Loading...
08070168 CITY OF CUPERTINOa BUILDING DIVISION PERMIT C0NFRAC':� BUILDING ADDRESS: PERMIT NO. 1.8800 LOREE AVE KEITH ROOFING CO INC 08070168 OWNER'S NAME: PERMIT ISSUE DATE 1111a. DOROTHY MC CONNELL 920 LINCOLN AVE 07/23/2008 NE: (408) 295-8616 ITATRSANITARY NO. CONTROL NO. ARCHITECTANGINEER: BUILDING PERMIT INFO BLDG EI,ELT PLUMB MECH 30a LICENSED CONTRACTOR'S DECLARATION Job Description I hertby aflum Oat I am licensed under provisions of Chapter 9(communeing p with Smcdon 7008)o(Diasion 3 ofd¢Business and Rofusiom Code.and my liceumu RE—RF T/0 CMP INSTL 1/21-PLYVM &40YR CMP CLSA 22SQ n full forte aM e0 j License Clua Lk.L ^ Dau fenuactar iq ARCHRECTSD 0 GG 22 1 undewnd my plans shall be used as public records, 6 L Licensed Pmhuional 5 OWNER-BUILDER DECLARATION <E 1 bortso .(Em that 1 i. exempt from the Conons Co Ucense Law for de p O following won.Permit t ]8313.Business and professions Cod,:Any an or county, §E! whim tits ant a p,aliit m conwseL alar.W prove,demolish.lir¢pair any suunum ^Z> priermits tensed ,esu mquitu pr applicant for such permitmncuse La,dsuumem < titLLboencing <dpmsuan 7to 001 pm Division nrdreonlranmrsu.z��onsCod�9 Sq.F[. Floor Area Valuation 0 $ (commencing with Saum]8nd of Division 5 of We ctcd musand Professions Cede)of $13000 NLL io u exempt de applicant and or beer for We subjects thee evmpuen Any violation of Section than five nay applicant roe a permit subjnets dee applicant m a civil penalty of Number Occupancy Type nm deme de.n live hundma sell¢(oos] 37515022 . P Y YP ❑L u owner of the prvpcny,mr my employees with wagesas Neirsehe cempevadon, and Pr Weweak,and NeswnontunotinI wow OnsOuta(Sec.]oN,Businm and osywhoru ecce:The ConvxuYn Liana oes doca Out apply m rt owner or Required Inspections row ertywbo Wiprovidmprovea Wcrmn,endwho aressuce net tendeh Offeedthrough his owe em.l eW,proadeddpmx imiswid tsanowruofc"Offered Wer- - - Wilderr,the Wilding ter impmmmm�g thatd wlatin one year orimpro a for dee p se of builder will haw the burderr of Proving box k did der Wild er improve far pogrom of sale.). ❑1.as owner of the Property,aro osclumvely comwerine wide licensed conuacmrs 0 mutant the,project(Sec.]ON,Business and Profestiem Cede:)The Conu.cuh U. ceme law docs net apply to an owner of property who Wilds or improves Warren,and, who contracts for such pmjcm with a contractor(s)licensed pursuant in We Conuauoti Licnic law. ❑l am eacmpa under See .B&P C for On rtason Owner Dau WORKERS COMPENSAI]ON DECI RATION 01 1 hereby affirm under perWty of perjury one of We following deolw8ons: haw and will manofn a Certificate ofComem an tilf-ileum for Wort Coupon. satien,as provided for by Section 7780 of We labor Code,for dee perfonnance of de work for which thin permit is issued. ❑1 haw and will maintain WorkeYs Compensation Insurance,u required by Section 3700 of dee later code,for We performuca oftim work for whim dein permit is timed. . My Werkefa Co pen tion l na c oiu and Policy num rare / Cartier. Policy Ne.: rte. CFJLTI�PTION FROM WORKERS' COMPENSATION INSURANCE (Thu section need net be completed if the permit is form,hundred dollars(SIM) or less) 1 comfy that in We performance or We work for which this permit u Wood.l"I not employ any penin in any mavneran as W became subject in tim Werkers'Compermation Laws of California.Dau Applicant NOTICE TO APPLICANT.If,after matin{most Certificate of Evemptien,you NouW become subject m We Wormrs Compensation proanfou of We LA Wr Cade you most .,O fonhwide comply with such provisions or Wu permit shall W decned metol z I CONSIRUCDON LENDING AGENCY [—� Ihereby affirm Was Wert 4u comuucdnn lending agency for f perfewer mf Ri We work for which this peamit is issued(See.3097,Civ,C.) Q Linde',Name M z Irndefs Adder U O 1 cen ifr deal I haw read this applicxion and rum that th,above uformafion in U,^' cmmlL I agree in comply with LI city and county ordinances and sum laws¢hung