06080112 CITY OF CUPERTINO - a'`-xe� •rr a'+"+ ' ' x seri '. -',�."'.
BUILDING DIVISION PERMIT r CONTRACTOR4NFORMATION
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BUILDING ADDRESS: s J.B. ROOFING CO. PERMIT NO.06080112
10583 SANTA
OWNER'S NAME: PERMIT I55UEDAM
RICHARD LUMACTOD 929 BERRYE
NE:
SANITARY NO, CONTROL NO.
(408) 452-0960
ARCHITECT/ENGINEER: BUILDING PERMITBLLUMBDG EIPCT PLUMB MECH
700 LICENSED CONTRACTOR'S DECLARATION 3 Job Description
w I hamby affirm that 1 ma Broad under provisions of Chxpmr 9(=mm.ncing P
li. with Section 7")of Division 3 of tm Business ad Professions Code.and my licomeis
fallrnro amde S REMOVE EXISTING BUR. AND REPLACE WITH SIMILAR
Licc�nsup9❑aa Las
Damjl.-tl-J7 Contncwr�. . CLASS A
ARCHITECT'S DECLARATION
i e< I understand my plans shall W used as public records
jLd
.cepw Licensed Pmhssi...I
S OWNER-BUILDER DECORATION �� "1
q 1 b.mhy M.Nu lm exempt from the c Contractor's LiLaw for the '\\
:M0 following moon.(Section 7(31.5.Business and Professors Code:Any city or county
Q ffwhich requimu a permit to construct,alcor,improve,demoluch,or repair any structure
prior to its issuance.A.rewores dee applicant for such permit to hleaaigned satement
that he is licensed pursuant to dee provisions of the Contrmmrl lJ=mae Law(Chapter 9 Sq.Ft.Floor Area ValuZ0110840
i am•m (commencing with Section 7000)o(Division S of the Business add Professions code)or
that he is aumpt tharcfmm and the bass(m the mlegrd exemption MY violation of
Section 7031.5 by arty appEesd for a permit subjects dee applicant an a civil penalty of APN Number Occupancy Type
not ream than BK hundred dollars(M). 34217002 . 00
❑I,as owner of the property,or my employees with wages u their sole compensation.
will On the wort.and Neswctum is not intended or offered fonah:(Sec.7014,Business Required Inspections
and Pralwo.ns Cade:The Contractors License Law does not apply m e ns an owner of q P
Property who builds orimprnvea Nemon,and who dassuchwork himalfordwugh his
own employans,provided that such impmvemenu are not intended oro@red image.If.
however,the building or improvement is sold within one you of completion•dee owner.
builder will have Ne burden of proving that he did not build or improve for purpose of
sale i.
❑1,as Owner of the property,am exclusively manuring with licensed=ruectors to
eautrect the project(Sec.7044.Bm inea aM Professional Cade:)The COmamrs Li- _
moue law does not apply in an owner of property who builds ser improv.Nemo,and
who contracts for such projects wide a contractods)licensed pursuant on the Contractors
License law.
❑1 am exempt under Sec ,B d P C for this mason
Owner Dao
WORKER'S COMPENSATION DECORATION
1 hereby aRnm under penalty of perjury one of doe following decloations:
1 have and will maintain a CaNEcum of Conant to alf-insure for Worker's Compen-
smion,at provided for by Seedon 37M of be Labor Code,for this Perform==of dee
wart for which this permit is issued.
1 have and will maintain Worl erf Compensation Insorace,u acquired by Section
37W of the Labor Code,for Ne performance of the work for which this permit is issued.
My Wmime,Compensation losese.cartu and Policy numer art:
Carter.gPolicy No.:Z
141-0 t,:ELCTEMP ION FROM Q
COMPENSATION INSURANCE
(Ihusectian recd nm Ee complcmd ifdm permit is faro..hundred dollen($1011
or less.)
I certify that in the performance of we work for which this permit is issued.I shall not
employ any Person in any manner ad as to become aubject to Ne Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after mating this Certificate of Exemption.You should
became subj=t be 0.Wmtms9 Component..provisions of the labor Cade,you must
.J z forthwith comply with Seel,pradmoru o this permit shall be dcemed revalued.
