04090045 CITY OF CUPERTINO `"""' ` '°` '' - `
euTLoinc DIVISION PERMIT CoN�R� -T„nR ' R�'IA-P,ON,.* , _
BUILDINGADDRESS: MANADA ROOFING INC PERMRNO04090045
-7685 N
PERMIT ISSUE DATE
OWNER'S NAME:
SUSAN Y EIRA PPAV-KTT7. 24717 FAIR VIEW AVE
SANITARY NO. CONTROL NO.
NE:
(510) 881-4722
BULECT PERMIT INFO
IT
ARCHECT/ENGINEER: BLDG ELECT PLUMB MECH
I� f�
+�oo LICENSED CONTRACTOR'S DECLARATION Job Descriptio
INALED I herby erFwr Net l am hice d a provisions of Chapwr 9(commencing
WILL 7").fDivision Jof H wend Profcssium Codc.and myliccn¢is
-raw, ler anderr REMOVE EXISTING WOOD SHAKES
z L.eenwelass Lla.g ZOeZ'4/
n Dram —`�7—canlnnar INSTALL 30 YR ASPHALT OCT /9 2004
ARCHITECT'S t1EGbARA1-ION
�i v�bndcrawnJ m s s used ea P naNs
BUILDING
ud� Licensed Pmfeubuff
Oat I ow exempt fr DECLARATION V
a 0 1 hereby aRrto that I am exempt from the Conlncmh License c Law car the
i p D following solar,permit 1 ]IDLs,Bminesa and Profcsslnm Code:Any city structure a�$ which its Isu a permit re residues
I c4 elver.Impww,demolish,m e a sired Nemen
prior mits Issuers,aLLuntto Me Ne previsions
rue such rector'wice se Law statement Valu�gt
Nmhmu lig with
pursuant to Me of Disions of the eBuanurWccnwlaw(Chapter)tu Sq.Ft. Floor Area v OOQ
$ Meths s exemithnteioom andM busiSafrafthcBcd cus andexempt Professions Cow)of
'has he b exempt anteroom ppli end the.perm for the sllegcd exemption.to Any violation of
Sadon 1081.3 by arty appliant forspermit subjecu the applicant •civil penalty of ppN Number Occupancy Type
of man men EK handled dollars(M). 36611167 . 00
I,as owner or'he property,or my employees with wages as their sale compensation,
will do the work and ammuaum is nmioneded omfnred fmrsale(Sec.10,14,Busions Required Inspections
and PrefeaxNm Chile:c:TConvenor"Curve law does nm apply w on owner of 9 P
property who Wilds or improvesthenron.And who doessuchwork himsellortheough his
own employees,provided ton such improwmenuan not intended croRewil forsole.If.
however.the building or improvement is sold within one year of compledomn,me uou-
builder will haw Me burden or proving that W did not Wild or brown f"papose of
sole.).
❑1,as owner of the property,em exclusively connecting with Ilansed contraction to
convect the project(Sec.70,14,Human,and Profoniom Cade:)The Crominar'a Li.
awe Lew does not apply in an owner of property who Wilds or improves thereon,and
who convects for such packets with aconu tsu r(s)licensed pursuant to the Convectors
Lwcnn law.
❑1 am exempt under Sec. B St P C far this reason
Owns" Dow
WORKER'S COMPENSATION DECLARATION
1 beccby nlrirm under penalty of perjury one of the following dalanumm:
Dhaw aW will maintain a Ccrtihuw of Consent w nif-imam fur WarkersCampeau.
an.as pwvidcd for by Senion 7100 of the labor Code.far the perfactoance of the
work for which this Permit is issued.
C I have and will maintain Worker's Compemaion Insurance,as required by Section
1100 of me Labor Cade.For me pecftomanee or on work For which this permit is issued.
My Wokee,C rcnsann Indema unix and Policy number are:
es�soCamIic�y N$$
CERTIFICATE OF EXEMPIDW&WORKERS'
COMPENSATION INSURANCE
(Thisaation need not becompleted fine permit is foranc hundred dollars(SIM)
or pus.)
1 certify mot in de performance of me work for which this permit is issued,l shell not
employ any permit in any manner an as as become subject to the Worken'Comremnion
Laws of California.Dan
Applicant
NOTICE TO APPLICANT:If.after making this Cenirwaw or Exemption,you should
become object in the Worker`s Compemaion pwvi"iom or she la Wr Code,you a.
O fo"With comply with such prowwom or this Permit Nell W deemed n
uked.
Z,� CONSTRUCTION LENDING AGENCY
[r 1hemhy affirm matthem is ecomtocdmi landingeput,far the rnfmtoance of
Ci> me Work fur which this permit is mood(Sec.3011.Civ.C.)
