03070182 CITY,OF CUPERTINO nw>r �txwn `' ,�r
BUILDING DIVISION PERMIT 6ONTRACTOR INFORMATION.,:. -
13UILDINGADDRESS: LOS GATOS ROOFING PER"" 03070182
OWNER'S NAME:- 1771 SMITH AVE. PERMIT ISSUE DATE
NE: SANITARY 0.
(408) 298-9399 CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
y0Z, LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that I am hesitated under pmvixions of Content, p
r 9(commencing
wflh Section 7M(o of Division 3 o(Mc Beinus and Professions Codc,and my license is
Zln in full forte and�_3
of cel.
iqz Lima.Class � Lir.«�(Z(I�7D'J REMOVE EXISTING SHAKE, INSTALL 30 LB FELT
Dart
ARCHITECTS DEC coa �F{jQl� raj. j�j RK TL SHINGLES BY CERTAINTEED
ECLAR I N v,?w 'y'
�y aQ l understand my planssha11 M used u public..ads o
7y
3u� Licensed Por(cuinnal ZU�3
Can OWNER-BUILDER DECLARATION JUL 2 0
i I hereby aRrm Nat I em exempt from the Conuaclors License Law for the
00 following reason.(Section 9031.5,Business and Pmfesiou Code:Any city or county
$ which requires a permit m ennsouct,ella,,impnwc,demolish,or repair any smucml4•
brei prior m in issuance.also requires The applicant for such pemniuo flea signed nadmcnl;
-IJBWq.
s that he is licensed pursuant Inthe provisions of Ne ConmOur's License Law(Chapter 9 Ft. Floor Area Valua
�Fo (commencing with Section 70M]of Division 3 of the Business and Fortuitous
td(]fl Code)at 800
$ NN M is exempt therefrom and do buss for IM alleged esemption.Any viobtion or
SeNon]NLS by any epplicam for a permit subjects Ne applicant o a civil Penalty of 3�•p�I I�T�er00 Occupancy Type
notmort Nan raw hundred doll..(SSW).
0 I,as owner of the property,m my employee,with wage u their sole compensation,
Will do the work,and The atm
rurmre is not intended or offered for sale(Sm.7004,Business Required Inspections
sod Proletarians Code:The Connar,Littnm law does and apply to an owner of - q p
progeny who builds or improves Therenn,and who does such work himselfor through his 3055 — FRAME
Own employees,provided tat men improvements are not intended oroRered for ale.If, 307 — INSULATION
however,Ne building or improvement is sold within one year of completion,the owner.
t builder will haw the burden of proving that he did not Mild or improve for purpose of 601 - ROOF TEAR OFF
sale.).
01,as owner of the property,am exclusively contracting with licensed contractors to 602 - ROOF PLYWOOD NAIL
construct the project(see.7044,Business and professions Code:)The Convactur•s U. 603 — ROOF BATTENS.
to.Law doe not apply to sa owner of progeny who Mild,or improves thereon,and 604 - ROOF IN-PROGRESS
who contracts for such pmjeeu with a conlnrlor(m)licensed purauanno IM Contractors
Limps,Law.
0 1 am exempt under Sec. ,B k P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby aRrm under Nulty of perjury one of Ne following declarations:
have and will maintain a Cenificare of Consent o selbinsum for Worker's Compere
on,a pfor by section 3]W of the labor Cnde,for the performance of the -
M for whichhich this permit is issued.
0 1 hoe and will maintain Worker's Compensation lnsunntt,as required by section
37M or Ne Lahr Code.for Me perfolmmce of the work for which this permit is issued.
My Worker's Cnm noti/o—n In,unntt am rand Policy numMnre,;,,
�` Trier;S<,eo /—etNlSa Policy No.:2 Z7�Lf7 d_,?
CERTIFICATE OF UEMMON FROM WORKERS'
COMPENSATION INSURANCE
..lis sectimaIced not Mcampleard R the permit is fm one hundred dnllan(SIM)
nr lcuJ
1 certify that in the performmce of the work for which this permit is Issued.I shall not
employ any person in any manner so as in become subject to The Workeol Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
Weems Subject to the Worker',Compensation provisions of the labor Code,you must
.,O forthwith comply with such provisions nn this perm itshall x deemed rtmked.
'z r CONSTRUCTION LENDING AGENCY
(~ k(or by which
that Nowise Cnn(See.3 97.Ging .) for The perfurmanli of
C' 7 Ne work(or which this permit 6 issued(Sec.3097.Civ,C.)
W0. z Lender's Name
= z Lender's Address
U 0 1 ccnify that l have read this application and sum that the trove information is
Ly P correct.I agree to comply with all city and County ordinances and sum laws relating 10
0U building cmmwction,and hereby adhofim repreumatiwe of this City To enter upon the
�a above-mentioned property for inspection purpose,.
