08070116 CITY OF CUPERTINO �k..$"r!s'nsx.t" ' > .-�sw'3•"aa °�
BUILDING-DIVISION. PE CU1."T,R'ACT�,QR ORNx4� ,IOI�i";
PERMIT NO.
BUILp1 cAA0R"5 AN JUAN RD ARTISAN BUILDERS 08070116
OWNER'S NAME: b PERM17I ISSUE DATE
MAC LECKRONE 771 CLEMENTINA ST 07/16/2008
NE: (415) 863-2232 SANITARY NO. CONTROL NO.
7ARCH=/ENGINISER: BUILDING PERMIT INFOBLDG EIF.CrMECH
!3CLICENSED CONIIIACTOR'9 DECLARAnONIOb D0SCr1 tlOn
1 hereby affirm Jut 1 ser li¢ncd under Provide-ofCMPter 9(commencing Psection]at10)ofoimdon3ofteBusinessandPrefuco son myIke=isRE–RF REPLC LOW SLP SHEATHNG CLS A 20SQ
4f#01nse L'c.g
fit Da¢
r..'ones"
VIU Le
ARCHr1ECI-S DECLARATION
iI 1 understood my plans Audi be used as public records
Jy
o Licmued Pm(csdond
icOW NEA-BUILDER OECUAAnON
i I 1 botchy slRrta Net I am caempr from On Convanars License Law far the
00 following woo.(Secuun](1513,Business and Profesdons Code:My city or county
<m which requirca a permit In cmuu,u:c Ater.Wpmvs,demolish,a repair any smnure
°z< Prior a its issuance.onto"Weet the applleant formch remit o rile a signed slaeaem
££xx0 Nat heisliccnscdpursuanttothepmvisionsaftheContracwn'LfconscLaw(Chaper9 Sq.Ft.Floor Area ((-- Valuation
yF (commencing withsation]000)WDivuionJnftheBudneuandProfessinnsCade)tor $50000
'5a
Nu he is esempt thorniness and the but$for the alleged ca mpt an.Any violation of
Section 7011.5 by airy applicant roes permit subjects use applicant in.civil penalty of �W�i Number Occupancy
set mere dun fin hundred dollars ISM 34217080 .`lrit' T'Pe
❑Lo on wo cefthe ft,tWo,ar is wirnwgauthev hale compensation,
will dothewort,andthe rbc umtIntendedUaoffered wdo consols(Sec.In.Budde of
and property
ions Code Tbo.thereon.U.law don set apply lf rt owner of Required Inspections
own enywbo kildsaid Oat such eogand wM an,not cuwmkhimrelfm Nonage his
awn employees,provided Aur wen impw old wit in not ear ofc oroRetcd for We.mean..
howewWildn"r.the building aimpmvemantishath he
one year or Wpncwc foron,the useof
Wilder will have the Wrden of paving that k did not Wild or implow far purpose of
tole.).
O I.as owner due pfnpcny,me eac etawly convecting with 0ansed conoacwn b
mnsnnas the pmlat(Set.7(44.Busirtess and ProfULDOW Cade)The Conuacsnes Li. .
cove Law does not apply u an owner of property who Wilds or impwws thereon.W
who contracts for such pmjcm with a contranor(s)0vnsed pasom,to the Conumror's
License law.
I en nsompt under See - .B&I'Crou this mason
Owner Dau
WORKER'S COMPENSAnON DECLARATION
I herby aRm under Penalty orpmnjay one of On following declarations:
1nave andwillfor by ecdon37eofConsentreCode,fwefa&ortdACompan-
ation,r pmviMd for by Ss bout l]00 of the labor Code,for the perfanmanw a(the
wort for which this permit is issued.
tj�1 have and will maintain Worker's Corepensmlo t Insuranm,u wired by Section
3700 of the labor Code,for the perfe rmwce of the wort for which this Permit is issued.
My Worker's Compemaua!Luunnca carnia and Policy number are: 'I'
Carrier. i•T � I'I/Ny Policy No.: ooh {y
CERTIFlCATE OF EKEMPIONFROMWORKERS'
COMPENSATION INSURANCE
(]hiswcdan need not the compleed lithe pconit is We=hundred dolWs($100)
he kis)
I an;fy that in the performance of the work for which this permit is issued,l shall not
employ any pence.in.ny manner an as to Wcome wbjccuce the Woftes Compensation
Laws of Califomia Dae
Applicant
NOTICE TO APPLICANT:If.After making this Cmnincae of Exemption.you sbould
become subj.u the Wortmh Compensation pnovidow of the labor Code,you mus
.J Z forthwith comply with such previdons or Our permit"I k demand rmmked.
z O CONSTRUCf30NLENDING AGENCY
4F 1 hereby aRra Nal them is a construction lending agey fthepe
rlurmAnce of
p: ti the work for which this permit is issued(Sec.3119'1,Civ.C.)
