08080038 CITY Ok'CUPERTINO K774 77077Tt+ 7737777
BUILDING DIVIAION PERMIT Cb1VTRAC"TQR INk'bRMATIN
emL.RT1601�SEVEN SPRINGS DR LOS GATOS ROOFING - 08080038
OWNER'S NAME: PERMIT ISSUE DATE
CTIA ANNIE; P 0 BOX 1726 08/05/2008
NE: SANITARY NO. CONTROL NO.
(408) 298-9399
ARCHITEC RINGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I�
Sap LICENSED CONTRACTOR'S DECLARATION Job Description
rd"� 1 hereby affirm that 1 an demand under provisions of Chaper 9(commencing p
with Seetian 70110)of Division 3 aide Business and Promssiuns Code.sed mylieenau RE—RF CLSA 22SQ ASPHLTSHNGLS TYP30FLT &RMV EXT
in full fares and if
5DI LKenxC Lic.g O WDSHK
Sv-� Dem Conuxmr
e ARCHITECT'S DECLARATION
i 1 undenunJ my plass aM1ell he uxJ u public rxnN4
t
yud Licensed Pm(essionel
OWNER-BUILDER DECLARATION
I heteby am.Nat 1 em exempt Item the Contractors Licence Lew for the
o O following reason.(Section NO 1.5,Business and Professions Code:Any city or county
I Pi which mquims a permit m eons 1,after,improve,demolish,or repair my structure
zap prior in its ismaxe.also requites the appliance forsuch permit in rile a signed atstement
F<
but he is licensed purmenttothe provisions ofMeContractor's LicenseLaw(Chapter 9 Sq.Ft.Floor'Area Valuation
p$ (commencing with Section 7")ofDivision 3ofthe BusinwadProfessions Code)sir " $5028
3 that he u exempt memfmm mal the basis far the alleged eumpdon.Any vMMxmm of
Session 7031.5 by any app0mnt for a permit ubjects the applicants to a civil penalty of
me am uses five hundred dollars($5007. 36652047 .Number Occupancy Type
❑1,u owner of 0e pmpmy.m my mployem wire vngas u theirale mmpevadm,
will do Newark,and thect
sbuu e NMI im�d
med onalfered ro sate(Sec.70/4,Business
ad Profitable.Cade:The Canusctert Lima Law dam not apply as An Owner Of Required Inspections i
property who Wildscrimpmtes mane .ad whadanmch makhimselfar through his ..-
own employaet,provided that much improvements are notimaded xaffemd foram.If,
however,the building or improvement Is mid within am your of completion,the owner-
Wilder will haw the burden of proving that M did not build or improve Ix puMom of
"Is.).
❑I.an owner of the property,rte exclusively calming with licensed cam acmrs to
constmel the project(Sec.7044.Business and Pmfassions Code:)The Cordamr's U.
eense Law does not apply te an owner of property who Wilds or improves menton,ad
who co mustsfar such projects with a conractor(s)licensed"mutant to do,Cmuators
Lina Taw.
❑I as exempt under See ,B&PC fmthis moon
Owner Dem
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of pel]ary one of the following dcclB oro:
I haw and will mainum a CCrtiBmm ufCanant to alf-imum Ix WukartCorran-
Milan,as provided far by Sectmn 3700 or the Labor Cade,for the performurm of the
work for which this parmit is issued.
❑1 haw end will maintain Worker's Compeusation lusunncu,as requited by Section
3700 of the Labor Cade.for the perfarmam of the woh for which thin Permit is Issued. '
My WerlMr;�[Cf��j,pen`�a�a�dorn inmrm/�mmier"ci policy numMpr are:
Cartier. OJrN+xL YWM Policy No.: 161-a- 0 2
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This secdm need not W completed Mine permit ufxax hundred dollar(flail)
or tees.)
I modify that in the performance of the work for which this permit is Tssad,I shell set
employ any peace in any matter a as become subject a the Worken'Compensmon .
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.alter making this Cenincne of Exemption,you moZ
become subject to the Workers Comperesda provisions of the Labor Cade,you amt
O fcawith comply with such provisions or mu permit shall be deemed mmked.
Z CONSTRUCTION LENDING AGENCY
P v'"5: 1 hereby al that them la a construction lending agency for the performance of
ani„ the work fur which this permit u abuse(Sec.3097,Civ.C.)
14 0 Leaders Name
r7 z Lenders Add.
U Q I aeify that I have mad Ws application and sum that the move information u
coma Ingres!m comply with all city ad county on imxes and sum laws relating m
.SSV^
Wilding construction,ad handy&urban repssuesta t of this city to enter upon the
W &hove-mentioned property Or inspection purpaas
�L,y, rap (We)agree to love,indemnify ad kap harmless the City of Cupertino against
fy y Iialuitim,Judgments,costs ad expenses which may in my way mares agNnt sold City
V in consequence of the grading of this Permit. �+
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date ,-]—'`�]�
SOU EGULAT70N�S//
�ii�nmyllG l.fl g x, Guam'10 Re-roofs
Signuu of ApplfmMZARDOU Guam
HAZARDOUS WildinMATEg
ALS palmaLOSURE Type Of ROOF
Will the a Cupertino
m fauns Wilding aecupml sass or handle H alth ad
u defixd by the CupeNno Municipal Cada Chapter 9.11,roti the Hmlth ad Safety
Code'Samoa x5531(')7 �a All roofs shall be inspected prior to any roofing material being installed.
Will ase applicmt or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it h';dew alf cmtaminants u de0xd by the Bay Amu Air Quality Management all new materials for inspection.
Dis nm7
❑Yen 044-�
I hew mal the lurallous materials ram enc ma.under ChmscaS.95ofthe Califor-
niaHu lth&Safety Code,Sscdcmb 5505.15533 am175534.1 understand dulifthe Wilding p
dem not curently how a unant dot it u my mapomihility m mdfy the occupant
teg9l�'m/p/(hu which must bas rot Prior m imxnce of a Cmificate o Q
CT�(LhOJ .fi_taz7 Y�5/off Signature of Applicant Date
Owner r auhamcd agent Dam All roof coverings to be Class'JQ"or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36652047 . 00
DATE ISSUED. . . . . . . : 08/05/2008
RECEIPT # . . . . . . . . . : BS000005694
REFERENCE ID # . . . : 08080038
SITE ADDRESS . . . . . : 11601 SEVEN SPRINGS DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CHA ANNIE
ADDRESS . . . . . . . . . . : 11601 SEVEN SPRINGS DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5126
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 5, 028 . 00 0 . 60 0 . 00 0 . 60 0 . 00
IREROOFRES SQ FEET 22 . 00 286 . 00 0 . 00 286 . 00 0 . 00
---------- --------- ----- ----------
TOTAL PERMIT 286 . 60 0 . 00 286 . 60 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
--- --------------- - -------
CHECK 286 . 60 #2664
---------------
`DOTAL RECEIPT 286 . 60
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
T/V 8�e f o8
l CITY OF CUPERTINO
REROOF
•CUPEkTINO PERMIT APPLICATION
APN# ' ^ 5 2- -G y Date:
Building Address-
0601 ,l60 ,0
Owner's Name: Phone #:
ya 39/-- 2& y 7
Contractor: LOS ��U Phone #: -'/08' 2 g'
U 9 _ 9S 99
t�r—Q. v S � �`? �{
`J Fax#: OF _2y f- '3 -71
Cupertino Business License #: Contractor License #:
23� � / 3 0 70
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ?< Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) Other (Specify)_I�re-30 12el�
Number of existing coverings ❑ Provide I.C.B.O. Report##
X To be Removed ❑ Provide Mfgr. Installation Specs.
R 0 o � iq ss A-:_
Job Description: Q-a.r-oo (2s2s7�--0
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
CITY OF CUPERTINO
REROOF
•CUft"QTIN0 FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
2-2 IREROOFRES Re-roof Residential B 1SFDWLROOF
1BSEISMICRE Seismic Residential B
1REROOFMRES Re-roofMulti-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
. 1BUSLIC Business License B
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:
Job Site Address: �� sgIs�hn-
-
Roofing Company Name: S 1Ta —
y n
Applicant's Signature: Date: /
• Greg Casteel
Building Official
Revised 11/2/04
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
Cl OF
*UPEkTINO Fax(408)777-3333
BuildingDe Artment
JOB ADDRESS: / PERMIT #
OWNER'S NAME: a�,.� r PHONE #
GENERAL CONTRACTOR: Q S FAX # G
I am not using any subcontractors:
✓ Signature D e,,
Please check a22licable subcontractors and com Tete 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
wn r/ ntrac r Signature at