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05100089 CITY OF CUPERTINO BUILD:r'G DIVISION PERMIT BUILDING ADDRESS: PERMIT NO,0 510 0 0 8 9 llER'SRNAME: PERMIT ISSUE DATE UDOLF GOTTWALD 05 PHONE: SANITARY NO, CONTROL NO, I ARCHITECrfENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 304 LICENSED CONTRACTORS DECLARATION JobDescri tion Ad 1 Wroby affirm that 1 am Iicxucd under provisions of Chapter 9(commencing p with Section 70(10)of Division 3 of the Business and Professions Cade,Anti my license is n; iimIt fa.Claenderr_Jr ja4„ REMOVE EXISTING REPLAC COMP fa Z License Class IJc.« k / Data cwSDECr CONTR: SHADOWFAX ROOFI I��j{ �1 7/05 c "�rar e'- AacHlrecrs DECLARATION REC #01000013309 y I undcraunJ my Plots shall bo used a public rtcoNx g� u Licensed Profcuional O/Y O yG OWNER-exemptRD the ConTION Ta/ g I hconthy,(Arse that 1 1. exempt from the Contractors Any c Isco for the W a9 00 fallowing mama.(Sadao 703 1.5.Business and Improve, ns Calc:Any airy or county L� $ which inquires issuance.permit to eans the alcor,improve,demolish,ort to e.sig any atrudaro ✓ prioroiuensedpursurequires promd.icant for suhpecmr'.Lice.signed that he is licensed purauanimtim provisiomofthe Conuacmri Littese law(Chapter9 Sq.Ft.Floor Area she bValuation 6SS (commencing with Section 7000)of Division 3 at the Business and Profession,Code)or $11519 that he Is exempt therefrom and she far the alleged exemption.My violation or gecdm 7031.5 by airy applicant for a permit subjects the applicant to a civil penalty of APN Number c 'panty Type not more dun Ova hundred quit...(SSOq. ❑1,u owncr of the propmy,a my employee with wages u the4 ante compewtion. will do thework,and theauuctum Isnot intended car uttered foraele(Su.704,1,1lusinau and Procession,Cade:The Contractors License Law does not apply to an owner of Required Inspections property who builds crimpmves themon,and whoduessuch work himself car Wvugh his awn employees,provided that such improvements are not Intended oraReted formle.If. v however,the building or improvement B sold within one year of eomple ion.the owner Wilder will have the human of proving than he did not Wild At Improve for purpose of sale.). (:11.u matter of the property am exclusively contracting with licensed conuac7mn to construct the project(Sec 7044,Business and Professions Cage:)rite Contractors LI- cense law does not apply to an owner of property who Wilds or improves thereon.and, who contracts for such projects with a conuocmr(s)licensed pursuant to the Contractors License Law. ❑I am exempt under Sec. .B&P C for this Masan er Data WORKER'S COMPENSATION DECLAiNTION 1 hereby affirm under penalty of perjury oto of die following declarations: ❑1 ham aM will mainuin a CeW fiuW ofConuni to wif-insum far Work eaCanpen. anon,u provided for by Section 3700 of the labor Cade.for the performance of the work for which this permit is Issued. ❑1 have and will maintain Workers Compensation Insurance.as rtq.i.d by Section 37W of the IaborCode,for dm performance of the wort for which this permit Is luted. My Workers Compensation Insurance carrier and Policy number am: .vu Carder.J`Tif.W P?.iAm Policy No.:.�8s�aS 4.vry a�S CERTIFICATE OF EKEM MON FROM WORKERS COMPENSATION INSURANCE (This section need not bocomplewd lithe permit is krone humaeddolla s(SIM) or leas,) 1 certify that in the performance of the work for which this Permit is issued.I"I oat employ any person in any manner an a At become subject to the Workers'Compensation Laws or California.Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subjut to the Workers Compensation pm inions of the Tabu Cone,you most 0 O forthwith comply with such provisions An this permit shall W de mN rtwknd. Z'` WCONSTRUCTION LENDING AGENCY (ti Irtby.ifirm that them ase construction lending agency for the performance of C > the work for which this permit 13 issued(Sec.3077.Ci,C.) Q LeMces Name z Lenders Mdrus U Q I malty boat 1 have ruad this application and sum met the above Information Is - 14 comms.I at=to comply with all city and county ordinances and some tows relating m Q building construction,and hereby authorise mprommadves of this city to enter upon the shove-mentioned property for Lupection purposes. 