(We)ague m save,indemnify and keep harmless the City of Cupertino against
I,) liabilities,judgments,costs and expenses which may in any way terms against said City
U,'ZZ, in consequence of the granting of This permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SSD RECO TIONS.
9 'V Re-roofs
Signature O(ApplichaViCoomicaor Dale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant same or handle hazardous tumoral
u defined by the Cupertino nicrpal Code,Chapin 9.12,and The tical to and Safely
Code,Section25532(a)7All roofs shall be inspected prior to any roofing material being installed.
0 Ye, u
Will the 11"licam or future buildingoccupam use equipment or deviaa which If a roof is installed without first obtaining an inspection,I agree to remove
I ho,ardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
riu7
[I Yes >No
I have reu1 the hmnrdress 25505,5533 and
merm under ChaPmr6 an of dm Wilding
nim HcaWg:Safcty Co lwndue .4tili,25533and25534.1undcu4nd thuifthc IOrO - 7"-Z
Jots not curunll rad a tenant,Nat II Is my rtsfw,ulbility 10 notify IM cupant of Nc � � ^ ��� ���
rem cmL w 51 be m 110!Itt iiill •cem ficaN of Occupancy. C
7-L3�03 Signature of Applicant Date
Owner ser emhorivcd age.. gam
All roof coverings to be Class "B"or better
030 'A o/ SZ
t�(! - CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # 359 - /3 -() 3S 7 Date:
- ' 2-3 u3
Building Address:
222-0 C/_ellan
Owner's Name: Phone#:
qO5 255- 9'y 6 0
Contractor: / Phone#: License#:
�DS at.roS �. X08 meq$- y WO 70
Contact: Phone#: Cupertino Business License#:
1r2a a ori y08 23� 8
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles �( Asphalt Shingles
Wood Shakes /❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) �L Other(Specify)
Number of existing covering— El Provide I.C.B.O.Report#
U To be Removed 1K Provide Mfgr.Installation Specs. S
I Have Read, Understand and Will Com1 With Cu ertino's Tear Off Policy:
• Job De;cript'on: 3G
Residential Comme ial ❑
Fire Zone: Yes ❑ No Confirmed with Planning D,_ept. if
there are an restrictions: u
Cost of Pro' t Type o Construction: Occupancy grow : ,
Qty. if
A licable 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
•
BaildinsDlvisioa
! 10300 Torre Avenue
• Cupertino,CA 95014-3255
Telephone: (408)777-3228
F= (408)777-3333
�. CUPERTINO
Building Department
- RERO F. 'TEAR ®FF POLICY
revleed 6/75/01
1. You must schedule an inspection for the tear off the day before the date you
wish the inspection to be made.The procedure is to call the Building Division
(777-3228)between the hours of 8:OOam and 4:00 pm.for next day inspection.
2. .When the roof is torn off,the nails removed or driven in,and all of the dry-
rotted wood has been replaced,then you gust call the City Building Division.
An inspector will be there within one hour.There are special hours for this
• service:between 8:00 a.m.and 11:00 a-m.and between 1:00 and 3:00 pML
3. If you call for the tear-off inspection and the job is not ready there will be a
re-inspection fee of$100.00 charged,which must be paid before another
inspection is made.
Joe Antonucci
(Chief Building Official)
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CI 0 Fax: (408)777-3333
CUPERTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
2. New roof coverings shall not be applied without first obtaining all inspection
'arid written approval from the building inspector.A final inspection and
approval shall be obtained from the building inspector when the reroofing 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) Preinspection and/or tear off approval
2) In progress inspection approval.
3) Final inspection approval
a) Spark arrester installation.
S. 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of V"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 of inspection
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name:
Address:
I;eroofngCompany Name: ze,<S
Applicants Signature: Date: Q
Joe Antonucci
(Chief Building Official)
6/25/01
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• PERMIT INVOICE OPERATOR: christya
Sec : Twp : Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35713033 . 00
INVOICE DATE. . . . . . : 07/23/2003
REFERENCE ID # . . . : 03070182
SITE ADDRESS . . . . . : 22201 MC CLELLAN RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : BOGDANOVICH NICK AND SUSAN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4062
CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481
COMPANY . . . . . . . . . . : LOS GATOS ROOFING
ADDRESS . . . . . . . . . . : 1771 SMITH AVE .
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 298-9399
FEE DESCRIPTION ACCT NUM CHK TOTAL FEE PD TO DATE BAL DUE
------------------------ ------------ --- ---------- ---------- ----------
PERMIT FEES 4116 P 157 . 00 0 . 00 157 . 00
SMIC FEE RES 2013 P 1 . 00 0 . 00 1 . 00
------------ ------------ ------------
158 . 00 0 . 00 158 . 00
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
•