m O building construction.and bertbyauthodu leprtaenutives of Nu city to cnmrupnn the aheve-mentioned Property for inspection purposes (We)agme m save,indemnify and keep harmless the City of Cupertino against rn lismlilia,jedgmonu,coed and upcnw which may in any way.croste agalut said City U z in consequence of gunfing of this MMIL ti APPLICA ERS ANDS AND WILL COMPLY WITH A NON-POINT Issued by: Date SO ]IONS. am erAppfionUConmenor Dam Re-roofs xnzARDous MATERIALS DlsaosuRE Type of Roof cowrie Cupantno¢tum Doddinge.Clsmt,mm2.andfirluma Hcaffioand Safety a,denned by tie Cupertino Municipal cede.Chapmr 9.12.sew ted xealth.lid Samir cede,Section 35532f.)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yu 16 vett We. applicant or funis,Wilding Occupant If a roof is installed without first obtaining an inspection,I agree to remove nP ! rs Air Quality aanawhim g hmardnua air contaminants ss donned by the Bay Arta Air Quality Mangcm,n' all new materials for inspection. iavicsT 1 ❑m _fNe 1 have mad dee haurdous mxcriau aequimments under chapter 6.95 of the Calif¢- nia Health&SafmyCodc.Sntlou 25505.25577 and 25530.1 undersand ft ifdee Wilding side.net c dy have.iman4 beat It u my mpartaNlily m mtif�ereupmt of de rtgnim wnicnmuakmcipriormisausnmefaCcrufxaoof rep pr. Signature of Applicant Date r or authodred agcni Dam All roof coverings to be Class'n"or better CITY OF CUPERTINO • 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37515022 . 00 DATE ISSUED. . . . . . . : 07/23/2008 RECEIPT # . . . . . . . . . : BS000005562 REFERENCE ID # . . . : 08070168 SITE ADDRESS . . . . . : 18800 LOREE AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : DOROTHY MC CONNELL ADDRESS . . . . . . . . . . : 18800 LOREE- AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : ROGER BRIGHT CONTRACTOR . . . . . . . : BRIGHT, ROGER LIC # 21477 COMPANY KEITH ROOFING CO INC ADDRESS 920 LINCOLN AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95126 TELEPHONE . . . . . . . . : (408) 295-8616 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BSEISMICR VALUATION 13 , 000 . 00 1 . 30 0. 00 1 . 30 0 . 00 1REROOFRES SQ FEET 22 . 00 286 . 00 0 . 00 286 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 287 . 30 0 . 00 287 .30 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- CREDIT CARD 287 . 30 VISA --------------- TOTAL RECEIPT 287 .30 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF • 0007 0 / (,j CITY OF CUPERTINO REROOF •CUPEI�TINO PERMIT APPLICATION APN # v Date: ci7 � � Building Address: Q CJ e� Owner's Name: Phone #: ` Do :�2�— `8?6,6 Contractor: Phone Fax Cupertino Business License #: Contractor License #: 94117 SS � Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof wilt-Up roof 4sphalt Shingles a Asphalt Shingles ❑ Wood Shakes a 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. Job Description:,�eAv0 e as �� Residential ommercia Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: applicable, include in plan set & the sheet index. Valuation: II je d, Understand and Will Comply with Cupertino's Tear-Off Policy: S re Revised 6/16/08 CITY OF CUPERTINO d© REROOF CUPEI,TINO FEE SCHEDULE • Number of Fee ID Fee Description Fee Permit Type Squares Group 1RER00FC0M Re-roof Commercial B 1COMMLROOF 1BSEISMICO Seismic Commercial B 2 1RER00FRES Re-roof Residential B 1SFDWLR00F 1BSEISMICRE Seismic Residential B 1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF 1BSEISMICRE Seismic Residential B 1BUS AC Business License B Revised 6/16/08 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408) 777-3333 WUPEkTINO Building De artment JOB ADDRESS: PERMIT # OQ 0--7 O/ !_ Q OWNER'S NAME: Y14e&jjjn6ff PHONE # -�2 X-2- GENERAL `ZGENERAL CONTRACTOR: FAX # I am not using any sub contracto Ti Signature Date Please check applicable subco ors and complete the following ' ormation: 60 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 X23 a actor Signature Date