08090168CITY OF CUPERTINOW11
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BUILDING DIVISION PERNIIT
C01ti'CRAC 10R INFO MATIDN.
BUIL1VK D ESS:
TUf�g(g SANTA TERESA DR
LOS GATOS ROOFING
PERMIT NO.
08090168
OWNER'S NAME:
PERMIT ISSUE DATE
WILSON RICHARD D AND HELEN T
P 0 BOX 1726
09/25/2008
NE:
SANITARY NO. CONTROL NO.
ARCHrtECTIENGINEER:
BUILDING PERMIT INFO
•
RE RF RMV EXT SHKRF BLDG ELECT PLUMB MECH
O O O O
LICENSED CONTRACTOR'S DECLARATION
Description
pur 9 Montercing
1 hereby Snare Na I am liccasm under provision of of Cham
- ---^^_ -, -..� .. ..!_ .Job
with SecdonlOMof Division Saf Ne Busircssand Professions Cade.a mylicenseu
in full fonx sed art 0
I.ueruc CI Lie.
Dam Contraum
ARCHITECTSDECIARA I
I understand my plans shall he used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby of oro that 1 am eacrept from the Cmi rutars License Law for the
following mason. (Secdon NO 1.5, Business and PmfcssioN Code: Any city of county
which mounts a pcomil to cnmaroct alter, improve, demolish. or repair any suuc,u e
! prior to its issuance, also requires ties applicant for such permit o file a signed aumment
Out he is licensed Pursuant to Ne proviuon of the Contrabri Lkcam law(ChaPler 9
Sq. FL Floor Area
Valuation
(commencing with Section 700M of Division ) of the Business and Professions Code) or
Out has is exempt therefrom and she basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
P y YP
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not mom Nut five hundud dollars ($500).
❑ L ot he of N proputy, err omployeu wish verges u aM (Sec.
Required Inspections
Business
wo is ens W, Business
l is sal
NC wan4 Cad NC
Law diner not apply bD1i.
i Law Sara not apply lf an owner of
and Pr o Com t s License
sed Profession Code: The
work himself orthrough his
improves ermes fid who is
property who builds or Mproves themonand who Sm
net mounted
awn a uip Nat such i art notofc molfemd forsak IL
er. see tis mid wit yeas ofimprov completion. pu owe r.
however, the ing or i is said
building or den
of proving a did of of
builder will have the burden of proNng Nu k SIS not ddld or improve for purpose of
an
sale.).
O 1, as owner of the property, am exclusively contracting with liunud wmrabn b
construct the project (See 7014, Business and Profusions Code:) The Conoabes Li.
memo law circa not apply in an owner of property who builds or improses themmn, and.
'
who contents for such projects with a contractor(s) licensed possum in the Constitutes
Limmun law,
❑ Iamcxcmpsundcr Sec. ,BhPC for Nu moon
On. Dau
WORKERS COMPENSATION DECLARATION
1 hm ereby affirms under penalty of perjury me of the following declarations:
1 have and will munuin aCert]Bceu ofconen' an mIf-mem, for Wmkeea Compen-
'
Semon. as provided for by Session 3700 of the labor Code. fer the performan¢ of Sec
west for which Nu Permit is issued.
0 I hese and will maintain Workers Compcnation Insurance. as nyuifcd by Soction
3700 ofthc labor Code, for Oce Performance of Oce work for which this p rookut Wood.
'
W.ic,. /C�ampenudw Insunn¢ carrier aM number
c. y No.: 1_1 N I �
Carrie. U Cr4(N/ Poliry
EXEMPTION FROM WOR ER
FROM
CERTIFICATECOMPENSATION
COMPENSATION INSURANCE
.
(Thu attd. reed tet he compleud lithe permit Is forom hundred dohas (5100)
or ma)
1 cenifv, den in the performance of the work for which this permit It issued. l Asti not
Cmploy amypeRon In aay mMnCf fa a5 an become, Subject no ft Wndlefe' CampCOaatiall
Laws of California. Date
Apl ism
NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you .Mould
become subject be the Workces Compcnnmon provisions of the labor Code, you most
forthwith comply with Such provision or this permit shut] ed deemed rewkcd.
I
CONSTRUCTION LENDING AGENCY
1 hereby arm that Nem is a controctinn lending agenry for the performance of
the work for which Nu Perone u issued (Su. 3091, Civ. C.)
Undees Name
Under's Address
I certify that 1 have mad this application and Sum Na Ne above information is
correct. l &&rte b comply with all city and county arillme es and Sum laws teeming to
building construction. sad hereby auNorim representatives of this city to enter upon the
mon-rommus ed property for Inspection PatP=L
(We) agree to ave, indemnify and keep hamlea the City of Cupertino again,
liabilities, Judgement, casts and expenses which may In ay way eceme against aid City
in of the grarting of this
APPLICe
UNDERSfANDS AND ANTWILL COMPLY WITH ALL NON -POINT
SOURCE RECgUL ONS.
