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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
,QNTRACTORJNFOiWATION,
BUILDING ADDRESS:
PERMIT NO.
RESPONSIBLE ROOFING INC
06030089
0 E:
PERMIT ISSUE DATE
PHONE:
SANITARYN LNO.
tCHITECT/ENGINEER:
—15 1
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
o
Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing
with Section 7") of Division 3 arrive Buunasa end Professions Code, and my limem, is
in full forte end end 3-ZeaA.d
f '
License ssa L"'
REPLACE EXIS jIBERGLASS CAP ROOF
Date Convenor /%__ -� _ _
ARCHITECTS DEC RALA TISK---
I understand my plans shall I c used es public menrda
-
I` U
�AI\ 2006
Licensed Professional
OWNER -BUILDER DECLARATION
ate License taw for the
1 hereby (Grtn that 11. exempt from the Conlon&
Co
following mama. (Semon WH L5, Business and Professions Code: Any city nr county
.
which a permit ac cnnsuucl elms, improve, demolish. m repair any structure
primmits iensedfalsorequirestheapplicant for such permit to Fix a summcm
.1s isu
FL FI Value
that the Law
Sq.
eBusinesaLicenselaonsCo,mr9
me cecnscdpursuantmlWnfDisio"of
(commencing with Section nand) of Division 3 or the Business Conde) or
,
on. Anynvi
that M1c u exempt threfrom and she bssu for the dlegw exemption. Any violation of
sA�D ♦��T*uTIj(D b r
Occupancy Type
Semon 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
riot came then five hundred dollars (MS
3 G O J L u 1 . 0 0 .
0 1, as owner of the property, or my employees with wag" es their sole compensation,
Required Inspections
will do the work end Ne mare ure u not intended or offered image (Sec. 7061. Buss••..
Add Pmfrsdons Code: The Conlrutors License law does not apply to an owmr of
property who builds orimproves themon, and wliodoessuch workhimself ord mugh his
own employees. provided thatsuch improvements are not intended oronemd fursde. If.
Kow"er, the Wilding or improvement is sold within one year of completion, the owner.
builder will have Ne burden of proving that he did not Wild or improve for purpose of
sal,.).
0 I, n owner of the proper, am "dusivcly contracting with licensed comma ms m
construct use, pmject (Sec. 7061, Business and predictions Code:) The Contracmr's U.
came Law 4. not apply m en owns or property who Wilds or improves thereon, and .
who contracts for such pmjwm with a contrsemrtq licensed pursuant to the Contractors
License Law.
0 1 am exempt under Sm. , B St P C for this reason
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby AD. under penalty of perjury one of the following declarations:
0 1 have and will maintain a CcniGcate of Consent to self-iname for Workers Compen-
satian, ore provided for by Seton 37W of the Labor Code, fur Ne perform... of tW
it for which Nis Permit is issue&
have and will maintain Worker's Compensation insurance, As required by Section
...rd of the tabor Cock. far the performanca or the work for which thea permit is isued.
My Workcra Cprope""�y°6an 1 ccotta end Policy number am:
yaha
Carrier. t�i7�rYG /uor+.n/Poliry No.:-��/_�.[�_!!�,�c %�
CEKTIFlC OFE% PfiONFROMWO KERB 5
COMPENSATION INSURANCE
' .
This =Jim need nothecompimed Rde Permit is fovea, hundred dollars(SIM)
Or lcsa)
1 certify that in the perfnmance of Ne work for which this pc.I, u issued, I shill not
employ any Anson in any manner an ac to become subject to the Workers' Compensation
Laws of Cathrornla. Data
Applicant
NOTICE TO APPLICANT: If, after making this Cci iGcmc of Exemption, you should
Wcome subject to the Workm's Compensation provisions of the LaMx Code, you muse
forthwith comply with such provisions or this permit shell be, demand masked.
.. - .
CONSTRUCTION LENDING AGENCY
I hereby affirm Net there I,. mnstmninn rending agency It. the perform men of
the work fur which this permit is issued (Sec. 3097, CO, C.)
Lender's Name
'
Lender's Address
1 eanify that I have read his application end Anne that the AWve information is
career. I agree to comply with all city and county oNinamxs and sum laws relating to
building construction. and hereby authorise mprammatives of this city to enter upon the
property for irex a purposes.
alcoveties
(We) agree m save, indemnify and keep hadmiess the City of Cupertino against
liabilities judgmonodents, expeponnses
openseswhich may in any way eceme against said City
inconsequence of the granting of this
of the
APPLICANT UNDERSTANDS ANDD WILL COMPLY WITH ALL NON -POINT
SOURCEREG
Issued by: Date
A S.
