06090276 CITY OF CUPERTINO aP� �vt
BUILDING DIVISION PERMIT ` ONTRACTQIi INTO].tnMATJQN,
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BUILDING ADDRESS: SKYLINE ROOFING - PERMIT"°'06090276
10646 MERRIMAN RD
OWNER'S NAME: PERMIT ISSUE DATE
DUARTE DANIEL AND EVA 1630 FOXWORTHY AVE 2006
NE: SANITARY NO. CONTROL NO.
(408) 353-3935
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BO O PLUMB
MECH
CI
j�c LICENSED CONTRACTOR'S DECLARATION Job Description
hereby afitrm Net 1 am licensed under provisions of Chapter 9(commencing
?tj with Section 70(10)of Division 3 of the Business and Profession Code,AM my license is
in fail rem"
aM en _ REROOF- REMOVE EXISTING PLYWOOD, 1/2" PLYWOOD
>'z Llaeme n Lio.t `r`r GARAGE
i0 Dam e"houer 40 YEAR SHINGLES, 24 SQUARES, CLASS A
AR ITECTSDEC TIO
I I understand my plan aNll he used As public records
ICV
9
m3 Licensed Professional
OWNER-BUILDER DECLARATION
I humpy 4111m Not I em exempt form she Con"mor's License law for the
a O following reason.(Section 703 1.5,Business and Prorusiom Cade:Any city or county
which mquims•Permit to COUNT e,alter,improve,demnlW,or repmr any structure
_Z>^ prior m its issuance.glso requires tiw applicant forsoch permit he file a signed swearent
p Wt he is liccnsod pursuant to th provision of the Comocmr's Liccmc LAW(Chapter 9 Sq.Ft.Floor Area vatu 00
(commencing with Section 7000)of Division 3 of the Business and Profassiou Code)m
K — that he is exempt thcmfmm and the but$for the Gila{ed exemption.Any violation of
Section 7031.5 by any applicant for a permit objects the appllemt to a civil Penalty of ppN Npmber Occupancy
not mare than five hundred dollars($500). 3 4 216118 . 0 0
I,uownm ofthp,Opcny.amy wploym with va{esss me'v sole eampenvJen,
Will douewoak.uWNe souctmeis net acutes mnemes Law
nd does t sale Act
7(u,Business Required Inspections
/
Will d*,W iork Cade:The Conusomfa moked Law docs wt apply m m owner of q P `^
property who builds urimprovesthenen.and who Messuch wmkhimselfa Waugh his fJ
own employers,presided that such improwmenu me not Intrude l OruRrmd tamale If.
however,this building or improvement t$sold within one year of mmpledco.the Owner.
builder will have due Wrdm of proving that h did ret build or improve for purpose of
Age.).
❑1,as Owner of the property,aro exclusively contracting with licensed wntranma to
wrmtmet the project(See.7044.Business And Profession Cade:)The Carnesm,U.
ecus law does nu apply m An owner of property who builds O,improves thers:an,ard.
who contracts for such pmjecu with a contracmRs)licensed pursuant to the Contramofs
License Law.
❑I sm exempt under See ,B&PC for this mason
Owner Dace
WORKERS COMPENSATION DECLARATION
1 hereby aMon under penalty car pc,jury one of the fallowing dalenuam:
1 have.M will maiouin a CWIBA uor Commot to self-inure far Workds Cmnpen.
We..As provided for by Section 3700 of the Labor Code.for the performance of the
work for which this permit Is issued.
❑1 have and will maintain Worker's Compensation Insurmce,As required by Section
37W of the Lather Cade,for me performance of the work for which this permit is issued.
My Worker's
'aComp utationnIItwmece carrier and Policy number Me:
Caner, rr=X7fGa+f 1 Policy N.,
CEIITIFlCATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
CTht$semian need notes,completed Ifunit permit N for one hundred dollars(SIM)
or leu)
I certify that in the performance of the work for which this permit is urged,l MAI nm
employ any person in my manner at as to become subject to the Warkeri Compensation
Laws of California
.,g{�ta°m
Applicant 1� I%
NOTICE TO APPLICANT.If,after making this Cerincam of Esemption.you should
become subject to the Worker's Cempa subs,provident of the Lahr Cede you muss
,J O foMwith comply with such pmvisiou m this permit to deemed mroked.
