06060183 CITY OF CUPERTINO 1 m++
'• BUILDING DIVISION PERMIT y�CON�TRACTOlk-J , bRMATIOIV
-4 L+. Si,
BUILDING ADDRESS: WINTER ROOFING, INC PERMrr N°'06060183
10226 PARK CL
OWNER'S NAME: PERMIT ISSUE DATE
RHONDA GIVER 151 WYANDOTTE DR 06/20/2006
)NE: SANITARY NO. CONTROL NO.
4083638052
ARCHIIECTIENGINEER: BUILDING PERMR INFO
BLDG ELECT PLUMB MECH
0 0 0 0
:pp LICENSED CONfRACTOR'SDECLARATION Job Description
F 1 kmby affirm that l am licensed under Provisions of Chapter 9(commencing
`j wish Seclion7OM)of Division 3ofthe Busimseand ProfeuicasCode.andmy licenser is
info
REMOVE WOOD SHAKES 1/2 OSB BOARD AND PRESIDENTI
cna L1CemeClass — I"'" SHINGLES CLASS A
nF Do ^Irv, _Canlrsmmr,,,d
ARCHITECTS DECLA'A"
A oN WINTER ROOFING RENEWED BL 6/20/06
< 1 undenund my plans shall stated u public mcnnu
JyU
k G Licensed Professional
S OWNER-BUILDER DECLARATION
f I hereby Affirm that I am ammpt from dons Contractor's License Law for due -
p O following moon.(Session 7031.3,Business fcd
and Proc.m Code:My city.,..my
'e m�+ which mquiros a pumit Ira construct alter,improve,demolish,m repair any swmum
L Z), prior to its issuance,ala.mquile;thedppl6am inn such permit to BIer a aig.d StlNmcnl
<
that ku liccnaed pursuant to Nc provistom of ba Contractor's Licrme,Law(Chapter 9 Sq.Ft.Floor Area Valuation
x $ (eommammii with Section 7000)of Division 3.f the Buso.orad Profession Code)or $9980
y _ that As is exempt Nclefrom and the huffs for Ik alleged m omption.Any violation of
Section 7031.5 by any applicant(me permit subjects the applicant m a civil penalty of APN Number JU u Occupancy Type
not Damm down five hundred dollars(MM).
❑I.uowrer of Ne propmy,mmy cmployeu with wagrau Neu sole compensation.
will do the work,and theswmum is not intended or offered forsao,Sce.704/,Bminms +.
and Professions Cade:The Contractor's License Law does not apply m an ownu of
property who builds or improves tkreon,and who daes such work himself or through but tltl L�y. d
own a
however.
the uiprovaded Nos such improvements are not year
of
m peerod fmuu,s..
huilde, the building ft or improvement u sold within one year of completion,the owned
builder will love Ik burden of proving that he did not Wild or improve for purpose of
salt.).
❑L as Owner of Ik pmperty,am exclusively contracting with licensed conamums to
construct the project(Sec.7044,Bosom and Profmions Code:)M Convacmr'a Li-
eeue law dot mol apply to an ownm of pmpeny who Wilds Or rmpmvu theroon.and
who contracts for such project with a contractor(s)licensed pursuant to tk Cmnlracmes
License Law.
❑I am emmpt under See ,B k P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby a1Bsm under penalty t(perjury ane of Use following declarations
l lure and will maintain aCertificmm of Consent to self-insure for Workr's Compen.
salitn.u provided for by Section 3700 Of tk labor Code,for the performance,of the
wolt for which this permit is issued.
I and will maintain Worker's Compensation Insurance,u required by Section
of the labor Code,for the performance of the work for which this Permit is issued. '
My Wmrkm's Co pensatiov btsuwna nrrim vnd Policy number ane:
Carrier. C Policy No.: CJfj f/OI/
CE I 0fMPPTION FROM WORKERS' p
COMPENSATION INSURANCE
Crhuses mn need marc cmmpitn d stone permit is frame hundreddoRan(SIM)
or lcsa)
1 c rtifr drat in the performance of the work for which Of,permit is issued.I shall nm
employ any person in any manner an as as became subject to Ik Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL other making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of our labor Code,you raw
,Jz forthwith comply with such provisions or this permit shallk deemed msvkd.
