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08050245CITY OF CUPERTINO y��a,gT DrJISION PERMIT 1�r�"'� rONTRAVT� n4�N O Tj•v BUILDING . BUILDI!1V9TE5j:LACER SPRING CT INAME: LOS GATOS ROOFING PER08050245 OWNER'S PERMIT ISSUE DATE NANCY LO P 0 BOX 1726 05/30/2008 ONE: SANITARY NO. CONTROL NO. ARCHITECf/ENGINEER: RE-RF RMV EXSTNG SHKRF INSTL BUILDING PERMIT INFO BLDG ELECT PLUMB MECH AST-14 TYPR 0 0 0 0 LICENSED CONTRd ��„-,,, _T, -��___ Job Description under of Cap 1 hereby affirm Net I am licensed Bu under pmvisif of Chapter 9 (commencing vitt Scairn roll.) of Divui.n J rfWe Butincss and Prafestiuns Cade, and my Ikcnrc u is Ben tura and e0as Z 3 Clors Dam ro % Contractual P K ARCHITECTS DIECLARATON I understand my plans shall he mud as public records Licensed Professional OWNER-BUILDER DECLARATION 1 bcmby affirm that I am attempt from the C.nuactors License Law for the 1 ' j fallowing mown. (Section 7031.5, Business and Poefessmas Code: Any eby or county which mquira a permit t. construct. alms. improv=. dcmuilsh, or repair any structure _ prior an its issuance. also naps. the applicant for such Permit m file. signed uamment ' Jim islicensed athe ofdin Contractur's Liecuse Law (Chapter 9Sq. Ft, Floor Area Valuation that pursuant provisions (commencing with Section 7000) of Division 3 of ft and Pmfeaions Cade) or that ha u exempt donefmm and the baso for the alleged e¢mpd.n. Any violation of APN Number Occupancy Type Section ]0315 mit by mry applicant fora persubjc,. the applicam.1. a civil penalty of net mere Wan An hundred dollars (SSOtlI. 0 L as owner of the property, a my esoployces with wages M We'v sale compennation. Required Inspections will da the wart. and thaarecture is ant Wmnded or rlfcred for aide, (See.] .ersi.w.' and Professions Cade: The ConuacWrs License Law dao rot apply m an owner of e ns q P property who builds or improves them.n. and wh.dassuch work himself., Waugh his awn employees, provided that such improvements am not intended aeRertd forst If. hrwewr, We Wilding or improvement is sold wild. a. year of completion, We owsm, builder will have the burden of proving that he did not bid or improv for purpose of ism). 0 L., owner of We property, am eaclusivcly contracting with licensed rnnuxtors in construct the pmjea (Sec. 7014. Business and Profutiav Cade:) The Contractors U. scat taw docs not apply W an owner of prop:rty who builds or improves thereon. and who contracts for such projects with a contractors) licensed pursuant W ter Committees Liceo¢Law. O lameaemptunderSee ,B&PCfathismssun Owner Date WORKER'S COMPENSATION DECLARATION I hereby aQno under penalty of perjury and, of the following declarations 0Ihaw and will ConsentrCoem.fumforWorkeraceatb- eCeni3am of I. noire, ss provided far by Section 3]00 a( the labs Code. for the periarmana of the soak fa which this pcmtil is tuned. 0 1 have and will maintain Workers Campenudon Insurance, u requited by Section 37000fW labor Code, fa am pedo... of We work for which this permit u I..W ' My Work Csmpeo ion Nsunn� amifr and Policy number art: Carrier A/( .Lpf. r'as NCY PoI'hry No.: 6119 CIO- CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu acedon nod netbecamphned if are permit Is for one hundred dollars (SIM) or leu.) I uatify that in the performance of the work for which this prrnk is issued, I shall not employ any person in my manner to as to become subject in We Wadmrs'C.mpewtian Laws of Califamis. Dam Applicant NOTICE TO APPLICANT. Ir. after making this Corollate of Exemption, you antacid • become subject as 1W Worker's Compensation provisions of We Labor Code. you muss forthwith adrPlY with such provism. or this permit shall he deemed rewked. I CONMUC710H LENDING AGENCY 1 hereby arm that them its committed lending agency for dm perfurmane of the work for which this Petrick is issued (Sec. 3097, Civ. C.) Lenders Name - , Lcautna Address 1 anify that 1 have rad des application and aunt tw the show lamination is correct. 1 agree m comply with all city and county .rchr o en and stem laws relating W Wilding construction. and hereby au tori¢ mpmsenmtivcs of Nis city in amr upon the show-mentioned property for Inspection purposes. (We) agree i. save. indemnify and keep harmless the City of Calcium, agtlnst liabilities judgments.,mas and uprises which may in any'w'ay. against said City in cmmegance of We grwung of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date '70 SOURCE ULATION �C.w Re-roofs 5')74 cg Sigma .f AppllanUCrnwm cr Dim HAZARDOUS MATERIALS DISCLOSURE Type of Roof ./ Will the applicant or future building eccupancsmm.,hand], havruous material ss dcfhned by the Cupertino Municipal Code, Chapter 9.12 and the Halth and Safety Section 11112(11? C Ya %N. All roofs shall-be inspected prior to any roofing material being installed. oCade, Will We applicant or future building occupant use equipment or &view which If a roof is installed without first obtaining an inspection, I agree to remove emit hvardnm air cmteminants ss &Food by the Bay Area Air Quality Management all new materials for inspection. District? 