wartehce of the ■■■Ml■■ LV��
wont r provided Ter mi sissued.
3700 of the Taber Came.for Ne Performance of the
work for which that Permit is Issued.
❑1 have and will maintain Workers Compensation Insurance,an required by Section
3700 of the Labor Code,Car the performance of the work for which this permit is isau,4
My Wmkera C mPension Imo we carie,and Policy number AM.
Capri I TION FROM
1�_
CER FICA F SATIONINSUROMW WORKERS'
COMPENSATION INSURANCE '
(This sccllm need Act be completed If the permit is foram hundred cia0m($100)
or Leas)
I unify that in nue performeme of tins work for which this permit W issued,I"I net
employ any person in any mannerso As As become subject to dm Workers'COmpensadan
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Ccnificaw of Exemption,you should
became subject to the Worker's Compensation provamns or the Labor Cade you must
.,0 forthwith comply with such provision or this permit shall be daemon revoked.
z CONSTRUCTION LENDING AGENCY
E-. 1 hereby alfnm that mere is a construction Lending agency for the perfurmsece of
IY> the ,it for which dds Permit is iamd(sec.Som,Civ.C.)
Q Iandch Name
z Lenders Address
V O I certify that I have read this application andsat¢Nu the AWve inf..due W
LL F cArte[t.I agree to comply with ell city and County ordinances and sole laws relating to
0O building construction,and hereby authorize reprcsenutivea of this city to enter upon the
[A above-mentioned property for inspection purposes.
(We)Agree m ave,indemnify and keep harmless she City of Cupertino Aguirt
req liabilities,judgments,coats and expenses which may in any way accrm,gainst said City
U Z in consequence of the granting of this permh.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date -9 —d 6
CE REGULATIONS, 4
-O Re-roofs
Signuurt of Applin onuacmr Dam
NA ARIGG s MATERIALS DI Type of Roof
Will the applicant or Futuro Wilding occupant stem At handle hazardous material
u de0ned by dm Cupemino Municipal Code.Chapter 9.11,and the Health and Barely
Cole.Section 15532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yrs ODI.
Will the applicant m future building assonant use aquipmonl m devices which Tf a roof is installed without first obtaining an inspection,I agree to remove
emit haadous air contaminants As dcOmd by me Bay Area Air Quality Management all new materials for inspection.
DlndeV
[3 Yes [µ6
lb ave mal Ne havaNau macriab mquirtmrauundcr Chapter G9Sof the Glifm
ria H.IOISafctyCade,S.d.M.505.25533and25534.1uMeaundmnifdm building
non currently have a mm s.that It is my responsibility to notify,the occupant of the
u emu ' hue men prior lea ar,certirmamArOc any. , Signature of Applicant Date
Ow ,unuthariudag m ISl Dana All roof coverings to be Class nBn or better
s
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY 0, Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
Gad6 ,, ,5 G
OWNER'S NAME: (a,, 2 ct f PHONE #
GENERAL CONTRACTOR - 1q bV Ccri FAX #
I am not using any subcontractors.a-�Ne _L
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
Sheet Rock
Tile
•
Owner/Contractor Signature Date
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35611068 . 00
DATE ISSUED. . . . . . . : 08/21/2006
RECEIPT # . . . . . . . . . : 35693
REFERENCE ID # • • • : 06080166
SITE ADDRESS . . . . . : 930 LIBERTY CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : LANGSTON NICHOLAS A AND MARGAR
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : LINEBARGER CONSTR.
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--- ------- ------------- --- ------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 12 , 000 . 00 191 . 16 0 . 00 191 . 16 0 . 00
BSEISMICRE VALUATION 12 , 000 . 00 1 . 20 0 . 00 1 . 20 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 297 . 36 0 . 00 297 . 36 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
--- -------------- ------------ ------------------
OTHER 297 . 36 VISA
TOTAL RECEIPT 297 . 36
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 on re-roofing.
Homeowner's Name: 1Li C� \I
Job Site Address: "13D` i'Yy� �/ . _ l�✓PJ �f6/
Roofing Company Name: lel ��►cC�1S l�C7l�` S f C��^
Applicant's Signature: Date: �J l O
Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
• CJ���- REROOF
ERTINO PERMIT APPLICATION FORM
APN# - ;5(0 J l I —ate
Date: �, � O 4
Buildin rests:
b L � r-Lo
O per's Name: Phone#:
\os Ll0�;.
ontract r: Lice e
to t: Cupertino Business License#:
�r-
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ ,phalt Shingles 3/Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ 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:
c eD
Residential Commercial PS or
Fire Zone: Yes ❑ No [] Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy p�roup:
a uw roc){; s
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