0. (Wc)agree m an.indemnity and keep harmless the City of Cupertino against Tag liabilities.judgments.coats and expenses which may in any way accrue against said City U,Z In consequence or the granting of this permit. APPLI ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:3 Date SO E0.EGULATION 51111114 O r Re-roofs gwuro car pli H ZARDOUS MATERIALS DISCLOSURE nue Type of Roof Will the applicant or future Wilding oceupantnoro or handle huardous material As defiocd by Use Cupertino Municipal Code,Chapter 9.13,and the Health and Safety o.Schon 35532(a)? ❑Yes /pl IllIIIvvvvvv��No All roofs shall be inspected prior to any roofing material being installed. Will the applicant of f num building occupant on equipment or dcvicca which If a roof is installed without first obtaining an inspection,l agree to remove emit havardous air conumimnu as defined by the Bay Aroa Air Quality Management all new materials for inspection. District? 0y1 alk. lit wmWLhchaardnwsmwdabrtquimmenuunderCNpmd.93oldeCalifm- ID ni.Health&SafciyCodc,Seedom25505,75533md25534.lunder..d NG 1,he building docs not cummly haw a ten 4 that it Is my responsibility m notify do ss:uPant of rite roqul nu which must b pdorto nuance eracertificate or Occt ancy. $I nature Applicant Dat narm.ut agent ZI Dau All roof coverings to be Class"B"or better . CITY OF CUPERTINO ' Item 1 Of 1 PERMIT RECEIPT OPERATOR: suem COPY # 3 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36203031.00 DATE ISSUED. . . . . . . : 10/17/2005 RECEIPT #. . . . . . . . . : 31638 REFERENCE ID # . . . : 05100089 SITE ADDRESS . . . . . : 1026 PENNINGTON LA SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : RUDOLF GOTTWALD ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4930 RECEIVED FROM . . . . : SHADOWFAX ROOFING CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , • TELEPHONE . . . . . . . . : 'FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 12,000.00 191.16 0.00 191.16 0.00 BSEISMICRE VALUATION 12,000.00 1.20 0.00 1.20 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 192.36 0.00 192.36 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 192.36 1121 TOTAL RECEIPT 192.36 • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 aClOF Fax(408)777-3333 PERTINO Building De artment JOB ADDRESS- PERMIT # OWNER'S NAME: mon-w,�y /� PHONE y GENERAL CONTRACT pW FAX # o X6 .275 I am not using any subcontractors: - /o S —TT ignature Da e Please check applicable subcontractors and complete the followmi 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 Roofing Septic Tank Sheet Metal Sheet Rock Tile er/ ntractor Signature Date CITY OF CUPERTINO REROOF OCUPEkTINO PERMIT APPLICATION FORM APN# 3l� 03 D31 Date: Building Address: zG w Owne ' N e: Ph ne#: w o8 :Ir 2- -SZ Co actor. :S/�A,p� - Phone#: o?)a(,S— License#: ,32-?.V7 v Contact: Phone#: Cupertino Business License#: p �C Type of Roof Covering: /00 /p//7/S Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof Asphalt Shingles K Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O. Report# A To be Removed ❑ Provide Mfgr.Installation Specs. Ak I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: 9OV61 - /,< S cm- aae- w cr-J �o Residential Commer al ❑ Fire Zone: Yes ❑ NK Confirmed with Planning Dept. if there are anrestrictions: LJ Cost ofProject: Type of Construction: Occupancy )up: 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 CITY OF Telephone: (408)777-3228 CUPEI�TINO 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.z Homeowner's Name: ;� COZt731.rJAZJ� Job Site Address: /O Z(o ��7!/1i��17J� / AJ /• Roofing Company Name: _5h7 w-QBLtJ �f17C O Y-�sc�i Applicant's Signature:<Zdd.1 Date: / O is Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper