08040085 CTTY OF CUPERTINO ISERNIIT f ijkr�ra.yF�a,k 3 i•�+�7�7� M�T�a
6UIOF artivlsldtd �.y Qlvti^,g,1�L'].X
PERMIT NO.
amL111W�Tt"'AINER PL XTERIA INC 08040085
OWNER'S NAME: PERMIT ISSUE DATE
YOST GAIL A AND WARREN P 1709A LITTLE ORCHARDIST04/11/2008
+.orr m
(408) 289-5353 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMITINFO
BLDGO ELECT� PLUMO MECHO
�0o LICENSED CONTRACTOR'S DECLARATION lob Description
e 1 hereby affirm that 1 am Restated under pmvWau of Chapter 9(commencing
with Section 7000)ofDivWon 3 of the Buainmad Professions Code.and my license u RE—RF,RMV EXTNG TILE INSTL CLS A 33SQ 1/2"CDX
C�P,
mull farm and f � voi c. PLYWD
Z mfull 1 C I,ic.N Of0102
S Dem�1�'a�DOn
DECLARATION dA
e AacxlrEcrs � � BUS LIC NOT EXPIRED UNTIL 11/30/8
y 1 understand my plane shall he used as public records
3u
5G Licensed Professional
y OWNER-BUILDER DECLARATION
I hereby affirm that 1 am ma ep,from dm Conbumrs License Lew for the
O O fallowing resent.(Stedon 713 1.3,Business and Professions Code:Any city or County
Swhich requires a permit to condruc4 alma improve,dmulish,or repro,any awm o,
iy prior to its issuance,also require;the applicant for such permit a rile a signed statement
�< that he is licemd pumant In the provisions of the Conuacmra Lieenm Law(Chapter 9 Sq.Ft.Floor Area Valuation
51 (conantWas with Section 70D0)M Division 3 of the Business and Professions Code)or $15950
dust he u eumpt Nemfrmn and the basis for W alleged exception.Any violation or
Section 7031.3 by any applicant fm a permit objects the applicant la a civil penalty OfNumber - Occupancy Type
Inst mom than five hundred dollars($5=. 31646026 Cl7'
I,uownmafdicpmpwy.mmycmploycuwiffimuudm mkcompcwdan,
will do the worked the a==is nolimmraMd moRemd entails(Sec.70m.Business Required Inspections
and Profcadnu
ons Code:The Caacmr's License Law dos Inst apply m an ower nter q P
property who builds or improves thcco m,and who does such warthimself m though his
own employees,provided dmsuch improvements are not intended moEmed forme If.
however,the building or ieprowroml is mid within am your of Completion,the owner- -
Wilder will have the burden of poving that M did Out build or improve fm purpose of
amJ.
❑1,as mvoer of the pmpny,am mclumwly conuecling with licensed Conuam es in
comment the pojecl(Sec.704/.Business and Prommons Cade:)ThwLi-
e Conctarh
cense Lvw data not apply m an owner of progeny who builds or improves dor om.and,
who contracts for Such Projects with a cMaamor(s)licensed par ant m da eantome's
Licen a Law.
❑1 aremmpe under Sec. .B a P C for Nis neuron
Owner Data
WORKERS COMPENSA71ON DECLARATION
I hereby aBirm under pewry of perjury aro of the following declwdaa r
1 ban and will maintain a Certificate of Consent m¢If-iasum far WorkeYsCompen-
sadon,u provided for by Section 3700 of due labor Cade.for the Performance of the
work for which this permit is issued
❑1 have and will maintain Workers Compensation Insurance,as requited by Semon
3700 of Nc laborCode.fm the per(mmu.of the work for which this permit is issued
My Workers Compensation Insurance carrier rd Policy mob. Zig
Cartier. STATE � PPolicyl
No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section lad not be Completed ITlhe pcmil is forme hundred dation($100)
or mss)
1 mnify the,In the prfarmu co Of the work for which this permil is issued,l shall not
employ any Aron in any manner an as m becarm subject to tita Workmes Cmcpenudn ,-
laws of Califaoie.Dam
Applicant
NOTICE TO APPISCANT:IL after making this Ccnifiata of Exemption,you should
become Subject in the Workers Compenadon previsions of the later code.you masa
.J O fanhwith comply with such provalons m this peenit shall be sec od revoked.
,zt y - CONSTRUCTION LENDING AGENCY
[+ I hereby affirm the dam a a eansuuc,inn cundingagemy,for the perfermaeceaf
E
25the work for ed which this Permit is isry (Sec.3097,Civ.C.)
