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CITY OF CUPERTINO
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INT{URMATION ;.
BUH:DINC DIVISION PERMIT
-.CONTRACzTOR
LDING ADDRESS:
OLD COUNTRY ROOFING
PERMIT N0.06060145
497 PLUM BLOSSOM DR
Fo
NER'S NAME:
PERMIT ISSUE DATE
ilk ABELAR PHILLIP
125-B GROBRIC CT
06
IF NE:
SANITARY NO. CONTROL NO.
(707)864-5557
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 l�
LICENSED CONTRACTOR'S DECLARATION
Job Description
hemby affirm that 1 ren lisiued under provisions; of Chapter 9 (commcxing
with Section 7") of Division 3 of are Business and Professium Code. and my license is
In pA fame and affect. $17e_g 62-2.731
TEAR OFF 2 LAYERS OF ROOF. RESHEET OSB ADD 40 Y
License stens
Dae w,,
ELK COMP SHINGLES CLASS A
C TS R 1
fie r
1unrofssional
FT7 ED
Licensed Professional
OW NEm BUILDER DECLARATION
OWNER
1rgJ�� g�yJ�i`
I Wmhy .(Sore that 11. exempt (mm N. Contractors law for the
Any
Co : C
following matin. Cod.: My city ar county
'!ID Ls, Business and Pne,
which aquifu Permit a derons
permit re eonuua aper. Improve, demolish, car repair any uumuro
priormsliesed a6um to the tW Applicant of for Such permi0o01es, Law matom.nt
issuance,
that Wiscing wit purwanl to the provisionsofComrutos
•� y
Sq. Ft. Floor Area
Valu IbB000
and Proflaw(Uapur9
(commencing with Section 3 of Business and Professions Cade) or
Ss
(aDivision
and the al
Nat he k exempt therefrom and Ne pati far da allaBcd exemption. Any violation of
tham a is
Fl
Section 703M by my appliant far a permit subjects One applicant to a civil penalty ofppN
Nan fin mart Nw hundred dollars ($300).
j�l�er 10�
3 6 61 U d ,
Occupancy Type
❑ 1, as owar o(Ne pmpenly, a my employees with wages ss Juv tole compensation,
Required Inspections
will do the work and Ne sWcwa is not intended or offered tarsale (See 1061, Business
and Profession Coda: The Comrxtor'v Licenx law docs not apply to an ownen or
pmpeny who Wilds or improwda em,and who doessuchworkbimfelfor Waugh his
awn employees provided that such improvements arc not intended oraffered for sale. if.
havevcr, the building or improvement is mid within arc year of completion. the owner -
builder win haw the burden of proving that W did not build or improve for intrinsic of
sale.).
❑ 1. u owner of the property am exclusively convening with licensed conn vers in
construct the pmject (Sec. 7(Ji14. Business and Professions Code:) The Contractor's Li-
c.nse law does Out apply to an owner of property who Wilds or improves thereon, and,
who contracts for such pmfeN MN a conlractons) Ikensed pursuant in NC ConVxtors
License Law.
❑ Iamuemptunder Seen .Bh PCfarthismem.
Owner Data
WORKER'S COMPENSATION DECORATION
1 Wreby affirm under penalty of perjury am of the following declamation:
1 haw and will maintain a Certificate of Consent in self-insun: far Work es Co.,. -
ion, as provided for by Section 3700 of the labor Code. for Ne performance of the
work for which On Permit is issued.
1 have and will maintain Worker's Compensation Irtsurmea, as tapnad by Section
W of IW Labor Code. fw Ne performance of the work for which Nis permit is issued.
'
My W Ys eom .mfioa Insyrana carrier and Policy number b
Cartier J ata/M.r�Iw� Policy No.f ir V T
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed if Ne permit is fmone hundred dollars ($100)
or loss.)
I certify Nal in Ne performance a the work for which this Permit is issued. I shall not
employ any person in any manner an as to tame subject o Ne Workers' Comprstsation
Lawa of Califontia Data
Applicant
NOTICE TO APPLICANT: If. afar making this Cerdficau of Facmption. you should
became Subject to due Worker's Compensation provisiwu of de labor Code you muss
' foMwiN comply with such provisions or this permit shall W darned revoked.
CONSi
1 W Can's iso conNLENDINGAGENCY
hy agency for the perfurmana of
Nat thea len canswcti30
' r which 7, Car'
e work fon which this permit k issued (Sec. 3097, Civ, C)
Lcndcfs Name,
L
L.ndeYS Address
'
I I comfy that 1 ban read this application and state Nat Ne noon informaliun u
Corsa I agmc to comply with all city and county ordinances and sure laws mitring to
Wilding construction, and Waby authorim mprom utives of Nis. city to enter upon N.
'
'boss. -mentioned property for inspection purposes.
(We) agree to same Indemnify Nd keep harnal. IW City of C.wnuno.']Inst
j Iiabiliaes.jWgmcnts,costs and cape"•^•which may in anY'a'+Y ague againstsaid Ciry
in canxqucnce of 'Tartan' of Nis pe 'r.