0 Yes (KNu Ihawrewl Whxavdous ma%5.255uirtmcnu under Otspmrd.95.flhe Wilding nicer a,c. Safely Cade, building to mmmLt255115s myrand25534.1 doss nm ear otic hoc • sena tut it u of, m mtiI the oaupwl of We a et. su nec of Ccity mquirem which most ct pia, to issuance of a Ccnificam.f a perry Signa re of Applicant Date S 3< og roof coverings to be Class '%¢" or better o r.rarth.rircdas=rot DataAll • 2 ITEMS OF 4 • E CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 36655016.00 DATE ISSUED.......: 05/30/2008 RECEIPT #.........: BS000004951 REFERENCE ID # ...: 08050245 SITE ADDRESS .....: 11861 PLACER SPRING CT SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: patg COPY # : 1 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT AMOUNT --------------- 703.40 --------------- 703.40 VOICE ID DESCRIPTION -------- ---------------------------- 601 ROOF TEAR OFF 604 ROOF IN -PROGRESS REFERENCE NUMBER -------------------- 42630 VOICE ID DESCRIPTION -------- ---------------------------- 602 ROOF PLYWOOD NAIL 605 FINAL REROOF OWNER .............. NANCY LO ADDRESS ..........: 11861 PLACER SPRING CT CITY/STATE/ZIP ...: CUPERTINO CA, 95014-5103 RECEIVED FROM ....: LOS GATOS ROOFING CONTRACTOR .......: RANDY BROWN LIC # 23481 COMPANY ..........: LOS GATOS ROOFING ADDRESS ..........: P 0 BOX 1726 CITY/STATE/ZIP ...: LOS GATOS, CA 95031 TELEPHONE ........: (408)298-9399 FEE ID -- -- UNIT QUANTITY ----------------------- AMOUNT PD -TO -DT THIS REC NEW BAL IBSEISMICR VALUATION 5,454.00 -------------------- 0.60 0.00 ---------- 0.60 ---------- 0.00 1REROOFRES SQ FEET 28.00 364.00 ---------- 0.00 364.00 0.00 TOTAL PERMIT ---------- 364.60 0.00 ---------- 364.60 ---------- 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT AMOUNT --------------- 703.40 --------------- 703.40 VOICE ID DESCRIPTION -------- ---------------------------- 601 ROOF TEAR OFF 604 ROOF IN -PROGRESS REFERENCE NUMBER -------------------- 42630 VOICE ID DESCRIPTION -------- ---------------------------- 602 ROOF PLYWOOD NAIL 605 FINAL REROOF INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO • PERMIT INVOICE OPERATOR: patg Sec: Twp: Rng: Sub: Blk: Lot: APN ......... 36655016.00 INVOICE DATE......: 05/30/2008 REFERENCE ID # ...: 08050245 SITE ADDRESS .....: 11861 PLACER SPRING CT SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER ............: NANCY LO ADDRESS ..........: 11861 PLACER SPRING CT CITY/STATE/ZIP ...: CUPERTINO CA, 95014-5103 CONTRACTOR .......: RANDY BROWN LIC # 23481 COMPANY ..........: LOS GATOS ROOFING ADDRESS ..........: P 0 BOX 1726 CITY/STATE/ZIP ...: LOS GATOS, CA 95031 TELEPHONE ........: (408)298-9399 FEE DESCRIPTION- DUE FOR AMOUNT DUE PAID BALANCE ----------------- - -------- - ---------------- ---------- SEISMIC ---------- RESIDENTIAL PRINTING-PERMIT 0.60 0.00 0.60 RE-ROOF: RESIDENTIAL PRINTING PERMIT 364.00 0.00 ---------- 364.00 -------------------- 364.60 0.00 364.60 VOICE ID -------- DESCRIPTION ---------------------------- VOICE ID DESCRIPTION 601 ROOF TEAR OFF -------- ----------------------------- 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF E d J05 02Y5 CITY OF CUPERTINO REROOF CM OF CUPEkTINO PERMIT APPLICATION APN # 2l/U 0 ".5J` -�%� % �, C> Date: O� Building Address: Owner's Name- ;afl 26 Phone #: �o&e _7?yS- Contractor: LOS' r� 0 p -P 10 Cj Phone #: Llo 6j3 `J Fax #: Yo�?3 %j Cupertino Business License #: 23 / Contractor License #: 0 70 Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles ` Asphalt Shingles X Wood Shakes /❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) )6 Other (Specify) �e�Jf . Number of existing coverings 1i Provide I.C.B.O. epoit rt # To be Removed Proov-idee�Mfgr. Installation Specs. S S pp� !_�IQSS Jot Description: D��z Residential Commercial ❑ Fire Zone: Yes ❑ No Confirmed with Planning Dept. if � � � C.� -� there are any restrictions: ElValuation: I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy: r - 49 TY 0 CUPERTINO CITY OF CUPERTINO REROOF, FEE SCHEDULE Number of Squares Fee ID Fee Description Fee Group Permit Type 1RER50FCOM Re -roof Commercial B 1COMMLROOF 1BSEISMIC0 Seismic Commercial B r� �} S oC jj 1REROOFRES Re -roof Residential B 1SFDWLR00F l 1BSEISMICRE Seismic Residential B 1REROOFMRES Re-roofMulti-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 stat# policy on re -roofing. Homeowner's Name: Job Site Address: i ORoofing Company Name: �yr1 SC_�p n 70' Applicant's Signature: Date: v i • Greg Casteel Building Official Revised 11/2/04 I: CITY OF stUPEkTINO is • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: // �&/ PERMIT # OWNER'S NAME: PHONE # GENERAL CONTRACTOR: Tia ., FAX # . . .. . 11, OP Signature Please check ar)Dhcable Slthrnntrarfnrc and rnmr ].f -c +ho F..I1.....:.... :.. G.,,., a:...... Y at 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 141 at