06090227 CITY OF CUPERTINO ,-1. .=bn MATY 77�" ^a�.,�'`��•s''/'�'-�Ta
IfUILDINC DIVISION PERMIT 4 �Q ?1� ,.TORI IF'o
BUILDING ADDRESS: ROOFING PERMITN0.06090227
11615 OAK SPRING CT
OWNER'S NAME: PERMIT ISSUE DATE
MICHELLE DING 888 FAULSTICH CT 09/25/2006
Eo SANITARY NO. CONTROL NO.
(408) 298-9399
ARCH17ECf/ENGINEER: BUILDING PERMIT INFO MSCH
B�LDG EO PLS O
o o LICENSED CONTRACTOR'S DECLARATION Job Description
w 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing p
:I with Section 7000)of Division 3 of0u Business and Profewmar Coac,end my lianuk
!� inr.11raecanae0ect REROOF- REMOVE EXISTING SHAKE, INSTALL TYPE 30
Riz Lwcnmcl� 9 lic.p �Gc?�� FELT, GRAND CANYON SHINGLES CERTAINTEED. CLASS
it- Dau Consractar /G1 a a l �FrN/.
ARCHr1ECPS DECLARATION 26 SQUARES
i understand my plans Mall he used as public tocarN
)yU
I
Licensed Pmrcssional
OWNER-BUILDER DECLARATION
I hctohy.(Sero o n I em exempt from tie Co License Any c Law for Ne
O O fallowing mason.(Sedan 703 11,Business and Professions dem Calc:Any city or county
which mquiros•permit m enuweL slur,improve,demnikh,to repair my strueturt
_E� pda,I,.11 umco.els.mquima lheapplieml for Cmuscmitmrileaelgnd Charm9
< Nal he islkcnud shut requires
I.Mmkohtheoplianf Ne Cch PermiYLiecuse afile alaw(Chapw9 Sq.F FlFloor Area Valuation
5�9 (commencing with Section 7")of Division 3 of the Business and Professions Cade)or $5622
u ..
at he k exempt t unefrose and the bask for the alleged esomptim.Any violation of
Section 7031.5 by any applicant for a permit mbjeca the applicant m a cMI penalty of APN Number Occupancy Type
..,.am than nw hudtod dollars(5500).
❑1.uownerof Neproperty,mmyemplaymwithwagsutiewmlem Pe m,
wiU do Newark.and thestruaumkrot uwdedmoRsdfarsau(Sa.IINa,Budneu
Required Inspections
YW Property
who lou Cade'mTh.pr COnYCmn,Li2me oce daea ml apply le rt awMl of q p
propertywhohuiCod---mpmathereon,mdwhad Wdual cut
apply
leaWo of
awn employes,provided thnnmh improwments are notinu tiled oroffemd plastic If.
havewr,Ne building or implowment is mid within arc year of mmpldon,the ownw-
builder 040 have Ne tendan of proving that he did rot build ar Impwas far purple of
0 1,ae owner of Ne property,am exclusively contracting with Became!Became!mnvmmconstruct to
/
construct the project(Sec.7046,BusProfessionsand Professions Code:)The Cnnuumr's U.
come ^/
cele law dos nal apply toe an with
a of property who builds or tmprovu thereon,and.
whocontractsLace for such pmJeN with a eonuador(O llcaued purwant m the Canwclor's
0 l orn Law. /
❑Ism exempt untla See ,Bed PCfa Nis moron
Owner Dew
WORKERS COMPENSATION DECLARATION
1 hereby affirm under peslly of perjury,aro of Ne fallowing daluetiorae
I M.a ad will..Iowa.Canilicam of Covent to teff.mono(ar Warner'a Compen-
noun.u provided for by Section 3700 of the labs Code.for the perfares.of the
work for which this Permit Is headed.
Mw and will maintain Worker's Compeuatlan Insurance.as required by Section
700 of the Labor Code,far the performance of Ne wart far which this Formir is issued.
My Worker'+Compensation woomm.carrier and Policy number are:
Cartier: Sr3b G,,y2) Paw N..: Zo,'6-ZZ74_
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This salon need not he mmplewd if the permit Is foram:hundreddollars($1001
tor less.)
