06120035 CITY OF CUPERTINO
BUILDING DIVISION PERMIT bCONTRA.GTnRANK RMATIOI'J
F4
BUILDINGADDRESS: DIAZ ROOFING PERMRNO.06120035
10241 MIRA VISTA AVE
OWNER'S NAME: PERMIT ISSUE DATE
Aft PETER C. HANSON 6 N ROYAL LINKS CIE . 12 /11 /200F,
NE: SANITARY NO. CONTROL NO.
(925) 565-0960
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
coo LICENSED CONTRACTOR'SDECLARATION Job Descri tion
WF 1 hcaby".Our l am licemed under provisions of ChaPar 9(commencing P
;iW with Section 70M of Division 3 of On Business mad Professions Code.and my license is
.qi 4¢0 on"Veff 3e Lica 1FFgQGI _ TEAR-OFF SHAKE, INSTALL r'2" OSB, INSTALL
�❑ Data Cos 2��y PRESIDENTIAL SHAKE CLASS A (20 SQ)
ARCHnECI•S DECLARATION
i s� 1 understand my plans Call M used as public records
liU
°Q Licensed Professional
i 5 Out IF..UIIDER DECLARATION
Contractor's
2 C C I hcrchy affirm on I a1..Busher from Ne Casions C's :Any c Law for the
p a following ratan.(Sadao 7031.5. 1,WWI.
and Rafredam n,.1 Any city or roomy
e m which agvitm n Permit m rims un,altar,improve,h pemit t nr repair any Nudure
i y Prior a its Lensed Portion,riveto On the applicant for such permik mice s signed statamem lS 5 O 0
<
thin
Z�0commenicunsedSlathepmvisionsorthe eBuxmriL Prolliaw(sCode) 9 Sq.Ft.Floor Area Valuati$
(can a is exempt thations and of the basisfon ro(thcegeiness empdon.Anyovi Cade)of
��$
that he u comet therefrom and the buil(ter the alleged exemption.Any violation of
Section 703 L5 by any applicator for a permit subject the applicant to a civil penalty of APN Number Occupancy Type
not moa Nan rave hundred dollan($500h 35702033 . 00 P y YP
0 1,m ownser of the property,or my uoplores with wages as Neu sale eompereadon,
ns
willdatheworlemdkhe rtructum is not intended or offered forath(Scc.70M,Businev Required Inspections
rod Professions Cade:The Comraaar's License law dare not apply m way an aor q P
Property who builds or improves thenar,and who alas such work himself ar duough his
own employment.provided that each impruvemeaa art out intended aaffemd for ale If.
however.the building or improvement la sold within one year of complete.,the owner.
builder will ave the burden of proving that be did not dtiW or improve for purpose of
sale.).
❑1,ur t Or i of the property,am reclusively contnming with;)TheeC eenuauors U.comwct nes waa apply
in an Business and proteaproperty
who
Code)The Contractor's nd
whoconsentcontracts law dao nos apply je to owner or Property vete W d p or improves Neaten,and
wbenseLfor soda projects with aconuanarp)licensedpunmm in the Cantraaor's .
License law.
❑I am.crept under Sec ,B&P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury ane of the following dalantom:
I have and will maintain aCeetifioa of Content to aelf-imam for Workcr'sComport.
sation,a provided fa by Section 3700 of the labor Code.for alae Performance of the
work far which this permit Is lased.
❑1 have aM will maintain Worker's Compewton Insurance,as required by Section
3700 of the Labor Code,for On performance of the work for which this permit is caused.
My Worker's Compensation buurame1onior and Policy nuuCmWC�ares 1
Cartier. [} �0.Mey Policy N..;ff5__ L'i65--ZQp _Z
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(ibis section need not M completed if tk pmmi,is for one andad dollars(SIM)
,it loss.)
1 ceniry Our in the performance of the work for which this permit is issued.1 sill not
employ any person in any immerse as in become subject to the Workeri Compenaton
Laws of California.Date
Applinnt
NOTICE TO APPLICANT:IL oar making this Cenificzta of Exemption,you should
become subject in the Worker's Compematan Provinces of the labs Code,you mum
,,- O forthwith comply with such provisions or Nis permit shall be deemed mvoked.
Z " CONSTRUCTION LENDING AGENCY
'e-v "�' (hereby WE.ttet Vert isacmava:um.lending.,ney for Ne pcifamanec of
a the work for which On permit a causal(Sec.3097,Civ.C.)