QLeadoes Name
z Lenders Address
U Q I adlfy met 1 haw read this application and sun this me aW w information Is
U.F comesr.I egae to comply with ell city and county ordinswas and state laws whaling w
O(, building construction,and hereby cumarin repnsemann of this city to enter upon me
fZ ahmvc(We) 8 1...roperty fmimpcnion keep
l
(We) red ro raw.indemnity and keep heemiess the City.1 Cape
against
yliabilitlu,judgmens.wesu and nNews which may in any way same against leadCity
m7Z, 1
U Z in coeguenee granting
of me of this permit.
APPLIC UNDERSTAND AND WILL COMPLY WILL NON-POINT Issued by: Date
SOURCEGULATIONS. ��/
/ l - � �' Re-roofs
Si pplie HAZARDOUSMATERIALS DISCLOSURE Dai Type of Roof
Will the eppllaa ttar future building occupant stow or handle livsrelous material
as darned by the Cupenpno Municipal de,Chapmr 9.12.and Oc Health and Safc'y
Cade,Swunn2s532(e)1 All roofs shall be inspected prior to any roofing material being installed.
Yu u
If a roof is installed without first obtaining an inspection,I agree to remov
Will the applicant or future building=upon,use equipment or devices which ,
I hverdoa air contaminants as defined by me Bay Arca Air Quality Management all new materials for inspection.
vin? /
❑Yes [�N'r sy
I how,and me hvmd'ma mandalsnquinmenu underCharnr6.95 oflhe Califor.
nu Halmurremy Codc,Sauom 2s i tsuay.. .....1 undcnuvb lhwif the Wilding �'<^`' '
docs n t eurtenay avw e to ani Net it u my respomihilily w nouly the acuponl of the �-��/
n cmawhichmue Mellon no curia Centric awm(OC cu a Signature-of Applicant ate
uthorwil agent All roof coverings to be Class"B"or better
CITY OF CUPERTINO
I� 1 of 1 PERMIT RECEIPT OPERATOR: 8uem
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36611167.00
DATE ISSUED. . . . . . . : 09/09/2004
RECEIPT #. . . . . . . . . : 26978
REFERENCE ID # . . . : 04090045
SITE ADDRESS . . . . . : 7685 NORMANDY WY
SUBDIVISION . . . . . . .
CITY . . . . . . . .
. . . . .
: CUPERTINO
IMPACT AREA . . . . . . .
OWNER SUSAN Y EIRA FRAYNE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA '"95014-5252
RECEIVED FROM . . . . : RICARDO PEREZ
CONTRACTOR . . . . . . . : RICARDO PERES LIC # 24826
COMPANY . . . . . . . . . . : MANADA ROOFING INC
ADDRESS . . . . . . . . . . : 24717 FAIR VIEW AVE
CITY/STATE/ZIP . . . : HAYWARD, CA 94544
TELEPHONE . . ... . . . . : (510) 881-4727
•E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ' _
______ _____________ __________ __________ __________ __________ __________ _
BPERMFEE VALUATION 12,000.00 191.16 0.00 191.16 0.00
BSEISMICRE VALUATION 12, 000.00 1.20 0.00 1.20 0.00
__________ __________ ----------
TOTAL PERMIT 192 .36 0.00 192 .36 0.00
METHOD OF PAYMENT AMOUNT NUMBER ' '
____________ __________________
OTHER 192.36 VISA
TOTAL RECEIPT 192.36
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
•CUPERTINO
Building Department
JOB ADDRESS: PERMIT #
/(16 Cc,Cy,
OWNER'S NAME: y PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: a g
Signature D9/
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
lastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
Community Development Department
Building Division
+fir City of Cupertino
.: 10300 Torre Avenue
Telephone: (408)777-3228
JP E QT IY OF N O 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.
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:
Job Site Address: 7f0 /���/��� 24�C
Roofing Company Name: /%/ -J�(16 /
A plicanYs Signature: 7— Date: /O�
• Greg eel
Building Official
Revised 1/30/03
Printed an Recycled Paper
CITY OF CUPERTINO
' y REROOF
CUPERTiNO PERMIT APPLICATION FORM
APN# / Date /�
Building Address: C9 ! ( k
Owner's Name: Phone#:
S"U u�tJ
Contractor: Phone#: License#: g p 67;;,71
Contact: Phone#: Cupertin Business License#:
a2i cam' � `z s�o-76o-6s 3 a
Type of Roof Covering:
Existing: Proposed:
P
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles �Asphalt Shingles
Ar, 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 Cl Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
•; Job Description:
lJ �S ��G- 5/ 749 0 K/mss r¢ C
Residential Commercial ❑
Fire Zone: Yes jP0 No Confirmed with Planning Dept. if
there are any restrictions: Ll
Cost of Project: ��� oeo Type of Construction: Occupancy group:
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