I certify that in the perfommu ce of the work for which Nis permit is teres.I shall not
employ any person in my manr arm as m become subject to the Worked Compensation
Laws of Celifomis Dow
Applicant
NOTICE TO APPLICANT:IL after making this contribute:or Emmption,you should
,some subject to the Warker's Compensation praNsimu of the tabor Cade,you a=
wJ O rmimua comply with such provisions or this permit Mall be accrued rewked.
z ti CONSTRUCTION LENDING AGENCY
[.r 1 Wrathy 4MM that Nom Is a coutrucdon lending agency for the performanm of
Pv+> the work far which this Permit Is issued(So..3097,Civ.C.) -
WQ Lender's Name
z Lender's Address
V 0 1 certify that I haw read We application and sum Nu the.bow informed..k
Ola (•" correct.I agree to comply with all city and county ordinances and sum laws totaling to
0 V Wildingmnsuuction,and hereby saborine re msenmiwsaf Nie city to enterupnn the
r Gid shmic-na timd properly for inspection purpams.
(We)agree to on.indemnify and kap harmless the City of Cupenfno ageiut
ti N Imbitids,Judgments,eons shad"Panama which may in my way torus agalut said City
Uz in consequence of the seaming of this permit.
a•+
APPLICANT UNDERSTANDS ADIPWILL COMPLY WITH ALLON-PQI Issued by:s4taDate
SOURCE //
Re-roofs
HAZARDOUS
Siguturt of AppliwDau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII tie applicant or forum Wilding e.Chariot
car handle Health anmamrial
u tleRnetl by the Cupertino Municipal Code.Chapwr 9.13.reed the Health and Safety
Cala,Section 35532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
WIII Ne applicant or future building occupsnl eau equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
moll ha utowm air contaminants u dcOned by the Bay Arta Air Quality Management all new materials for inspection.
Disuitt0
ye,
Ihow mal the hanrdaus 25SDakrequl and
25534.1u dcamm G95 of Nc Wilif �� ��. ✓ OT
haslasrom wherry Coole,how. tww at!L.sssnamoss53o.ywxmmt their P WildingJ G
Jou rot cunenOY haw•wont.Nn I k my responsibility m notify the pent of
requirements wnw amey an mac r, d„ Signature of Applicant Date
Owner or authodocd&gent / Dam I All roof coverings to be Class"B" or better
CITY OF CUPERTINO
n 1 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36652072 . 00
DATE ISSUED. . . . . . . : 09/25/2006
RECEIPT # . . . . . . . . . : 36186
REFERENCE ID # . . . : 06090227
SITE ADDRESS . . . . . : 11615 OAK SPRING CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MICHELLE DING
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : LOS GATOS ROOFING
CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481
COMPANY . . . . . . . . . . : LOS GATOS ROOFING
ADDRESS . . . . . . . . . . : 888 FAULSTICH CT
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 298-9399
IREE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- --- -------
BPERMFEE VALUATION 6, 000 . 00 126 . 36 0 . 00 126 . 36 0 . 00
BSEISMICRE VALUATION 6, 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 126 . 96 0 . 00 126 . 96 0 . 00
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
CUPEt�TINO
Building Department
JOB ADDRESS: I ) L= /_S 04_ PERMIT #
OWNER'S NAME: QQ , PHONE # So S 7 8 6 G
GENERAL CONTRACTOR a FAX #
I am not using any subcontractors: /
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
ofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
• Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CI 0F' Telephone: (408) 777-3228
• C 1 I p[kT I R ® 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 building4nspector. 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:_. -T
Roofing Company ame: Tee -
O
Aplicant's Signature: Date:
Greg teel
• Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
• APN# Date:
2.0/
3(olo-SZ- 0� Z 0
Building Address:
SIS 0A S` r,h
Owner's Name Phone#t
1" 01t) q yDy SOS - 78'6
Contractor: Phone#: O Y License#:
a. 0070
Contact: �� Phone#: Cupertino Business Licen e#:
Sairr�e� 3S/8
Type of Roof Covering:
Existing: Proposed-
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles " Asphalt Shingles
` L Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) Other(Specify) �O
Number of existing coverings ❑ Provide I.C.B.O.Report#
To be Removed Provide Mfg.Installation Specs. S' s '
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
• Job D scriptio
Residential Cohimercial ❑ 2t rj� Q r.cP u�
Fire Zone: Yes ❑ No Confirmed with Planning De t. if.
there are an restrictions: 51
Cost of Project: Type o Constructi Occupancy group:
Qty. if
A licable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
_ -_----•----.___. ---._ SEISMICRE --Sdsmic.E•eeRes._�__� a-BITLLD.IL�IG------
__ —BIqL-DING�---
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING