06060025 CITY OF CUPERTINO F -
BUILDi:4GDIVISION PERMIT GONTRACT(1RII FORMATION
BUILDING ADDRESS: T Dom-ROOFING PERMIT"°'06060025
11249 REDONDO CT
OWNER'S NAME: 3 PERNUT ISSUE DAT'`
HARRY VANDEVORT 3540 MARGATE AVE. 6
NE: SANITARY NO. CONTROL N0.
(408) 892-8872
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
l� 0
0o LICENSED CONTRACTOR'S DECLARATION Job Description
m 1 homby affirm that 1 am licensed under provisions of Chapter 9(commencing
i<6 with section 7000)of Division 3 of the Business ad Professions Code,andmyic.rmia
.oH in full fortcand m U1 REMOVE WOOD SHAKE AND REPLA 50 YEAR
by=_ ueemeclay C1 LA,-#_ PRESIDENTIAL COMP CLASS A ���
ARCHITECTS DELLA '' `''
h a i undcrsunJ my plans shall W used u public recmts
IdU
:,4A LwonacdPmrcum.] A
'O� Oat Ism exempt
Br DE Ce Conti ON JUN
TY2O
C C I hereby alfifm that 11. exempt from the Conuactofa License Lw for the Os
!CC O following moon.and,t ]ur 1.5,Business and wO.&.m Cade:Any city or county
fi which inquires n permit w ui s the aper,Applicant
for such
demWsh.ore pair any amain
prior miuisswnceursamgo the thovisio sof far smhpermitmfcea Law(ed matemem
(commecing wit Punaant mite of Diviom of Ne Bummer Limns LawlChapter9 Sq.Ft. Floor Area V t
1 'at Ise
(commencing with 70DO)ad ofbasis n3nftWBuincamhd professions vi Cade)of
Nat W u eswpt therefrom ad the buns fm the alleged exemption.My violation of
Schon 7031.5 by Any applicant for a permit mbjecu the applicmt to a civil penalty Of3 ApN N�tr�lt�er 0 0 Occupancy Type
An,mrt dun fhw hundred doll.($500} 5 621 U
❑1,As Owner of the property,or my employers with wage As their sole compensation,
will do the wort and the ancsum Is not intended Or offered for sam(Sec.]Oaa,Business Required Inspections
and Pmfevions Cade:The Canuacbn m e License Law daint apply to an owner of q P
propeny who Wildsnrimprowa dormers,and who daeasmhworkhimselfor through his
awn employee,provided wt such improwmena are not intended or offered forams.If.
however.Ne building bo improvement u mold within ane yeara comnowt(w the owncr-
salewill have the Widen of proving Nat W did at bulb m'unprove fm Purpnm of
uleJ.
❑1.as Owner of Ne Pinion,am exclusively co ivacting wits licensed comparisons to
constrmt the pmjea(Be,]Oat.Business and Pmfessiou Code:)TW Cmmwmdals U.
come law does not apply to an owner of property who Wilda or impmw.a thereon,and
who contracts for such prejecu with aeonatelor(s)licensed pursuant to the Contracmh
License law.
❑I am exempt under Sec .B k P C fm Nis mason
Owner Date
WORKERS COMPENSATION DECLARATION
1 hereby aRno under Kc ty of perjury arc of the following declamdom:
1ha.eandwillmain°!..c nmsamofcomenttoself-imuinfmwmk esCompcn-
scion,a provided for by Section 37M of the labor Cade.to,Ne penionance of the
Km*for which this permit is issued.
1Q t have and will maintain Waukee,Compenudan Insu .u mr,ii ed by Secdw
1] I of Nc fa rn Code,for Use pcnormance of the work fmwhwh Nu permit is issued.
My Warkc(s rope 'on Lou :e c,rric,rgpnd Policy number
Carries Q L l►oBey No.: t Q�' � y
CERTIFl COMPENSATION NSURANCE MCIF EXEMPTION FROM WORKERS' J S p 1 O
Inds accdon need not W completed if tW permit Is for.hundred dollar($100)
or ICA)
I ceniN tut int a performance of the woe,for which Isis permit is issued.1 shall nm
em Ploy any penon in any manes As to become subject to tW Workers'Compcmation
Laws of CaliforNa.Dam
Applian,
NOTICE TO APPUCANT:IL oder making Nu CcdlRcam of Exemption,you should
become subject m the Warkch CrouNm pian Provision of the lahm Cade,you muss
z fOMwith comply with such Provisions or tes Permit shall W doomed rooked.
rO C
CON
STRURION LENDING AGENCY
[r IkmbY affirm the Nemuacamuucdmn knding,gcnry for the penormarce of
a the work for which Ns pemtit Is issued(Sec.3097,Civ.C.)
