06030174 CITY OF CUPERTINO
BUILDING DIVISION PERMIT COIyTRt1G 'Q�,NF'�1RMATION k
33I�Y>):'rvdX n xkx4 r 5%2"AUkFL F-3;(Kek '+",.
BUILDING ADDRESS: PERMIT N0.
20400 MARIANI AV
OWNER'S NAME: ' PERMIT ISSUE DATE ,
BERG MARY A AND CARL E TRU TEE5542 MONTEREY RD 03/30/2006
E: SANITARY NO. CONTROL NO.
(408) 288-8680
ARCHITECTIENOINEER: BUILDING PERMIT INFO
BLDOO ELECTO PLUMB MECH
O
30o LICENSED CONTRACTOR'S DECLARATION JobDescri tion
1 hereby affirm that I am licensed under provisions of Chapter 9(commencing b p
wide Snefice 7")of Division 3 a the Bum.ad esC ,andmylicrnaiis
in full forcemdeffec 3j � OVERLAY POSITION OF WYTH 4: CAP SHEET BU'
Damn c cngmor �. UP ROOFING. CLASS A () Ja
' ARCHITECTS DECLARATION 4'�r''✓'
I uodcatsnd my plans shall be used u public records II, r
Ir sed Licensed Professional t-luU�j-o
OWNER-BUILDER DECLARATION t9U
0 I hereby affirm that]Earn exempt from Ne Conunnors License Law for the
i p O which following wan.(Saito 7 ser LS, t,MumA and Priew.doeues Codc:Any ally or county
$> whirl,requires a permit m enruvuct Blur,improv,deermit t m repair any swmure HHU
]F< the,he ibissuance.
ensedptluantto 2e provisions of
for Nth permit to Eleez Law(emmlllenl Y.a
Ytline Sq.Ft.Floor Area alU 1
tic that he n,ing exempt
Sm format and ths,basis f r th the ext essend Proon.Anynns Codo)ser
3—
that lu b eumpt Nuc(rom and the bub for du a11egW exemption.Any vloladon of EEty1a��ti N��pp{r1l�p
Section 7031.5 by any Applicant for a permit subjects dee applicant to a civil peesity of 3�6 L'GU l S�0 0 Occupancy Type
not mom Nu five hundred dollar, SSW.
❑I,as owner of the properly,ler my employees with wages u their sole to spemadan.
will do the wart.and Areatrunuu bo or Tmntded or offered to,aaa(Sce.7044,Besiw Required Inspections
and Professions Code:The Comtom ns
ecr'A License Law docs not apply an owner of q p
property who buildsor histrionics thereon.and whodemsach worklumselfor Waugh his
own employes,provided that such improvements see not intended orofferd forsal,if,
however,the building or Improvement Is mid within one year of completion.The owner-
builder will haw the burden of proving that M did not build ar Impose for purpose of
ma.).
❑1.m ownm of the property am euludwil,contracting with lianud conirmtars to
construct du project(See.7044,Business Ad Predations Code:)The Caoumurs I.I.
cense Law doe not apply An an sumer of property who builds or improv discover.and,
who contracts for such pmjeca with a conumur(s)licensed purchase o dee Convenors
License Law.
❑I am exempt under Sec ,B k P C for Ns wan
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 bemby of rad,under Penalty of perjury one of the following declarations:
❑Ihawam will munuina Cenifinu of Couemromlf-InsurefosWorkehCampen-
satian,As provldd for by Sccdun 7700 of W Labor Code,fm dee performance of the
work for which this permit is issued.
❑I haw And will maintain Workers Compensuion Insurance,As required by Section
07W of the Labor Code,for W performance of the work for which dela permit Is lusted.
My Workers Compe adm resonance Ja_rt}ia and Policy number are:
Comer: CEdtIIAA policy No.:Q3J
0. I gCATETOF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE '
(This section need not W completed if the permit is(wane hu idneddolW(g1 WI
in Imo)
I artily that In the perfomtmce of dee work for which this Permit is issued,I tlWl not
employ any person in my manner An As An become subject in the Worker'Compensation
Lawn of Califamla.Dau
Applicant
NOTICE TO APPLICANT:IL afar making the Cenineate of Exemption,you should
become subject b the Worker's Compensation provisions of W Labor Code,you must
.J O foMwith comply with such prombues m Nis permit shall k doomed mated.
CONSDWC ION LENDING AGENCY
[ti IImrby affirm that Nem isaconstruction lending agency for dee performance of
lei the work for which this Permit is issued(Sec.3097,Civ.C.)
