06050220 CITY OF CUPERTINO
BUILDING DIVISION PERMIT h-CONTRACTOR"INFORMATIO,N
BUILDING ADDRESS: MICHAEL ROSINGANA ""'Nu-06O5O22O
7790 ROBINDELL WY
OWNER'S NAME: PERMIT ISSUE DATE
MICHAEL ROSINGANA 05/25/2006
E:
SANITARY NO. CONTROL NO.
ARCHOEC(ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
1� C=
:oa LICENSED CONTRACTOR'S DECLARATION
mC 1 kreby afrm that 1 am Ikcnscd under provisions of Chapter 9(mmmcncing Job Description
.Zw with Section 7IX )of Division l of Ne Business and Professions Code,and my liters.is
'may In murareeand ffec SCoC 53 13 REMOVE 2 LAYERS OF COMP ROOF- INSTALL 30LB FELT
license Clea
;moo Dam t<- - Cont., LIFETIME COMP. CLASS A
qq� ARCHfIECTS DECLARATION ALL PHASE ROOFI � �Di* ODR BL 5/25/06
12 1 understand u rec
nJ my plans shall used public ords
>yU
e u•t, Licensed Pmfeuional
O g OWNER-BUnDER DECLARATION
C I hereby.(Tuns Nat 1 1. ,Business
from Me CanuacsufsLicense: C law for tW
❑O following moan.(Schon 71171.5, t.&herr.and P do o l Codc:Any city structure
JON
+ _
5m which requites.permit rernres,Me, alter.improve,h Permits urea sigany edswcmm Ju V
_I< primwiuissuance.
pumas requires,on use Novisios,ofcant forMe sucCohpermitwftookeLaw(Cha mem
E O that ficassand
wit pSewant on use of Division
n3 MeContractor'sTlcensc Taw(s Code)at
Sq.Ft. Floo Valuation
a€
(commencinghe withSectimanand)nubasisfrtftWBedexemptand on.AnynsCtdc)of $9700
y�� Nat he u eumpt Mcrefrom and the buss far the alleged exemption.Any viola0on of IL a
Smgon 7071.5 by arty applicant fora permit mbjecu Me applicant io a civil penalty of APN Num e Occupancy Type
not mare Ulan five hundred dollars(531)D).
❑1,u owner of tk pmpmy,a my wploycu with wages u Ne'vxk eompew0on, 36229004
will do U0).&..d Mesuucrum u oat inserters oroffered forxk(Sec.7061,Business
and Pmfexinm Cade:The Canuacwrs License law dons.1 apply w an owner of Required Inspections
property who Wilda orimprows Norton,and who doessmh work him.cif or through but
Owo emploe Wiprovided p suchimpiwidwi are retintefr moRerrlforoa r-
builder,Ne Wilding ori en o phovinu Bald within ons yens or improw for Ne Owe or
builder will have the burden of provinP Nat M did not build or improve for purpose of
sett.).
❑I,as Owner of the property am ucksa cly contracting with licensed rnntrxtars to
..moues Ne project(Sec.7044.Business and Rorossions Code:)The COnuacme.Li.
ccue Law does not apply to an owmr of property who Wilds Or improves Merton,and
who contracts for such Mijaus with a conuacwr(s)licensed parwam to Me Contractors
License law.
❑IamexemptunderSee .B&PCforNismawm
Owner Dale
WORKER'S COMPENSATION DECLARATION
I hereby art=under penalty to perjury one of the following dcclaraMons:
1 hart and will mainuin a Ccnificax ar Comm w self ivurt fro Warkrl Cempcn-
satmn,as pmvidcd rte by Section 3700 of 00)Inter Code.for the performance of the
work,for which thu permit is issued.
❑I have and will resinuin Warkra Compenvdmn Iuunnm,u¢yuircd by Scams
37110 of Ne labor Codc.for Ne per(wmance of the week for which this permit Is issued.
My Workers Comppepvas'ban Imutxnm carrier and Policy num
Canir: FO]k l Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
Cres scatter necei not W oomplcted if the Permit Is i.e.bandied dollar(PIWj
or 0.)
I certify that in Ne performance of the work for which this permit is issued.I shall not
employ any person in any manner an as b become wbj.i In U0)Warkrs'Compensation
Laws of Calif.mus.Dam
Applicant
NOTICE TO APPLICANT:It.after making Nu Certificate of Exemption,you should
become subject to the Workh Compensation provisions of the labor Code,you most
.JO faMwith mmpy w'iul such provivom or NU Permit shall be deemed mwked.
z'7 CONSTRUCTION LENDING AGENCY
(-� I hereby affirm Mrs Nem is a construction lending agency rat d0)performance of
a Me work for which this permit is issued(Sec.3097,Civ.C.)