?3 CONSTRUCTION LENDING AGENCY
[—� I hereby Off..Nat there is a=mutction lending agemy for the pMarun.of
D: dee work for which this permit is iuced(San.3097.Civ.C.)
fA Q Lenders Name
raj z Lender's Address
U 0 1 eeNfy that 1 have mad this application and sum that the above bdo madon is
I, F-' cOrten.l agree to comply with all city and county ordinances and sum laws Misting to
CU building construction,and hereby authorise reprosenutives of this city to enter upon the
} C. above-mcntiuncd property for inspccuon purposes.
(Wo)agree to save,indemnify athe d keep harmless City of Cupcnino agai
F'TA Iiadlivajudgmente.costsand expenses which may in any way same against aid Cnst
ity
U z in consequence of the grating of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date /
== ik ON—I[ -0 6 Re-roofs
signlgn um ✓C.nuemor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ohm applicant Or future building Occupant score or handle huvdous material
as dcMed by tm Collection Municipal Codc.Chapter 9.13,and Iht Hmlth ad Safety
Code,Semina 25532(a)7
❑Yn 'Lou All roofs shall be inspected prior to any roofing material being installed.
41 If a roof is installed without first obtainingan inspection,I agree to remove
Will the applicant or future building Occupant use equipment or devices which P g '
emit hauNnus air mmunnina s as defncd by Ne Bay Men Air Quality Management all new materials for inspection.
District?
❑Yes No
1 Mss road Ne hvardous\materials roquimmcnu underCMpter695 of the Cmifor-
nuHmalNhSmctyCodc.Smli=n505.25533md25534.1undcrstarld demifrhe Wilding
does Out commonly hast a mmarL wr it 4 my responsibility w notify t¢occupant of the
my wnicnm metyynrmiaaumm.arac.mrma IK-opammY. Signature of Applicant Date
f�1 oSc i6 oG
Owner nraNnnz.d,sen, Dole' All roof coverings to be Class"B"or better
Community Development
su".. 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
OUPEkTINO
Building Department
JOB ADDRESS: PERMIT
S.—. 010 04��
OWNER'S NAME• PHONE # 4Sz-o °I D
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors/.f4 ja- Iv , ,
Signature Date
Please check applicable subcontractors and complete the followin 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
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.
Homeowners Name: G ,� ,� L
Job Site Address:
Roofing Company Name: j �.�
Applicant's Signature: 9�, ju Date: n
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 34217002 . 00
DATE ISSUED. . . . . . . : 08/16/2006
RECEIPT # . . . . . . . . . : 35646
REFERENCE ID # . . . : 06080112
SITE ADDRESS ... . . . : 10583 SANTA LUCIA RD
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : RICHARD LUMACTOD
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : RW SMITH
CONTRACTOR . . . . . . . : BOB SMITH LIC # 27262
COMPANY . . . . . . . . . . : J.B. ROOFING CO.
ADDRESS . . . . . . . . . . : 929 BERRYESSA RD
CITY/STATE/ZIP . . . : SAN JOSE, CA 95133
TELEPHONE . . . . . . . . : (408) 452-0960
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------ - ---------- ---------- ---------- -------- - - ----------
BPERMFEE VALUATION 11, 000 . 00 180 . 36 0 . 00 180 . 36 0 . 00
BSEISMICRE VALUATION 11, 000 . 00 1 . 10 0 . 00 1 . 10 0 . 00
---------- - - - -- - - -- - ---------- ----------
TOTAL PERMIT 181 . 46 0 . 00 181 .46 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- - - ---------- ------------------
OTHER 181 . 46 AMEX
TOTAL RECEIPT 181 . 46
CITY OF CUPERTINO �� 2
A REROOF
• CUPEkTINO PERMIT APPLICATION FORM
APN# 3'12-I1 ^QO2 Date:
Building Address:
O s ame: Phone#:
44& - 3 3
Contractor: License#:
Co ct: Cupertino Business License #:
Type of Roof Covering:
Existing: n Proposed:
Built-Up Roof � CK Built-Up roof to-IL dlcl�
❑ Asphalt Shingles (/ ❑ 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: �(1
Job escription:
• G�1
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑' Confirmed with Planning Det, if
there are any restrictions: LJ
Cost of Project: T of Co s ctio Occupant roux
Qty. if
Applicable Fee lD 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