06070033 CITY OF CUPERTINO - a.��
BUIi:DINC DIVISION PER xCON'ba ;PPR INFQRM, 10 il,-
BUILDING ADDRESS: R E ROOFING & CONSTRUCTIO P"I tT!IG06070033
841 ROSE BLOSSOM DR
OWNER'S NAMHNSOE: PERMIT L`3UE DATE
JON TED 15230 CLYDELLE AVE 6
ONE: SANITARY NO, CONTROL NO.
(408) 626-9320
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
±Op LICENSED CONTRACTOR'S DECLARATION
w C 1 hereby affirm Bias[am li¢nud under pmvivons of Chapter 9(commencing Job Description
2w wiNWM
Busincrand ProfcssiunsCode.andmyliecnfcis
in fulC°�`1 REMOVE EXISTING WOOD SHAKE AND INSTALL NEW
s z LkcLic,g
-y-o LiceCam�m 1/2" CDX 30# FELT AND LIFETIME ASPHALT COMP
CEmili G
p I understand my plans shall he used as pupli U.
yyU
h Licensed Professional
3 OWNER-BUILDER DECLARATION
i1 hereby affirm that I am exempt(sum Ne Contractors License Law her she
00 fallowing mason.(Section 701.5.Business and Professions Cade:Any city or county
um ff which requires a permit m mn.L Alm,.improve,d,mol W,nr repair any macome
_Z< prior is its issuance,also residues she applicant forsuch permit to 0lc a signed statement $p
££ Nat he is licensed pursuant the provisions of pe Contmcmh Licence[aw(Chapter9 Sq.Ft. Floor Area ValUl�f4(](]
d�0 (commencing with Section 7")of Division 3 ofthe Business and Pmfcisinns Core)or
i $ that he u exempt Bierefwm and Be basis for Ne alleged exemption.Any violation of
Section 703 1.5 by any Applicants for a permit subjects the applicant m a civil penalty of ApN N tuber Occas
not mare Nan BK hundred dallars(M). 35903(44 , OO Occupancy Type
❑h o the.,...d the mbragemy or hooyeu with wagas as Bei(wle co 4.B.Ai on,
will the wart,and Bre swmum ra nos i Licessd ora w di sonata(Sec.7044,Business
and property
whProfessions Codc:The Contractin'smBremen.Liewho Law dam or apply 1f an owner of Required Inspections
propertywhobudIdsairire that
tu Nanon,and e is doesouchwort himselfair through has
own
wA.th hoprovidedpassuchimprovementsartnot intendedmplededforsale.r-
buwetin, Neaveteding prunprophavi.4soldwithincan year of completion.Neorm of
builder will have the burden of proving Nas he did nos build or improve for puswe of
salc.).
❑has owner of ct propcny,am=elusivelynesand Professions
with:)The Ccontrazmu i- 7/
construct the project(Sec.704,1.in owner
ig and Processions Cade:)The ConuwmFs Li-
cense law docs not apply a an owner of property who builds or improves;thereon,and
who contracts for such projects with a canvsnaKs9liansed pursuant m Nc Convwwh UX
m
Ola
O /
1 am exw.empt under Sec .B k P C far Nis reason � r
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby,aRsm under perulty,of perjury arc of Um following declarations:
1 have and will maintain a Certifumm of Consent to wlr-insure for Woicer'sCompen-
smon,azprovided for by Section 3700 of Um Labor Code.for the performanceof the
for which Nis permit is issued.
1 have and will maintain Worlogs Compensation Insurance,as resuiwd by Section
37or Bm tabor Code,for the perfonsu ea ofthe.,it for which in.permit
My s C ar'n frim su rame cortin and Policy number are:
Carrier. Policy No.:
CERTIFICATEOF E7 Pr10N FROM ORKERS'
COMPENS n( INSURANCE
(this section need not Wcompleted it the permit is for one hundred dollars(SIM)
nr I'm.)
I certify,Nat in the pcolie.ance of in.wort for which Nis permit is wr ed.l shall nm
employ any person in any mannerw u m become subject in the Worters'Comportment
laws of Califomia.Dale
Applicant
NOTICE TO APPLICANT:IL After mating Nu Certificate of Exemption,you should
become subject to the Worker'Compensation provision of Bre labor Code,you mug
,J O forchwim comply with such provisions or Nis permit shall Its, seminal.
deemed
'Z�i CONSTRUCTION LENDING AGENCY
[-+� I hcrchy elrum Nat there is a eonwuction lending agency,for else performance or
E
> the were for which this permit is issued(Sec.3097.Civ.C)
QLenders Nam,
r7 z Lenders Address
U 0 1 unify that 1 have read this application sort sum Nat Um above information is
U, P conch I agme to comply with all city And county oNinarue t and atam laws relating Be
0 t..) building construction,and hereby awbOdu¢p¢senutivice of this city to enter upon the
abovc-maneoncdpropcny ford cxNmon purpowhich x.
