08030015 CITY OF CUPERTINOr* �*4&.m4 ,}rar °„'I"rw�. sc✓'":?'� .=
BUMMNG DIVISION PERMIT CONTRACT"ORTTWORMAH, No,
111LfIylpPERMITN0.
(.f)('%NNINGTON LN INTEGRITY ROOFING 08030015
NER'ss NAME: PERMIT ISSUE DATE
HEMBREE ROSE L AND JOEL G 6820 MOSELLE DR 03/04/2008
'VITONE: SANITARY NO. CONTROL NO.
(408) 225-9263
ARCHITECTYENGINEER: BUILDING PERMIT INFO
BLDGO ELECr O PLUMB MECH
O O
'OZ LICENSED CONTRACTOR'S DECLARATION lob Description
u 1 hereby of iron that I am limned under provisions of Chapter 9(commencing
ii whbSection 7000)ofDi,htmm3af0mBusiness and PrafessimoConn.and myIt..is RE-ROOF,RMV SHK INSTL 7/160SB, 30LB 36"FLT,CLS
A=m in ran fovea and nrcttt. ��5- /
,q z Lieenm Clue Uc.p 1'j4A, 34SQ
J
;k-� Dale ARCHPIECTS OEC RATIN IstINTEGRITY ROOFING RENEWED BUS LIC 3/3/8
i l undersand my plass shall W used as public recnrth
syU
:at; Limrmd Professional
3 OWNER-BUILDER DECLARATION
<S I hereby strata Thal I am exempt from the Coneracmr's License Law far tie
C C following reason.(section 7131.5,Business and Professions Code:Any city or county
$ which torsion a permit to construct.allay,improve.demolish,or repair any structure
prior at its issuance.also requios the applicant for such permit m rile a signed maumen,
: 8 Valuation
thatWulimnsedporsuamoibepnoisiou.fNeC.mremr'.UttmeLlw(Chap.9 Sq.FL Floor Area
(commencing with Section 7000)m Division 3 of Use Business and Pmrommes Cantor - $18534
5 $ that las Is exempt tMsefmm and the basis fa the ellegcd exemption.Any violation of
seems 70715 by ary applicant for a permit subjects the appltuant m a civil Penalty of Number Occupancy Type
ma mom than ftw hundred cellars(M). 3 6 2 0 3 0 3 3:S7 U•
0 1,u owmr of Use pmpmy,a my emplayea with wage u their mic eampc=Uw,
will do the work and the structure is ootimended mail formic(Sm.7044,Business Required Inspections
and Professions Code:The Co ments's Lim=Law does rot apply m an owe nsner of q p
property who builds or Im prow themon,and who does such work himself or through his
awn gmploycu,provided that such improvements ss,not intended aollcrad forsale.R.
however,the buildag err improvement in sold within ane yea of mmpletiom.the owmer-
builder will ban the transient of proving that he did not build or improve fa purpose of
use.).
0 1,as as.of the property,am exclusively...opening with licensed mnumton to
......t Ne project(Sec.7014,Business and Profusions Carle:)The Conmemr's U.
come law dao not apply m an owner of property who Wilds or impmw Usrmn,and
who concocts for such pmjects with a commonstr(s)licensed Pennant as the Comracmfa
License Law.
0 l am eenpt under Sec ,B k PC for this wan
ter Dau
WORKERS COMPENSATION DECUBATION
I bwbY aRirm alder pcmlty of perjay am.(the following declaradonc
0 1 haw a,ul will maim d.a CeNftcve of Conan,m self-Iuum fa Worker's Camper
sa,lan,as provided for by Section 7700 of the Labor Cade.for Use Performance of Use
work for which this permit is issued.
1 have and will maintain WarYer's Compensation Insurance,as renamed by Smim
700 of the labor Code,(ar Ne performance of the woh far which this permit u issueQ
My Worker's Campensati.n Insurance carrier and Policy number are:
artier, s'r9arF jvn Policy No.:
3ooz 19 V'2ve
CERTIFICATE 00 EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not W completed irthe penal,Is far.huoAN do0srs(SIM)
Lou.)
1 certify that in the performance of the wank fa which this permit is issued,l shall not
employ anyperson in any mannerm as at became subject to the Worked Cnmpewtion
Laws ofCalifornia.Data
Applicant
NOTICE TO APPLICANT:If,after making this Cer iOcam of Eumption,you should
become subject in the Wool Compensation provisions of the Labor Code,you mus ,
z forthwith comply with such PMVWOM Or Nu permit shall be daemon mvekcd.