'Z,.,.'O CONSTRUCTION LENDING AGENCY
[--c Ikicby aMm that Nero is a comwction funding agency rat the p efurmmce of
!Ythe work fur which Nis permit u issued(Sec.3097,Civ.C.)
[13 Leachr's Name
::) z I<nder's Address. '
U0 I certify that I have read this application ant sum that Ne move information is
Uy correct.l agree to comply with all city and county ordinances and state laws relating to
C) building convection,and hereby authmdm mpmununivet of this city to cner upon the
r W aovcmcmmncd property forinpcNon purposes,
gy (Wer)agree w u ,i
sendemnify and keep harmless de City of Cue
prtino against
nF-m N liabilides.judgmcnu.crosuandeapc which may in any way acerse again,said City
the
V z AP 2 UN ERMungmf MISAND WPeruILL COMPLY WITH ALL NON-POINT Issued by: Date 20 _1)S
50
Re-roofs ��
i ort Appli nuactmr �Dase
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ik applicant or future Wilding occupanistwe Dar handle hvardous material
As dented by the Cupertino Municipal Code.Chapter 9.13,and the Hcathh and Safety
Cade.OYCA 35333(a)? It% All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtainingan inspection,I agree to remove
Wi11 the applicant oranto Wilding by ft Bay
equipment m devices which P g
Pan havvdnus air contsminants u dcfind by Ik Bry Area Air Quality Management all new aerials for ins a ion.
Distrim7 P
❑Yu Nu
Aaulho
the,haurdnus material quimmcros undcrChapter 6.95 of die Califmr
Ode,Satio 255f1355]7 and 25536.1 undcmm�d NazifNC Wilding _
ave a m dons u my mspomibility m Imdry Ik occupant of Ne �Q
us, I once of a Cerifcaam of Occupancy. sttU a of Applicant ate
�' 20—�� All roof coverings to be Class "B" or better
d agem Data
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: B1k: Lot :
APN . . . . . . . . : 32632009 . 00
DATE ISSUED. . . . . . . : 06/20/2006
RECEIPT # . . . . . . . . . : 34950
REFERENCE ID # . . . : 06060183
SITE ADDRESS . . . . . : 10226 PARK CL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : RHONDA GIVER
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : WINTER ROOFING
CONTRACTOR . . . . . . . : MARTINEZ, JAVIER LIC # 21207
COMPANY . . . . . . . . . . : WINTER ROOFING INC
ADDRESS . . . . . . . . . . : 151 WYANDOTTE DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95123
TELEPHONE . . . . . . . . : 4083638052
91EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 10, 000 . 00 169 . 56 0 . 00 169 . 56 0 . 00
BSEISMICRE VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 275 . 56 0 . 00 275 . 56 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 275 . 56 MASTERCARD
TOTAL RECEIPT 275 . 56
•
. Community Development
�4 10300 Torre Avenue
yCupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
•CUPERTINO
Building Department
JOB ADDRESS: PERMIT #
o a e e96'6:S61 �3
OWNER'S N q PHONE # yS=
GENERAL CONTRACTOR: w4•r Vvo FAX #
I am not using any subcontractors:
gnature Date
Please check applicable subcon ctors and corn Tete 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/Contractor Signature Date
CITY OF CUPERTINO
Q' REROOF
• CUPEkTINO PERMIT APPLICATION FORM
APN# �2-, n , 3�_ O� Date: —�h
Building Address: (/
G C r
Owner's Name: Phone#:
J _
I
zeiz
Contractor: License#:
i O
Contact: Cupertino Business License #:
H L
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof wilt-Up roof
/+sphalt Shingles Asphalt Shingles
❑
Wood Shakes O Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
• Job Description: V
Residential [GY Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy grow
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: a 0n
Job Site Address: /D &
Roofing Company Name: r
Applicant's Signature: Date: 6`i O-756"+
Greg Casteel
Building Official
Revised 11/2/04