W�Q Lenders Nwrc
] z Lenders Address
V 0 1 certify that T haw and this application and Sam dsu ere Shave infotmadan u
Iy,F correct.I agree to comply with all city and county ardinmmes and 11212 lawk misting to
0 U Wilding connotation,and hereby authdxc representatives of this city to occur upon the
W above-h odoned property for inspection purposes
py (We)agme to sew,indemnify and keep hmmless the City of Cupertino against
,n liabilities,jdgmcnu.caste and expends which may in say way accrue against mid City
V z in coca mance of the granting of this Pewit. (i^
ti APPLICANT UNDERSTAND ND WI COMPLY WITH.)LL NON-POINT Issued by: Date
SOUR REGULATfONS // �,,/
V8 Re-roofs
Signal Appli x nuacor Dam
xAZAR'0 S MATERIALS DISCLOSURE Type of Roof
applicant or fulum building accuP OLSlmc orhandle hauAaus malarial
a defined by the CupeniCo Municipal Code,Chapter 9.13.and ere Health and Safely
Corm,Semon 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
0y. AN.
Will the applicut Or future building occupant iso equipment or devices which If a roof is installed without first obtaining an inspection,,I agree to remove
It laconic. it co.beat nana as defioed by tire Bay Area Air Quality Management all new materials for inspection.
Din c17
❑sem ON.
1 hue mad die basaNmu mamAmmquimoeeS undcrchapum6.95 of the Cables.
tis H.W&Safmy Code,Secdaas25505,25533 and 25534.1 understand"tribe building
does wt curremy haw a sant, it' m, Peiuihilily ta a. the upanl of the
reyulmmcn0 heasthcme nraCe121'it Oc`" Signature of Applicant Date
y
Owner or authoriv agent All roof coverings to be Class'J¢"or better
Dam' '
• CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31646026 .00
DATE ISSUED. . . . . . . : 04/11/2008
RECEIPT #. . . . . . . . . : BS000004457
REFERENCE ID # . . . : 08040085
SITE ADDRESS . . . . . : 10324 MINER PL
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : YOST GAIL A AND WARREN P TRUST
ADDRESS . . . . . . . . . . : 10324 MINER PL
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2013
RECEIVED FROM . . . . : XTERIA, INC.
CONTRACTOR . . . . . . . : PHILLIP ULLIO LIC # 22345
COMPANY . . . . . . . . . . : XTERIA INC
ADDRESS . . . . . . . . . . : 1709A LITTLE ORCHARD ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408) 289-5353
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------ ---------- ---------- -------- ---------- ---------
1BSEISMICR VALUATION 15, 950. 00 1 . 60 0 . 00 1 . 60 0. 00
1REROOFRES SQ FEET 33 . 00 429 . 00 0 . 00 429 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 430 . 60 0. 00 430 . 60 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 430. 60 #2148
--------------- ..
TOTAL RECEIPT 430. 60
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF. TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
605 FINAL REROOF
•
CITY OF CUPERTINO
REROOF
CUPEIZTINO PERMIT APPLICATION
APN# y U 2 Date:
Building Address: /03.;?41 /!Jj/lP.e la64c E
0-atl —11NO; 04 950/,/
Owner's Name: WARRg1? y057– Phone #:
(ye) 974,11 -36,61
Contractor: X TER/A /NC . Phone #: VOa 723 76,103
S�GQ
S�r✓�oJE CH q5/v`U Fax #: #169 W3
Cupertino Business License #: 3 y� Contractor License #:
,?& 100 Q
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles A Asphalt Shingles
• ❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
r- To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: k&nov6 ex�c7"C- T/LE ACOF 33 SC4441ZFS)/ 1104WIf- Yo CZ)K
Residential Commercial ❑
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the there are any restrictions: ❑
application or if applicable, include in plan
set & the sheet index.
Valuation: 4r / 5 (?5o po
I Have Read Understand and Will Comply with Cupertino's Tear-Off Policy:
• 9444, cc
Signature
CITY OF CUPERTINO.
REROOF
•CUPEkTINO FEE,SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FC0M Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
1REROOFRES . Re-roof Residential B 1SFDWLR00F
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
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: 60 ARkfi7 YosT
,D3aV /1'J7/7FiePLgCe
job Site Address:
Roofing Company Name: X7_6eI4 1106
Applicant's Signature: — Date:
• Greg Casteel
Building Official
Revised 11/2/04
Community Development
10300 Torre Avenue
N ✓ Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
*UPERTINO
Building Department
JOB ADDRESS: l03p�l lnl�W P44C�5 PERMIT LIS-0 cp_
OWNER'S NAME: 4JAC96'17 yLZT PHONE # VOf 7a3 7lP(v3
GENERAL CONTRACTOR: X76R/A /.�C FAX # 510 S- 7a3 -7414 y
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinginformation:
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/qnyactor Signature Date