06050226 CITY OF CUPERTINO
HUILIDING'DIVISION PERMIT
BUILDING ADDRESS: D AND M ROOFING PERMIT NO.0 6 050226
19132 LOREE AVE
OWNER'S NAME: FERMrr]SSUEDATE
ROBERTO VALEZ 982 2ND ST 05/26/2006
E: SANITARY NO. CONTROL NO.
4082787896
ARCHITIECT'ENCINEER; BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOWS DECLARATION
1: 1 boulty art.that[Am licensed vote,provisions of Chapter 9(Commencing Job Description
;�� he Section 1010)of DivisloO of she Business awl Prolosomen Code.And my It"=is
K .1 r it reme"aMI Lic.N REMOVE EXISTING ROOF AND INSTALL 1/2"OSB PLYWOO
Do. Commoss AND 40 YEAR COMP. 30 LB FELT.
AK�Itl I�1 3 UELLARATION
I undconand my plans shall Ive need as public mccuds D&M PAID FOR BL 5/26/2006
Licensed Professional
OWNER-BUILDER DECLARATION
I bunchy AMM that I Am conceept from Me Communes I-kness Law for the
Co. Milmseng mossm.(S.6.703 0.Buismess And Proleaskou Coade:Anyity,a,ceunty
which mquires a Permit W conalmact.After.FunprMs.dermiub.to mPWT my someone
prior tu its tsmencts.Alto roquinu Mo applicant forsach isconk to file a signexi rememem
deas he is licensed pursuant In ft provisions of Can Contractors Uccom Law(Chapter 9 Sq.Ft. Floor Area Valuation
F, a (commencing with Section 7000)or Division 3 at he Business and Proftonimet Consul or $5790
that he Is wromin therefrom and the bull for the alleged conomption.Any violation of
Section 1031A by any applacount for a Permit subjocu,the appiiCML 10 A Civil Penalty Of AFN Number Occupancy Type
not more than five hundred dollars(M).
0 I.m�rofLhepmpmymmy=pioymwlthmMuftkwlcmmp�don,
will do the werk.and MAsAmMm is net intended car,irmad Russia(SM.7044,Business
and P,,(,W,,Coal,TI,Contractors I Monte Lsw docs,set qpiy As..or RpileNIn'spections
propersy who builclaccimproves Amoson.aml whodoessuch work himselfourthrearth his kN LEwz�N
Own employncs.pmvWcd MIL such improvements Am not intended oroffered for sale.If.
howevver,the building oringummunt is mid within orm year ofcomplemon.the momeor.
builder will have tim burden of proving MO M did not build or improve for purpose of A 13
.to.).
0 1.a cram,of the property,Am exclusively comarming with Boosted cOMACICAS as
construcs he project(Sex.`KPA4,Business Fred Ismicausioned,Code:)The Consomm"U- JUN -A5,1 2006
Cuban Law does not apply Is An emover a property whe builds OF imPrOm domman.and.
who coommut for such projerm;wish a manummor(l)Rebound posommal W Mo COMMACUMS
License Law.
[:]I am camnin umber Set _.B&P C for this roodus" NOW
Owner Dam—
WORKER'S COMPENSA71ON DECLARATION
I hereby affirm under penalty of pedury Can of the following decumuner
have M1 will AMMUM A Crusficem ofc.ass.I As AnIf-insurc for Warrater's C.mp..
sation,as provided per by Section 3700 of ft Labor Cents.for Me perfeemoseen of AM
work(or which this pcmit is hissed.
4PI-Mv.and will mainsain Woftes Comisconsadon Insurance,As required by Section
370D of the Labor Code.for he pceforommuct of Am Amok,for which his permit is houni.
My Worker's Compeasadoijlimmeme Carrier and PolicY,number AM:
carrier. _9til�, I'MAgA
CERTIFICATE OF EXEMPTION FROM WOMERN
COMPENSATION INSURANCE
(Indis section med notloccompicud ifft porreft Is feature humboul doll.($100)
or M.)
I cerfify has in to performance of Me wark hor which this perecil is Issued.I OW)not
employ any pomem In any manner an As to become subject In Mo Woftes'OnalivoclAtman
LAWS QfC3lifOMlA.DAM
Applicant
NOnCE TO APPUCANT:If.after making this CoMacate of Excen,mon,you should
twissom subjeert an Me Worricters Compensation pamisions of AM LAW Code.you most
z forthwith comply with such rombions or this Permit"I be entered revoked.