Undoes Namc
a z Under's Addax
U O 1 certify Nat 1 have read this tPplicaton and nuke thm the above aromatic.is
U. r correct.I agree to comply with all city and county ordinanem and sure laws relating to
U Wilding Construction.sod hereby authorim mpomnutives of this city to corer upon the
0. aavc-mc judgr repos and or narcNon purposes.
(We)agree to save,indemnify and kap harmless One City of Cupertino agaimt
► N in cc
ensu and of 0 a narcoses which may in any way attea against aid City
U z in co cef the granting of Nis permia
^ APPLIC UNDERSTANDS AND WILL OM PLY WITH ALL PON-PpINf Issued by: Date 2 ��--(/C
SOURC R ULATIONS. IIF I _
Q__ O Re-roofs
Sgnssu o ppbrenAZARDOUSMATERIALSDISCLOSURE rracturrData Type of Roof
Will Oe applicant ar future building oaupentsmrc abandlc aaartlam mamritl
as deMcd by the Cupertino Muni"pal Code,Chapter 9.13.and the Health and Safety
Code.Scotoo 255320)?
41 ❑Tr. ❑No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant ter rukua building occupant use equipment or deto..which If a roof is installed without first obtaining an inspection,I agree to remove
emit lovammis air cantaminans m defined by to Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes "ONa
Ihavcram Neaiardommatarials requiamciax n rcape,6.95 of OC Calif.,- ,,s
ria HcaiN& c Coda.Satiau15505.25533and255 dcaund thmifthc Wi ing Vl`/VI
alas not cu tly hum a tanan4 Our it u to pomi lit m n be Park,�"Wc
regairemcn lior 6L
ryuatpmc. tpriormiva r, ,xarOce, (( I� Signat eo Ap icant Date
Owner or authoriad agent // Data-I All roof coverings to be Class "B"or better
CITY OF CUPERTINO
m 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 3
Sec : Twp : Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35702033 . 00
DATE ISSUED. . . . . . . : 12/11/2006
RECEIPT # . . . . . . . . . : 36998
REFERENCE ID # . . . : 06120035
SITE ADDRESS . . . . . : 10241 MIRA VISTA AVE
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : PETER C. HANSON
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : DIAZ ROOFING
CONTRACTOR . . . . . . . : RODOLFO DIAZ LIC # 26457
COMPANY . . . . . . . . . . : DIAZ ROOFING
• ADDRESS 6 N ROYAL LINKS CIR.
CITY/STATE/ZIP : ANTIOCH, CA 94509
TELEPHONE . . . . . . . . : (925) 565-0960
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-- ------- - ------------- ---------- ---- -- -- - - - - - - --- - - - ---------- ----------
BPERMFEE VALUATION 7, 000 . 00 137 . 16 0 . 00 137 . 16 0 . 00
BSEISMICRE VALUATION 7, 000 . 00 0 . 70 0 . 00 0 . 70 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 137 . 86 0 . 00 137 . 86 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
------ - ---------- --- - - - - - - --- ---------------- --
CHECK 137 . 86 3589
TOTAL RECEIPT 137 . 86
•
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 ther above stated policy on re-roofing.
Homeowner's Name: �&kzV l - QV1 S•Q1In
Job Site Address: o2LAk M\V
Roofing Company Name: 7)k C12
Applicant's Signature: \\t V-\C.0 1V Date: IZ j
• Greg Casteel
Building Official
Revised 11/2/04
Community Development
: 10300 Torre Avenue
✓' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
4§UPEI,TINO
Building De artment
JOB ADDRESS: PERMIT #
C)2'-Al (M V4 % 12� o& I oZ 0035
OWNER'S NAME: eW C PHONE # S—SGS-01�IZa
GENERAL CONTRACTOR: FAX # qZe,
I am not using any subcontractors:
Signature bate
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
OCP i a Oc�3s
•
sua REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
351 -aa3
- 03 I b
Buildinp Address:
2 S c�
Owner's Name: Phone#: ZS '69 6'
a
C ctor: License#:
Ilg� Cf
Contact: Cupertino Business License #:
�.ud 2 92S 504 O
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
-er Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) .Gl- Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report
❑ To be Rein oved ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
kv - S� Ile vv\ t� `I i" 011S,310 k1 e� I cls t
ResidentialCommercial LI y20SO,
Fire Zone: Yes ❑ Noo Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy roup:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
•