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CONTRACTOR�INFURMATIO
BUILDING DIVISION PERMIT
;&�941T K,.
BUILDING ADDRESS:
R E ROOFING & CONSTRUCTION
PME15030131
OWNER'S NAME:
PERMIT ISSUE DATE
ONE:
SANITARY N CONTROL NO.
ARCHITECVENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH�
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 bumby affirm that I am liceued under provisions of Chapter 9 (Commencing
with Senion]gNl)afD/'vaion(1 of Ne Bualnrst end Profeuinm Code ntl my licenseis
a roll fomce ,M eGen!' 1'—'-11—12`I�i �l
'
License CI 1, "' L c.
REMOVE EXISTING LAYER OF WOOD SHAKE
,e conts,cm
INSTALL 1/2 IN. CDX
lundctsean my panahsilheuudD/"recaN
304 ASTM FELT AND MONIER LIGHT WEIGHT TILE
Licensed Pmtical... I --------
OWNER-BUILDER DECLARATION
1 hereby a1Bm Nn 1 am exempt from the ConuActo(s License Law for the
following muon. (Socuun 7031.5, Business and Profession Cade: Any city or County
which tuquires a permit to Convect, Aber, Improve, demolish, or repair any swetum
prior m its issuance. also raquitu the applicant for such permit to Ble asigned summon
Net he is licensed to the LA. (Chapter 9
Sq. Ft. Floor Area
Valuation
pursuant provisionnfthoComma(,Liecnse
(commencing with Section 700Q) of Division 3 of the Business and Profusion Cecile) or
Nat he Is Motto therefrom and the basis for the alleged exempdon. Any violation of$20000
APN Number
Occupancy Type
Semon 7031.5 by any applicant for a permit subjects the Applicant to a civil penally of
not mom than five hundred dolWs ($500).
O 1, Asowner of Om property, or my employe with Mgu u Neo tole eompewtim,
Required Ins ect nsA�
q P
will do the Mh, and the nnnurt is notinendedno0ertd lanale(Sec.70N, Business
and Profession, Cade: The Common's License Lav don ant apply m an owner of
prepony who builds orimproves Merton, and who do such work himselfor through his
own employees, provided that such Improvements arc not intended nortered for We. if,
however. the building or improvement i, sold within one year of completion, the owner.
n
builder will have the burden of proving that he did nm build or Improve for purpose of
"ie.).
A V
rontreann i.
❑ I. iv eater of Abs property, . B exclusively conuutins with :) The
comma the (Sec. Business and Code:) The Cmhemon, cad
w1WProfessions
in an a m pm ou(s who builds or impmvn thereon. erS
es not property
whocontractsLa, for such projects withaeonmcmr(q licensed punuamuthe Contrano(s
who Law de not apply c an with
License Isw.
0 I un eacmpt under S.C. . B k P C for Nia reason
�/yq� '
Owen Dae
WORKERS COMPENSATION DECLARATION
// N
I hereby alum i nhr penalty of perjury aro of tie following declarations
I Inve end will mainW n a Cn000eof consent toulf-huure fwwahe(sc.mA,
u provid fm by Secsion 3810 of the tabor Cade. fm the performers of th
or which this permit is iuuN.
ave and will maintain Workses Compenadon Inturance. Ate required by Scenes
k
f the Labor Code, for the performance of the work for which Nisamnisi end.
orkefs Compensation Insurance carrier and Policy number me
Cartier: �tA.e Poliry No.:
CERTIFICATE OF M P ION FROM WORKERS'
COMPENS ON INSURANCE
(This section reed trothecompleuab lithe permit a Wane hundred dallan(S 1001
or leas.)
T certify that in the performance of the work for which this permit u issued. I Nail net
employ any person in Any manner an u e Meme subject to the Worimm Compenssdon
Laws of Celiloma. Dein
Applicant
NOTICE TO APPLICANT. Ir, after making Na Cenific,e of Exemption• you should
became subject m the Worker's Comp mutton previsions of the lobo Code, you must
comply with such provision or this Permit bu deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby airum that them as connnctian lending a,ney for 1M perfumers of
No work for which Na permit 4 issued (See. 3071. Civ. C.)
Name
Lender's Add.
I certify that 1 have road this application end sera that the above Information is
comet. I agree m comply with All city and county ordinances and sum laws misting to
building conenction, and hereby Authorize representatives of this ity to enter upon the
above-mentioutl property for Wpecdon purposes.