Z^' CONSTRUCTION LENDING AGENCY
[•+� Ihereby afam that then is a comuuctme lending agency for the Performance of
ai the work fur which this permit in issued(Sec.7097,Civ.C.)
aA Lender's Name
D z Lender's Address
U Q 1 mnify Nat 1 have sad this application sod suss that Use above information is
,y t" comet.l agree in comply with all city and county ordinnums and sou laws relating to
OU Wilding construction,art hereby suth.nn,repruenutiw of this city to enter upon led
0. ah—c-mcmued m,,eny for inspection Pur(escs.
Wo)agree to save,indemnify and keep harmless the City of Cupertino apinat
liabilitia,juegmens,costs and expensca which may in any way.e.agitiulsad City
U z in emmequerec of the Starting of this permit
^'s APPLICANT NDERSTAN S AND WILL IT
M Y WITH ALL NON-POINT Issued by: Date
SOURCE
AT�
Re-roofs
oaf Appji VCamm,m u
Da
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
0 t e applicant ar future building amupmt a.Or havndous mautial
as coned by the Cupertino Municipal Cede,Chapter 9.13.and Use Health asm Safety
de.Section 25539(,)] All roofs shall be inspected prior to any roofing material being installed.
" 0Yu �Na
Will the applicam or future building occupant um equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
emit hmanlom air conmminanu as dclined by In,Bay Arta Air Quality Management all new materials for inspection.
District?
0Ym ;jrNu
1 have read the harardess mamdais requiomcros under Chapter 6.95ofde Cslifory
ria healthh Safety Conn.Seen=25505.25533 and 25534.1 unJcman l tha ifthc Wilding
does not currtnit lure p tranartHhoutit u my rmpomiM1i' tifY Use oecupan,of the
rtraire nma4 m pdarm err . ,moron Signature of Applicant Date
0
Gw nam ' - sent D,m . All roof coverings to be Class "B" or better
• CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36203033 .00
DATE ISSUED. . . . . . . : 03/04/2008
RECEIPT # . . . . . . . . . : BS000004077
REFERENCE ID # . . . : 08030015
SITE ADDRESS . . . . . : 1018 PENNINGTON LN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HEMBREE ROSE L AND JOEL G
ADDRESS . . . . . . . . . . : 1018 PENNINGTON LN
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4930
RECEIVED FROM . . . . : INTEGRITY ROOFING
CONTRACTOR . . . . . . . : GREGORY E. WILCOX LIC # 28418
COMPANY . . . . . . . . . . : INTEGRITY ROOFING
ADDRESS . . . . . . . . . . : 6820 MOSELLE DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95119
• TELEPHONE . . . . . . . . : (408)225-9263
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 18, 534 . 00 1 .90 0. 00 1 .90 0. 00
1BUSLIC FLAT RATE 1. 00 110. 00 0. 00 110. 00 0. 00
1REROOFRES SQ FEET 34 . 00 442 . 00 0. 00 442 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 553 .90 0. 00 553 .90 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 553 .90 #9627
---------------
TOTAL RECEIPT 553 .90
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
605 FINAL REROOF
r
0 D r5)
CITY OF CUPERTINO
did REROOF
•CUPEII;TINO PERMIT APPLICATION
APN #� /'
Building Address-
Owner's Name: II Phone #: h
Contractor: Phone #:
V Fax #:
Cupertino Business License #: Zgy/ Contractor License #:
�- co 55
Type of Roof Bring:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ' Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
Other(Specify) PA ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report #
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: n
I rc!s I&'�4)a L 7-1- 5A J Y1
Residential Commercial
Fire Zone: Yes No Ll Confirmed with Planning Dept. if
there are an restrictions: El
Valuation: OC7
I Have Read, Unqerstagond Will Comply with Cupertino's Tear-Off Policy:
Signa re "
CITY OF CUPERTINO
REROOF
1*CUPEiQT1N0 FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
3y 1REROOFRES Re-roof Residential B 1SFDWLROOF
IBSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
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: pp
Job Site Address: _J O I O / o f)n, Y7 n Lo,r)'e
Roofing Company Name: _Z Y-)
Applicants Signature: Date:
Greg Casteel
Building Official
Revised 11/2/04
Community Development
"*. 10300 Torre Avenue
s/ Cupertino CA 95014
Telephone(408) 777-3228
PEI�TINO Fax(408)777-3333
OU
Building De artment
JOB ADDRESS: PERMIT # 0 Q. o 0 O f
o
OWNER'S NAME: cue PHONE #
GENERAL CONTRACTOR FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontracto and complete the following information
VI 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
caner/Contractor Signature Date