0.Q LeMee's Name
�z l.cndeh Address
U O I cttlifY 0.11 have read this app0cation and me don On above iNomtotiun or
fy". coney I agree to comply with all city and county oNinsrcsa and sae laws rotating in
.O IS'J Wilding construction,and hereby authodas oprxmatiea of this city m enter upon lW
I37 above-mentioned property for inspection purpoma
(We)agree to cave,indemnify and keep harmless the City of Cupertino against
y liabilities,judgments.costs and expenses which may in my way steer against aid City
U,z in consequence of the swung of this fourth.
w. APPLICANT UNDERSTA ND WILL COMPLY WITH ALL NON-POI Issued by: Date 7—/
SOURCE REGULAnONS ,.Ari
Signature oupplicaut Con / Date U Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or intone Wilding ouvpantswc ab ndle huatdous maerial
an dented by On Cup sties Municipal Code.Chapter 9.13,and On Health and Safety
Conn.Seniors 35532fo]
❑relNa All roofs shall be inspected prior to any roofing material being installed.
Will the, heat or future Wilding occupant aro If a roof is installed without first obtainingan inspection,I agree to remove
pP L e equipment or devise welch Pe
tmh waeans air collum;rune u derima by the Bay AreaAir Quality Mwgemant all new materials for inspection.
Diwin] P
❑Yea �No
I ham mad the hvsrdew materials requiemenu under Chaperli.95 of Ne Califor.
nit Health d:Salty Cede,Sections 35515,25533 anu135534.1 undersand that if the Wilding
dons net amt y haw.enane that it u my MNp biliny a notifY de accupann of the '
.qui eh muu act Prior to us.of.Certifies.orOcevp.ncy. Signature Of Applicant Dale
^f6 at All roof coverings to be Class'1?"
Owner nu onoce asem Dae' g Or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34217080 . 00
DATE ISSUED. . . . . . . : 07/16/2008
RECEIPT # . . . . . . . . . : BS000005484
REFERENCE ID # . . . : 08070116
SITE ADDRESS . . . . . : 22701 SAN JUAN RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MAC LECKRONE
ADDRESS . . . . . . . . . . : 22701 SAN JUAN RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-3932
RECEIVED FROM . . . . : ARTISAN BUILDERS CO
CONTRACTOR . . . . . . . : JAMES A. WALBRIDGE LIC # 30069
COMPANY . . . . . . . . . . : ARTISAN BUILDERS CORPORATION
ADDRESS 771 CLEMENTINA ST
CITY/STATE/ZIP . . . : SAN FRANCISCO, CA 94103
TELEPHONE . . . . . . . . : (415) 863-2232
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ---- -- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 50, 000 . 00 5 . 00 0 . 00 5 . 00 0 . 00
1REROOFRES SQ FEET 20 . 00 260 ..00 0 . 00 260 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 265 . 00 0 . 00 265 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
---- --------------- --------------------
CHECK 265 . 00 #13131
---------------
TOTAL RECEIPT 265 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
Sug
CITY OF CUPERTINO
REROOF
• ror
CUPERTINO PERMIT APPLICATION
APN # Date:
Building; Address:
Owner's Name: Phone #:
Contractor: py��(, � �r p. Phone #: • 1-
Fax #: -4(9;.
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
o"Asphalt Shingles alAsphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles o Wood Shingles
o' Other (Specify)f,!!!u-q-P a` Other (Specify) gjAkCyp f
Number of existing coverings ❑ Provide I.C.B.O. Report #
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: .vcftl�- o teo1 sTirj4 a--fci N4- k-«r:
el5vtCN tic t -tb
Residential Commercial
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation:
1 Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
g\d=w ris - �z
Signatur
Revised 6/16/08
CITY OF CUPERTINO
REROOF
CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1 BSEISMICO Seismic Commercial B
,L O 1 REROOFRES Re-roof Residential B 1SFDWLR00F
IBSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
• 1 BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08
•
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: L t�o, 2 01`I g '
Job Site Address: OZ-7 Q (
Roofing Company Name: T(S t+j 9 UI t,O 2 P
Applicant's Signature: Date: '�s-d0
• Greg Casteel
Building Official
Revised 11/2/04
Community Development
10300 Torre Avenue
f!i
l
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OCUPEkTINO
Building De artment
JOB ADDRESS: PERMIT #
Z21ot AN 3✓AiJ 9-f� fz�-?C)I f G
OWNER'S NAME: M IJJ PHONE # 4IS— A.3 - Z 2 3 Z
GENERAL CONTRACTOR: S t/I vO LrhS FAX #
I am not using any subcontractors: _ LZ
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 7 O b
Septic Tank
Sheet Metal
Sheet Rock
Tile
-vg
Owner/Contractor Signature Date