_1 (We) agree to save, indemnify and keep harmless the City of Cupertino Against
IIWih udgmenu, costs and expenses which may to any My scow Against said City
in cmmaau a of the granting of this fammil.
ARLICA ►'. SRSTANOS M OMPLY WITH AL • NO -P0
Issued by: Date
/ SOURS RE S. I f^—
IL
.
Re -roofs
Type of Roof
BI{enure of licanVCen acro Dee
xAZAijD S MATERIALS D S E��
W. ca pliant rfume Wildin6 oc up ilemrc or ha smaeml
As EOEned by Ne CupeNno Municipal . Chapter 9.13• and the Health an
Code, Section 3357I(a)1
All roofs shall be inspected prior to any roofing material being installed.
Yu
El u
If a roof is installed without first obtaining an inspection, I agree to remove
• Will tin applk t or future building occupant sou equipment m devices whit
.telt haurdors air conteninamt u deo by Nc Bay Arm Air Quality Ma cot
District?
❑Yes
all n ate '
This read the heardoumeerielarequimmonu underCMpter 6.93 the Caller.
'inspection.
ne oL/
j9afmy ,Seth 73 d2553a.l understand thin if building
` 1 ✓
d.Vo( tly hew a en4 e k my, a nal lity u nMly tiro o. patq.�r Nc
requireme u bu r crtirkaeorocc c—/v�ll --Sign
€-Applicant Date
All roof coverings to be Class "B" or better
tercna hero<i. ere
x
i
C OF
�UPERTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building De artment
JOB ADDRESS: M12— I Z laLe TL
PERMIT # oP3 0 13 / 3/
OWNER'S NAME: A'nA�,,L u\�: WI ti
PHONE #
GENERAL CONTRACTOR V uoFi
FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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
l 1� . , S
" -
Septic Tank
Sheet Metal
Sheet Rock
Tile
Date
:4 J
CITY OF
UPEkTINO
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: 4 �, I N S w l iJ
Job Site Address: ' Q I `2'
Roofing
Applicant'4 Signature:
Greg Casteel
Building Official
�0O)r
Revised 11/2/04
Printed on Recycled Paper
Cow
Date:
n
0. 1 of 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 32643044.00
DATE ISSUED.......: 03/09/2005
RECEIPT #.........: 28873
REFERENCE ID # ...: 05030131
SITE ADDRESS .....: 10712 PEBBLE PL
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: suem
COPY # : 2
OWNER ............: WINGET CHARLES M AND KATHERINE
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-1333
RECEIVED FROM ....: RE ROOFING
CONTRACTOR .......: PROCTOR, PAUL LIC # 20615
COMPANY ..........: R E ROOFING & CONSTRUCTION INC
ADDRESS ..........: 15230 CLYDELLE AVENUE
CITY/STATE/ZIP ...: SAN JOSE, CA 95124
TELEPHONE ........: (408)925-9995
.OEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
-------------------------------------------------------------------------
BPERMFEE VALUATION 20,000.00 277.56 0.00 277.56 0.00
BSEISMICRE VALUATION 20,000.00 2.00 0.00 2.00 0.00
TOTAL PERMIT : 279.56 0.00 279.56 0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT NUMBER
------------ ------------------
279.56 8848
-_---279.56
1
CUPEIITINO
CITY OF CUPERTINO OE00 6/31
REROOF
PERMIT APPLICATION FORM
APN # �3 Z_ :�;
— C) / 1
Date:
BENERGY
Energy
Building Address:
log 12
/?L"13�LE ?(- .
Owner's Name: -K/
-�,a�,,rn.�N(;
�NI����
#:
sok- -1�2-303
Contractor
� L u* I
I Phone #: 4A -
CcttiJ 5 -2_G
License #:
12.7
Plan Check Fee
(Rwm L4j _1W_0
BUSLIC
Contact:
(SUIS �R� ruse
Phon#:
q{U - 421-7�I I
Cupertino Business License #:
3C) (0( S
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
❑ Asphalt Shingles
Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles i
MUb1 iA� kt i
❑ Other (Specify)
Other (Specify) lC
Number of existing coverings
AProvide I.C.B.O. Report # 2(c S (o
❑ To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description`)�CMv15L,,'�(Kiiv4 I Lkq fJ� WU01) SNAk ItvSTgt � NUJ i2 `t COXI
.30't 5
.ti A)4 0,1I CL I VJ b L
Residential
Commercial ❑
Fire Zone: Yes ❑ No ❑
Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Project: 20 OU , Joy
Type of Construction: Occupancy group:
Qty. if
Applic4ble
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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