F a (We)agree to save,indemnify and keep harmless the City of Cupertino against
h liamorea,judgmcn0.cosuand fing of this onil. may in anyway accme Against Art d Ctry
t_) z IAn cone AcUNDor the
gMANDS AtND Ott OMPLY WITH AI,L N N-POINT Issued by:s4te4 Date
"CURc no 1I`
(Il U Re-roofs
Sig of plicanuContram r / Dam
HAZARDOUS MATERIAL CLOSURE Type of Roof
iB.w-c applie Ieerumre building,ccupantsuerc c hausrdaus material
as defined by Nc Cupertino Mtem it, otic.chapter 9.13, d the calm and Saf,ry
Code.Section 25333(a)?
❑Yu All roofs shall be inspected prior to any roofing material being installed.
❑ o
41 Will the applicant or future building aaapant LLQ equipment an @vias which If a roof is installed without first obtaining an inspection,I agree to remove
emit hanolous air contaminants as de nrcd by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes
,�fhoo,p Ne Work.raminad,xquircrom,underClupter6.95 ofthe Califer.
nu HcAJO&S Cade,Srctiov 25505,25537 and 2553d.IwdersurW pnifdr buioul
Urea not current y A Nat it umy rezapo NIt m notify the occur.,or the
re4,ire'em wn tori as(, Tamar mrym,y. Signature of Applicant Date
Owner or auNorivcdagent / m All roof coverings to be Class"B"or better
CITY OF CUPERTINO
�m 1 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35903044 . 00
DATE ISSUED. . . . . . . : 07/10/2006
RECEIPT # . . . . . . . . . 35154
REFERENCE ID # . . . : 06070033
SITE ADDRESS . . . . . : 841 ROSE BLOSSOM DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER JOHNSON TED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : RE ROOFING
CONTRACTOR . . . . . . . : PROCTOR, PAUL LIC # 20615
COMPANY R E ROOFING & CONSTRUCTION INC
ADDRESS 15230 CLYDELLE AVENUE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95124
TELEPHONE (408) 626-9320
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- --- ----- - - ---------- ----------
BPERMFEE VALUATION 14 , 000 . 00 212 . 76 0 . 00 212 . 76 0 . 00
BSEISMICRE VALUATION 14 , 000 . 00 1 . 40 0 . 00 1 . 40 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 214 . 16 0 . 00 214 . 16 0 . 00
•
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_stated policy on re-roofing.
Homeowner's Name: / I w�/`G U EhJ b 11V
Job Site Address: U"1 ` �V kU`7 5 o M
Roofing Coryt am � 1 � �(( �(UI✓C i 1�/ I C-
PP s � IIo �Uh
A licant(s Si tore Date:
• Greg Casteel \�
Building Official
Revised 11/2/04
Community Development
' 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
OPERTINO
K41 0 -5 ,,55,M Building Department
JOB ADDRESS: PERMIT # -7 o Q 3,(/-
G
OWNER'S NAM E: lhJ 5 PHONE #
GENERAL CONTRACTOR: v N FAX #
I am not using any subcon actors:
Signature Date
Please check a livable subcontractors an complete the followinginformation:
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
i
CITY OF CUPERTINO
, REROOF
or
CUPERTINO PERMIT APPLICATION FORM
APN# 359 Date: I J J
Building Address:
_51.05501A JbR .
Owner's Name: Phone#:
Contractp? i ( License#: 7 , 1 G
f� � ��� W '- � Ci�r✓�llu,t.czltnv � �c. �l 2 � I
Contact: Cupertino Business License #:
�� 1L `Klf�iiAL__ 2Ufo �
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles �Q 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:
JK
Job Description: '70Aavr VU0,W 51iKKr tN5T/n , tilt` CyXt
3-C) arc Alzt OAAP
Residential Commercial ❑ C L kW'A
Fire Zone: Yes ❑ No/a? Confirmed with Planning Deft. if
there are any restrictions: LJ
Cost of Project: U 6 Type of Construction: Occupancy group:
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
•