' APPLICANT RSTAN LL CO Y WIjH AL1. N N -POINT
Issued by: Date
Re -roofs
Type of Roof
Signature or Dae
HAZARDOUS
S MATERIALS DISCLOSURE
Winds applusustorfuture Wilding occupantstore o asmaerial
ss earned by the Cupertino Municipal Code. Chapter 9.13, and Ne HeaIN anJ Safety
and one Hestia
c�de,ScONon25s3z(.)7
Ya No
All roofs shall be inspected prior to any roofing material being installed.
Will future ing
If a roof is installed without first obtainingan ins ection, I agree to remove
P g
Ile applicant or Wilding m
aecupause, equipment or devices which
:mit haaamous air conumimna as dc0ned by the Bay Area Air Quality Management
Dinrict7
all new materials for inspection.
iromenu under Chapter 6.95 of Ne
1 have afet the hvSwass
sZaerials 553 ft Wilding
25A3am12ss34.I
Calc, Saanmoor OC
to noulytlN weapon
dor Out currently
Jas Imp curmnJy hoc a enanL Nat it ts my responsibility m notily N. mcup.nt of Nc
it Or
requiamcnts wh' must Wmat pilar 'mance ofac.nir¢ae ora
Signature of Applicant Date
N°
All roof coverings to be Class "B" or better
owner Dau
&m 1 of 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36618001.00
DATE ISSUED.......: 06/16/2006
RECEIPT #.........: 34895
REFERENCE ID # ...: 06060145
SITE ADDRESS ......
SUBDIVISION .......
CITY .............:
IMPACT AREA ......
ILwYmijRslu s-7030&fe1 ii77
CUPERTINO
OWNER ............: ABELAR PHILLIP
ADDRESS ..........:
CITY/STATE/ZIP ...: ,
OPERATOR: amyw
COPY # : 2
RECEIVED FROM ....: BONITA JENKINS
CONTRACTOR .......: FOLK, DIETER LIC # 20389
COMPANY ..........: OLD COUNTRY ROOFING
ADDRESS ..........: 125-B GROBRIC CT
CITY/STATE/ZIP ...: SUISUN, CA 94585
TELEPHONE ........: (707)864-5557
•FEE ID UNIT QUANTITY AMOUNT
-------------------------------------------
BPERMFEE VALUATION 10,000.00 169.56
BSEISMICRE VALUATION 10,000.00 1.00
TOTAL PERMIT : 170.56
METHOD OF PAYMENT
-----------------
OTHER
TOTAL RECEIPT :
AMOUNT
------------
170.56
170.56
PD -TO -DT THIS REC NEW BAL
------------------------------
0.00 169.56 0.00
0.00 1.00 0.00
---------- ---------- ----------
0.00 170.56 0.00
NUMBER
------------------
VISA
069OUD �s
CITY OF CUPERTINO
•
Sam-
REROOF
CUPERTINO PERMIT APPLICATION FORM
•
0
APN #
361,d8'
oo/
BUILDING
Date: G
�6/oG
Building Address: 7 4 4 7
va P�j /
� Z)A,,Na'?,,,Owner's
Nam?��-si
BUILDING
Phone #:
2235
Contractor:
BUILDING
BPLANCHK
License #:
Contact: l
BUSLIC
Business License
Cupertino Business License #:
589 Z
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
-XC Asphalt Shingles
Wood Shakes
❑ Wood Shakes
Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings
❑ Provide I.C.B.O. Report #
❑ To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu
ertino's Tear Off Policy
Job Description: T o
o S g - q__Ze.D d 1/17
Residential
'Commercial ❑
Fire Zone: Yes ❑ No ❑
Confirmed with Planning Dqt. if
there are any restrictions: U
Cost of Project:
Type of Construction: Occupancy group:
A", 600 • OU
Qty. if
Applicable
Fee ID
Fee Descrintion
Fee Grrnin
! 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
• 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
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
nthe above stated policy on re -roofing.
Homeowner's Name:
Job Site Address: 7 Ll i 7 C
Roofing Company Name: Z ,
Applicant's Signature: / Date: Cl/G o 6
• Greg Casteel
Building Official
Revised 11/2/04
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 the
require 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
nthe above stated policy on re -roofing.
Homeowner's Name:
Job Site Address: 7 Ll i 7 C
Roofing Company Name: Z ,
Applicant's Signature: / Date: Cl/G o 6
• Greg Casteel
Building Official
Revised 11/2/04
Community Development
i 10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
CITY F
�UPERTINO
Building Department Fax (408) 777-3333
JOB ADDRESS: 7 4 4 7 �.� ��,� ,��
PERMIT #
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR
FAX #
r .
I am not using any subcontractors: O1� Clet;
SignAure Date
Please check applicable subcontractors and comnlPrP the fnllnwina infnr nf4,,-
21
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
El ral
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 Contractor ignature
G/i6/j, 6
Date