QLenders Name
z Landers Addw
U Q 1 amfy that I haw red this application and shim that the abow Information Is
,E --Treat.I—--u comply withall city and county oNlrumres and sure laws miming to
0 U building conshoction,and hereby authorise mprucmatim of this city to enter upon the
W .hon-mentioned property for inspection purposes.
ad (We)agree to an,indemnify and keep harmless the City of Cupertino against
ti,,iA IlabillimajudgmenW costs and expenses which may in any way acc7uc against mid City
U 7 in consequence of the guntint of this permit
r� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N-POINT Issued by: Date �-' J w L•
SOURATION
sign reofo�`r�U/rd/condulasor Re-roofs
ppb HAZARDOUS MATERIALS DISCLOSURE ere Type Of Roof
Will the applicant or future building occupant more orhandle htandous material
As defined by dee Cupertino Municipal Code,Chapter 9.13,and the Health and Safety
Colic,Section y55yz(a)? .t All roofs shall be inspected prior to any roofing material being installed.
Oyu ®Nu
Will the Applicant or f'ut'ure building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air conuminants u defined by the Bay Arm Air Quality Management all new materials for inspection.
District?
❑Yes Nu
1 h aw mad the hatrdws mauriab mqui semenu under CIDP ser 6.9 S of dee Calilor-
nlaHUlthBSafcty Cadc,SaUav BM5,g5555aod25574.imdcrmandthdifW building
doss not currently ban a Women,that It a my respomllelity u notify tie occupant of she
requlmmumm 'hmumbeme,Piioruiuuanccof.Ceninauof a" , Signature of Applicant Date
Owner uAll roof coverings to be Class"B"or better
or agent D
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
41UPERTINO
Building Department
JOB ADDRESS: 70 4" PERMIT #
4LfvPe,(41 a eea 9sviq 46
OWNER'S NAME: ZgLna PHONE #
GENERAL CONTRACT date FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and com lete the following information
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
Owner/Contractor Signature Date
CITY OF CUPERTINO
im 1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 31622018 . 00
DATE ISSUED. . . . . . . : 03/30/2006
RECEIPT #. . . . . . . . . : 33794
REFERENCE ID # . . . : 06030174
SITE ADDRESS . . . . . : 20400 MARIANI AV
SUBDIVISION . . . . . . :
CITY CUPERTINO
IMPACT AREA . . . . .
OWNER BERG MARY A AND CARL E _TRUSTEE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014
RECEIVED FROM . . . . : KASEY HARNISH
CONTRACTOR. . . . . . . : KYLE HYPES LIC # 23509
COMPANY . . . . . . . . . . : STATEWIDE ROOFING INC '
ADDRESS • 5542 MONTEREY RD '
CITY/STATE/ZIP . . . : SAN JOSE, CA 95138
TELEPHONE . . . . . . . . : (408) 288-8680
OE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC, NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 60, 000 . 00 1209 . 60 0 . 00 1209 . 60 0 . 00
BSEISMICOM VALUATION 60, 000 . 00 12 . 60 0 . 00 12 . 60 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 1222 . 20 0 . 00 1222 . 20 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 1222 . 20 50254
TOTAL RECEIPT 1222 . 20
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•
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: /F&� r e3
CV
Job Site Address: VVIva�4N i AJL
Roofing Company Name: ST>tTevjj�c,- r2coF>,�
Applicant's Signature: _ L4W� Date: (Oro,
• Greg Casteel
Building Official
Revised 11/2/04
c�(o�3b1�1�
CITY OF CUPERTINO
A-
REROOF
• CUPERTINO PERMIT APPLICATION FORM
APN# 3I 1022 6 18 Date:
W7
Building Address:
2O400 'wka.r i A>J t AJe-
Owner's Name: D Phone q7`f_
Contractor: License#: C ^ 8 3 q a-(p
t
Contact: Cupertino Business License#:
At- a q_r-os qO% -2.8to-7azs a 3 501 6%bota,
Type of Roof Covering:
Ea' ng: Pro sed:
�N�aSS
A— Built-Up Roof y Q�� )z Built-Up roof 4
Asphalt Shingles ❑ 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: I
OJ¢v Po.11`ON or` Agigc w / Iact built aFi'w
Residential ❑ Commercial + l5 000 Sl. FT, C 1496
Fire Zone: Yes ❑ No ® Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of roject: Type of Construction: Occupancy group:
� Ioqp vkl
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
•