'Z� CONSTRUCTION LENDING AGENCY
9 1 hmby affvm that there is a cemuca
vcion lending agency for w Performance of
C> the work for which this permit t$issued(Sec.3097,Civ.C.) ..
W Q Lrndcr's Namc
7 z lender'.Addmas
U Q I aril`,that 1 have read this application and sum that the above information is
U.F cmma 1 a{me m comply with Bit city and county omlnsnco and rete lawn ret$ting to
QU Wilding convection,and hereby authonve mpmsenutives of Nis city in coact upon th
W ahoy-mentioned property for inspection purposes.
W (We)agrca ro save,indemnify and keep ham0ess due City of Cuponino against
fry
liabilities judgments.eon and expenses which may in any way accorc against mid City ,
U z A APPLICANT
NDEYeIANDSf the&MAing of is permit.
^z APPLICAkm UNDE ANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date Glrw
SOUEGU .�` V,7 T-L/Lo A�
Re-roofs
Si{nmu of ApplicaAZARDO Dem
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant car future ni buildingaare
upmtatom handle anmaterial
As defined by Um Cupertino Municipal Cade.Chapmr 9He
.13,and the Health
mJ Safely
Code,Sao..25532(.)7 �� All roofs shall be inspected prior to any roofing material being installed.
QYes 'Erne
VIII the applicant or fursm building occupant use equipment car devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit harmonic;.1,cenumiomts u dcnned by the Bay Area Air Quality Mmagemcnl all new materials for inspection,
District?
❑Yca 04. -
I have mad the hvammassmamdab mquimmcm under Chapier6.95 orthe Celifoe
ria Healu&Safm`,Cade.Sadao 75505,25333 and 25534.1 understood duadda building
Jas rat curmntl haw a mes.L that it Is my responsibility to madly the oceupmt nr Ne
re menu mustt7pno,to issuance f.cmufcam0wpmey Signature of Applicant Date
y
Owner orauthoremdAgent —ZAll roof coverings to be Class"B"or better
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 34216118 . 00
DATE ISSUED. . . . . . . : 09/29/2006
RECEIPT # . . . . . . . . . : 36260
REFERENCE ID # . . . : 06090276
SITE ADDRESS . . . . . : 10646 MERRIMAN RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER DUARTE DANIEL AND EVA
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3924
RECEIVED FROM . . . . : SKYLINE ROOFING
CONTRACTOR . . . . . . . : RICK LAVERONI LIC # 24872
COMPANY . . . . . . . . . . : SKYLINE ROOFING
ADDRESS . . . . . . . . . . : 1630 FOXWORTHY AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95118
TELEPHONE . . . . . . . . : (408) 353-3935
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- --- ------- ---------- ----------
BPERMFEE VALUATION 9, 000 . 00 158 . 76 0 . 00 158 . 76 0 . 00
BSEISMICRE VALUATION 9, 000 . 00 0 . 90 0 . 00 0 . 90 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 264 . 66 0 . 00 264 . 66 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 264 . 66 1540
TOTAL RECEIPT 264 . 66
•
„p Community Development
10300 Torre Avenue
Cupertino CA 95014
r Telephone(408)777-3228
Cl OF
Fax(408)777-3333
�I GVUPEI�TINO
Building Department
JOB ADDRESS: [p(p,r-jr N PERMIT #O
OWNER'S NAME: PHONE # --7
GENERAL CONTRACTOR FAX #
I am not using any subcontractors: Z�
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 CQC" 'Ll (0
0��R
REROOF
• CUPERTINO PERMIT APPLICATION FORM
APN#
Building Address: U
l06 6 VA [v
Owner's Name:(� Phone#:
`eSZ--7qc?3
Contractor: License#:
Contact: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )�r Asphalt Shingles
(r Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Nu ber of existing coverings 1 ❑ Provide I.C.B.O.Report#
;WTO be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: x//2-1
L&M60G_ Ext51 tale fit' - PL vJCOO & \ s!j(tZ L&5
Residential [2 Commercial ❑ 12-4 EY Gf'J
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of ProjecSgg{{'' ,, Type of Coction: Occupancy grggp_3
ZDO ' CCC
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
•
+ 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: D D N t e I- w J Y�YL\—I
Job Site Address: 06 C{ 6 04(c Q Q I AA P
Roofing Company Name: y IL1G 2�0 l )JCS
Applicant's Signature: Date: -29-Q(�
• Greg Casteel
Building Official
Revised 11/2/04