3—
Re -roofs
Signuuan of Appllcant/Commeto Data
HAZARDOUS MATERIALS DISCLOSURE.
Type Of Roof
Will the applicant or future Wilding =upset more or handle herardous material
as deancd by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
CO. s25532(.)?p-1Yet Ha
All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant or future building Occupant are Wuipr or de ch
fT 6
If a roof is installed without first obtainingan inspection, I agree to remove
P g
emh hanrdnus air conuminenu u dcancd by the Bay Arta Air Quality Management
e onset anagens
all new materials for inspection.
P
District?—!
O Yes
1 have mw the horrendous materials requirements under Chapter 6.95 of the Cslifor-
ricalthASafety Cook. Sauuns 255115.25533 and 25534.1 understand that if the Wilding
not currently hart a mnenL that it u my 2xpontibilitY to and ry dm seen., of the
requimmenu which must be mel prior to issuance of a Ccoilin¢o�upancy
igna[ure of Applicant Date
All roof coverings to be Class "B" or better
Owner Or aamoriacd agent Dam
CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Elk: Lot:
APN ........: 32632016.00
DATE ISSUED.......: 03/17/2006
RECEIPT #.........: 33606
REFERENCE ID # ...: 06030089
SITE ADDRESS .....: 20650 PARK CL
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: bethe
COPY # : 2
OWNER ............: NIU JIMMY C AND NANCY H
ADDRESS ..........:
CITY/STATE/ZIP ...: SARATOGA CA, 95070-4830
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT NUMBER
____________ __________________
203.26 11269
203.26
0
RECEIVED FROM ....:
RESPONSIBLE ROOFING
CONTRACTOR .......:
ELMORE, PAUL M. LIC #
105
COMPANY ..........:
RESPONSIBLE ROOFING INC
ADDRESS ..........:
2882 SPRING ST
CITY/STATE/ZIP ...:
REDWOOD CITY, CA 94063
TELEPHONE ........:
(650)969-6151
0EE ID
UNIT QUANTITY
_ _
_______________
AMOUNT PD -TO -DT
THIS REC
NEW BAL
B ERMFEE
VALUATION 13,000.00
__________ __________
201.96 0.00
__________
201.96
______ ____
0.00
BSEISMICRE
VALUATION 13,000.00
1.30 0.00
1.30
0.00
TOTAL PERMIT
__________ __________
203.26 0.00
__________
203.26
----------
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT NUMBER
____________ __________________
203.26 11269
203.26
0
�µ.
CITY OF
CUPEkTINO
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Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS:
IFCIyv- Y'
PERMrr #
6:� 3dc
OWNER'S NAME: HYS. N 1 kA
-it) 6
GENERAL CONTRACTOR 8., 4r.
FAX #
I am not using any subcontractor .__ _� 3- / -7 -OSS
Signature Date
Please check applicable subcontractors and complete the following information:
4pOwner/ContVactor Signature Date
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
f?es i bl e n
32�`t�tp
Septic Tank
Sheet Metal
Sheet Rock
Tile
4pOwner/ContVactor Signature Date
Community Development Department
Building Division
: City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408) 777-3228
�C U P E IST I 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.
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: "S • Q i
Job Site Address: %D(Jz Rbr `__C 1"C [t
Roofing Company Name: Korc YI-r7YI C -
Applicant's Signature: Date: 3 OSo
Greg Casteel
• Building Official
Revised 11/2/04
Pnnfed on Recycled Paper
116
7
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CITY of
CUPERTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM 10(00300 $ 9
APN #
3vo - 3� - o I l�
Bldg Permit Fees
DatP•
H,,,vw
Building Address:
Energy
20(_052 I(_)V V --Ci rc 12
BSEISMICRE
Owner's Name:
BUILDING
Phone #:
r r •'
BUILDING
-.2Pf�-�OOb .
Contractor: Phone #:
12o Inc ((o5G)5D5•S'1b0
License #:
3)-84,q 6
Contact: Phone #:
Business License
Cupertino Business License #:
—u Uo
b-�YG1
105
Type of Roof Covering:
Existing:
Proposed:
Built -Up Roof
�( Built -Up roof
❑ Asphalt Shingles
❑ Asphalt Shingles
❑ Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings I
❑ Provide I.C.B.O. Report #
34 To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu
ertino's Tear Off Policy:
Job Des 'ptio :
i e l
A �i e✓ ctSs C r
Residential Comme ial ❑
Fire Zone: Yes ❑ No ❑
Confirmed with Planning Dept. if
LJ
there are any restrictions:
Cost of Project: Tw of Con truction: Occ�an�cy�roup:
I ;5WQ ro
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
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