ITl Q land s Name
jz Lenders Address
U Q I ccnify that 1 have read Nis application sort sum Nat Ne above inrosmation is
Uy Hcotmm 1 agree to comply with At city and county ordinances and sum laws relating In
OU building construction,and hereby authorim mpresenutiscs or this city to enter upon Me
H Cahovcmmuancd pmpcny for a pccuon purposes.
(We)agree to on.indemnify and keep harmless use City O(Cupenino against
Z inconsaucdgmcnts,cosuan Oft1I5cawhichmryin any wayamue againstsaid City
t..3z in conxgmnce of Ne granting of Nis permit.
^ APPLICANT UNDERSTANDS AND ILL COMPLY WITH ALL NON-POINT Issued by: Date 2.roC
SOURCE E ULA NS.
` v Re-roofs
'Stimat.of
A manoconmactor am
HAZARDOUSJJ�dATERIALS DISCLOSURE Type of Roof
Will applicant or Nt}Wilding occ.possubc Ot handle harem—material
as de0ned by Mc Cupertino Municipal Code.Chapter 9,t,2.and the Hca1M end Safety
Code.Section zss3z(a)?
ru All roofs shall be inspected prior to any roofing material being installed.
Season
Will Oc a lieant or fuwm Wildin oma ant nse If a roof is installed without first obtainingan inspection,I agree to remove
PP P p ea Air rut ar Mona which P g
emitict? air contamirunu u dcRud by Nc Bay Area Air Quality Management all new materials for inspection.
District? ..c
❑Yee dna
1 have mm the Warders m=nAlsmquimmems under Chapter 6.95 of Ne Califor.
nia Hca1M&Safety Code.Sections 25505.35533 and 25534.1 undoneantl Muir Mc building
docs not cumcnOY haw mount,Mur it u my me,muihility re twurY the omupant of Me
regnim uwnkhm bcmetpriar issaanmaraeertireate a Signature of Applicant Date • -
5 z 061 All roof coverings to be Class"B"or better
neroraatha a agent Date' g
Community Development
130 Torre Avenue
W� Cupertino CA 95014
" Telephone(408)777-3228
CITY OF Fax(408)777-3333
OUPEkTINO
Building Department
JOB ADDRE S: PERMIT #
-7-40 Koe>i tc-Doz� L?,-� 60Saz2o
OWNER'S NAME: A.v rN PHONE # (�p Lt S7
GENERAL CONTRACTOR: �` t 1F1 - cx>Fi tic, FAX #
I am not using any subcontractors: ---- 2 O
ign Date
Please check applicable subcontractors and com 1 e 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
s
Owner/Contractor Signature Date
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36223004 . 00
DATE ISSUED. . . . . . . : 05/25/2006
RECEIPT # . . . . . . . . . : 34551
REFERENCE ID # . . . : 06050220
SITE ADDRESS . . . . . : 7790 ROBINDELL WY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MICHAEL ROSINGANA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : ALL PHASE ROOFING
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : MICHAEL ROSINGANA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
•EE 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
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 275 . 56 0 . 00 275 . 56 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
-- --------------- ------------ ------------------
CHECK 275 . 56 8379
TOTAL RECEIPT 275 . 56
•
CITY OF CUPERTINO ()(Obbo�90
REROOF
• CUPERTINO PERMIT APPLICATION FORM
APN# — cq ` Ocl Date:
Building Addr
Owner's Name: (� Phone#: _
tri A C tY d511 � ASA ZSS �LIS�
C ntractor: License#:
CeG '�-_73
Contact: Cupertino Business License #:
P2.4A21z � � n�.c_=w�Z
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
V Asphalt Shingles / Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
--B—Other(Specify) ❑ Other(Specify)
Number of existing covering ❑ 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: C3�
Job Description:
` L71— (aeo-wv
Residential Commercial ❑ C`AsS F'r
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De I if
there are any restrictions: LAY
Cos ,, Pr
t of Projectbo DType of Construction: Occupancy group:
4 Ft ODS
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 Y4 " 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.
Homeowners Name:
Job Site Address:
Roofing Company Name:
Applicant's Signature: Date:
• Greg Casteel
Building Official
Revised 11/2/04