W�0 Lender's Nene
z Lcodeh Address
U Q 1 certify that I have read this application and sate the the,bow information is
U,H cancer.1 agree to comply with all city and county ordinances and sure laws mlating to
0O building continued.,and hembyauthodre rcprtmcrtrsd dor this city to cnmrupnn the
above mentioned Property for inspection purposes.
(~ y (We)agree m save,indemnify and keep harmpe
less the City of Cunino against
A
Tliapilitle,Judgmcnu.cosu and cap.which may in any wyacrnmagaimtsaid City p /
U z ire eonsegm,e of a gran6n of the pcm il. Date �^ J'�/G
.-. APPLICANT UN ER A DS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGUTI
6 Re-roofs C7 /
Signaturcol'ApolicohKonessuctury A Dam
HA DousldATEkALSDISCLOSURE Type of Roof
Will tW applicam or future Wilding occupana sam or lurullc huardous material
As dc0ncd by the Cupertino Municipal Cade.Chapter 9.13.and the Health ad Safety
Code.Sccuan 35532(a)] `� All roofs shall be inspected prior to any roofing material being installed.
❑ye r9
Will the, lien,or comm buildingarea nt haze If a roof is installed without first obtainingan inspection,I agree to remove
PP W Area
Air Qu ar Maal which P g
mit lavuanus air conumimnu n defimd by the Bay Ama Air QhWiry Management all new materials for inspection.
Disci,? gas
❑Yes 1'/YrNIh
I hAwh
materials requirtmenu under ChapW6.95afthe Califon
ria Hcalth23505.25533 a d25534.1 undersand thatifthc Wilding
Jou not cAvetow it u my responsibility m notify Ott.Pay Iaf t e
inyuirtmcprh's�Jy i, u ofe Ccrufiem of uCyscy. af
LV JSignature of Applicant Dale
Owner or Dam All roof coverings to be Class "B"or better
CITY OF CUPERTINO
om 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # : 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35621010 . 00
DATE ISSUED. . . . . . . : 06/05/2006
RECEIPT # . . . . . . . . . : 34675
REFERENCE ID # . . . : 06060025
SITE ADDRESS . . . . . : 11249 REDONDO CT
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : HARRY VANDEVORT
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : TD ROOFING
CONTRACTOR . . . . . . . : LESLIE HOANG LIC # 23155
COMPANY . . . . . . . . . . : T D ROOFING
ADDRESS . . . . . . . . . . : 3540 MARGATE AVE.
CITY/STATE/ZIP . . . : SAN JOSE, CA 95117
TELEPHONE . . . . . . . . : (408) 892-8872
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-------- -- ------------- - --------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 10, 000 . 00 169 . 56 0 . 00 169 . 56 0 . 00
BSEISMICRE VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
---------- --- -- - - - - - ---------- ----------
TOTAL PERMIT 170 . 56 0 . 00 170 . 56 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 170 . 56 VISA
TOTAL RECEIPT 170 . 56
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: {� C.t PERMIT #
j ) .2 y9 I� E c�0„ clo O Ca —b � C) a �J
OWNER'S NAME: N PHONE # S I o 9 19
GENERAL CONTRACTOR: T D FAX #
I am not using any subcontractors: r, S l 0 6
Signature Date
Please check applicable subcontractors and complete the following 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
•
Owner/Contractor Signature Date
o�oUou25
CITY OF CUPERTINO
• �d' REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# '35(o- 2-1 —0
10
Date: b ] O
Building Address:
( I 2 �¢. CfoNC1O
Owner's Name: , / P4one#: _
({ atrr. Vot » cls how x{08 51 00119
Contractor: I License#:
I p 200 jR r+ 8L( 55-91
Contact: I 44 0 CL14 Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
�{❑, Asphalt Shingles Asphalt Shingles
P� Wood Shakes I Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
_Number of existing coverings ❑ Provide I.C.B.O. Report#
)f To be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: Lr ¢ M O J Q w 00 c $ C(_ Ju p c t VV
SO e cox (r e7� f t 'Gk, I
cloTs, -A-
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning D,-ePt. if
there are any restrictions: u
Cost of Project: ���_ Type of Construction: Czj�? Occupancy group:
AA
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
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/ed policy on re-roofing.t/
Homeowner's Name: H ctV-r-�J an C n�
Job Site Address: 1 I a 9 28S DY% A D et
Roofing Company Name: 2p
Applicants Signature: _4FDate: S/ p 6
• Greg Casteel
Building Official
Revised 11/2/04