7-0
CONSTRUCTION LENDING AGENCY
I hereby Mr..&I them Is a Consumed"leading aonc,for Mo perfortmance.1'
the Fit for which this permit Is issued(Sea.3097.CIA.C.)
I"Ace,Name
Lgroler'sAddrou
z
U0 I ccedify Out I have read this plumcsa and sum Obs,use monve information Is
IIL E correct.I agree he comply with All city and county ondinseem and seek Ism miadnit th
0 building construction.and thereby aurnmen mprosmuives,of Oda city menucr upon Mo
.1,mve-evered...d'ropert,for inspe'u..Purpose.
(We)agree be save,indemnity And keep harmhuss he City of Cupertino Against
W liabilides,judgreconu.com;and expeneacs which May in my way aseen Against said city
u in cmuscrecom orthe among ofthis pcou'll. Issued by: Date
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
SOU
,KE REGULATIONS,
(d,e ZZ(I Re-roofs
Sigromen of ApplicsonVoonswaster, Dam
HAZARDOUS MArEFGALS DISCLOCM)RE Type of Roof
Will AM Applicant or future building occupant seem OF handfle KMMIFAA FrAmMal
As deflood!by the Curpertmor Municipal Code.Chapter 9.12.W Me Henthlb ad Safety
Cohen.Swum V55324)? All roofs shall be inspected prior to any roofing material being installed.
Oyu If a roof is installed without first obtaining an inspection,I agree to remove
Will the Applicant or future building occupard.um c4ulpment or d"hows which
emit buzardous Air conumfinants As defined by she Bay AMA Air Quality ManalcOlem all new materials for inspection.
Disukt?
0yos
I have med Me hassell.m=6,ls�immmumkrChpw6.95.fftCAlifor-
ma Heal"SalmyCodo.Socum 25505.25533 uA125534.1 urskonswed thatifes,building
does MA CUMCMIY have A M.4 AMA It is MY SUPOMINlitY 10 ossify the reelparl Of MAC
nobireaMinG Which Most IM MCI Flits W Mutation Of A CCMJ S ignature,of Appl icant Date
6&—o —2�� !V*V/;C� All roof coverings to be Class"13"or better
jOwnCrOrWmMd7CdA8CM " Dam I
_ Community Development
10300 Torre Avenue ...
9 ✓' Cupertino CA 95014
" Telephone(408)777-3228
� UPCITY OF ERTINO Fax(408)777-3333
Building De artment
JOB ADDRESS:Z Lc eC_ PERMIT0,�-Q
OWNER'S NAME: PHONE # C
GENERAL CONTRACTOR FAX# — 275-13
I am not using any subcontractors: 57�2-6 /O
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 . . . . . . . . : 37508003 . 00
DATE ISSUED. . . . . . . : 05/26/2006
RECEIPT #. . . . . . . . . : 34571
REFERENCE ID # . . . : 06050226
SITE ADDRESS . . . . . : 19132 LOREE AVE
SUBDIVISION . . . . . . •
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ROBERTO VALEZ
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : D&M ROOFING
CONTRACTOR . . . . . . . : LOPEZ, ALBERT LIC # 21104
COMPANY . . . . . . . . . . : D AND M ROOFING
ADDRESS . . . . . . . . . . : 982 2ND ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95118
TELEPHONE . . . . . . . . : 4082787896
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -------- ---------- ---------- ----------
BPERMFEE VALUATION 6, 000 . 00 126 . 36 0 . 00 126 . 36 0 . 00
BSEISMICRE VALUATION 6, 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00
BUSLIC FLAT RATE 1. 00 105 . 00 0 . 00 105 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 231. 96 0 . 00 231 . 96 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 231 . 96 3379
TOTAL RECEIPT 231 . 96
•
CITY OF CUPERTINO
��it REROOF
• CUPERTINO PERMIT APPLICATION FORM
APN# 3115-
Buil ' Address: (� J
Owner's Name: Phone#:
. v o - -Iic
Contractor: LicenseCe 7�S
c t 6
C ntact: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles R�Asphalt Shingles
Ca/Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 4 ❑ 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:
1'5 fin
Residential Commercial ❑ 3R�
Fire Zone: Yes ❑ No [k Confirmed with Planning Dept. if
there are any restrictions: Cr
Cost of Project: T e of Construction: Occupa cy group:
00 5-7 q0
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
i'
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: C(� y>�
Roofing Company Name: l,,/cgA/L/1��,
Applicant's Signature: (p �� Date:
• Greg Casteel
Building Official
Revised 11/2/04