Issued by: Date'
J
I
yIY�
Re -roofs
Signature c pIicaiCom sere Dam
H DOUSMATERIALSDISCLOSURE
Willy 01ertino future building lunolc
Type of Roof
the Cipsoll
u defined Chatrbreor
Bte Cupertino Municipal Cade. Chapter 9.12, and Ne HcaIN aJ Safety
Health and
a
Case, Section 25332(a)?
❑or Iiia
All roofs shall be inspected prior to any roofing material being installed.
Will unit applicant err ff etrrc building occupant sae equipment fir devices which
If a roof is installed without first obtaining an inspection, I agree to remove
it v -o es seco
Sir numio defined by the Bay Arta Air Quality Mangeme.t
all new materials for inspection.
�
/seers.
I❑ban miss Noufc,Sldus is 6.95 ofNe Wiing
ole Huh---flyhave-Secdrxonat it my retu12550s.I to
255W. 155emin33 5S34.IrClupcdthatr
comp Wading
does tet curtendY have a sauna Nat it a my mapoesihility b rbdfY the o¢upat of We
regClmince. whicesu be me, point to issuance of a CconfMale of OemFancy.
Signature of an[ Date
���
All roof coverings to be Class '%¢" or better
Ownmmau'mori>ad Dam
CITY OF CUPERTINO
2 ITEMS OF 4 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 35613010.00
DATE ISSUED.......: 09/25/2008
RECEIPT #.........: BS000006184
REFERENCE ID # ...: 08090168
SITE ADDRESS .....: 10850 SANTA TERESA DR
SUBDIVISION .......
CITY CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
OWNER ............: WILSON RICHARD D AND HELEN T
ADDRESS ..........: 10850 SANTA TERESA DR
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-4725
RECEIVED FROM ....: LOS GATOS ROOFING
CONTRACTOR .......: RANDY BROWN LIC # 23481
COMPANY ..........: LOS GATOS ROOFING
ADDRESS ..........: P 0 BOX 1726
CITY/STATE/ZIP ...: LOS GATOS, CA 95031
TELEPHONE ........: (408)298-9399
• FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
---------- --- ------------------------------------------------------
1BSEISMICR VALUATION 8,514.00 0.90 0.00 0.90 0.00
1REROOFRES SQ FEET 27.00 351.00 0.00 351.00 0.00
TOTAL PERMIT : 351.90 0.00 351.90 0.00
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
171
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
arle";
0 UPERTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION
OiO o«,p
APN #5�, /3 _ 0 O
Date:
Building Address:
OF5D e
Owner's Name:
Phone #:
Contractor: Los G -e .To S l2 o o -P
1 oGj
LJ
Phone #: z/0 T -2 9 8 _ 93 e)9
Fax#: YOF a2� - 93 -71
Cupertino Business License M
23y 8/
Contractor License #:
0 70
Type of Roof
Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
n
>� Asphalt Shingles �/te
Wood Shakes
❑ Wood Shakes
Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
Other (Specify) 5 •t
Number of existing coverings J
To be Removed
❑ Provide I.C.B.O. Report #
❑ ProvvideMfgr. Installation Specs.
S s .�7-- ooh elgss
Job Description:
,9 .7
Residential
Commercial
Fire Zone: Yes ❑ No
Confirmed with Planning Dept. if
there are any restrictions: ❑
Valuation:
I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy:
•
Signature
V
all.F
CUPERTINO
CITY OF CUPERTINO
REROOF
FEE SCHEDULE
Number of
Squares
Fee ID
Fee Description
Fee
Group
Permit Type
1REROOFCOM
Re -roof Commercial
B
1COMMLROOF
1BSEISMICO
Seismic Commercial
B
_2V
1REROOFRES
Re -roof Residential
B
1SFDWLR00F
1BSEISMICRE
Seismic Residential
B
1RER00FMRES
Re-roofMulti-FamilyB
1MFDWLROOF
1BSEISMICRE
Seismic Residential
B
1BUSLIC
Business License
B
0
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) h1 -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:
Job Site Address: /otfp So J:/of
Roofing Company Name: as 19
y � n
Applicant's Signature: Date: 20 d l
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF
#UPEkTINO
Buildine D
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
nt
JOB ADDRESS: PERMIT # C��o C)/
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: S FAX #
I am not using any subcontractors:: , . _.
Signature Datea
Please check aDDhcablp Rrlbrnnfrnrf,c .nfl .,lo+o +1,.,
�
OwnerContractor i)gnature
Z Z� o F
Date
SUBCONTRACTOR
BUSINESS NAME
v 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
�
OwnerContractor i)gnature
Z Z� o F
Date