05070160 CITY OF CUPERTINO P)F. je
9mLDINObIVIS1Oly ... RIVIIT', ,�CONTRA,CTQRIN.F'URMATION'-',
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BUILDING AODREss:• - PERMIT NO. ,
:, r " . , :' r ANNA BERENBERG 050701601
ER's NAME:,',.�' PERMIT ISSUE DATE
ANNA BERENBERG 07/26/2005
PHONE: SANITARY NO. CONTROL NO.
�-_ L: '1,'^ '..,'�',�•" )il V,,
ARCCHITEC(ENGINEER %,N11 fi „n ' ' BUILDING PERMIT INFO
�) I •,•' .BLDG ELECT PLUMB MECH
woo t,,t - LICENSED CONTRACTOR'S DECLARATION lbDescri tion.
I hereby affirm that 1 am luop
ronned under provisions of Chapter 9(cemmencing ._
2� nILwSccm, 7000)ofDiv4ien 3 df Ne Business and Professions Code,end my licenseis
full forts and e �
z uceve Clew - d39 :Lm., f-z se�/a�'D 'REMOVE: EXISTING SHAKE ROOF APPLY. #30 FELT
Dau;' ' - conlrrtmr a APPLY 50 LAMINATE. SHINGLES I
¢, :•,.v.!'- I 6RCHITECTS DECLARATION
eortapePummmomds ANTHONY' S ROOFING' - PAID IN FINANCE ON 7�26�05
yo LLMCdIcd FMIJAMo _
OWNE RATION
I a mm n xempl from the
C.nimcim's License law for the
Coo folln g mpeon.(Sccuon 7(1313,Business end Professions Code:Any city of county I
5$ which mquims•permit w ennstraw,abet Impovn.demolish,err rtpair Any moncture
_��^ Prlbrmi4 iuuance.elsu rtquima the applicantfar each permit to fileasiLned matemcm
;FFF< Naielscce withSemAntwthcprovialovnftheCbnulacus liamelaw(Chap¢r9 Sq.Ft. Floor Area Valuation I
Cdr
(commencingelsxcnin wmion7000the basiiofr oftheegedexemptond n.Anyovi Code)or .$7000 !1
a
that io la ekempt ihertlmm and the aper for the objects
the exemption.in Any l pen lty of
Section 70..5 five
any red dollars
for•011permitanbjecu Ina applicant m a civil penalty of APN Number Occupancy Type '
not mom Nen fiw huntlrtd tlalWa(5500} t 4
0 Las owner of die property,or my employepe with wgei As Meltable compenutlon,
will do the work,and the structure boot intended oro@rod format,(Sec.7044;Busiepe. FINALE
and Proreulom Code:Th rConuacmrl License Law does ant apply m'an owner of . Required Inspections
prepmy who builds m i mpmvsa Nemon.and who daauch work him¢(f or Ouou{h his
own employepe,provided thatmch impmvsm..4 hoe not inmMrd orofferttl fmssls Ir,
hewewr the building or improvement is sold within one year of completion,Ne owner- ,
builder will haw to buedcn of proving Nn W did rot Wild or improve for purport of ,
Able.)_ % . 2=�-'2005
I ' rS
co stru mvuer of the Scc.7 .'illi exclusively And
contracting with licensed C Contractors
a tors m mom Law protect(sec.7044,weer of.and Nm(peobv Code:)mu Cemracmra nd
cave law dope not apply c an owner of property who Wilda or improves Centro.end,
who cbmncu for such with•conlndaKs)IlcenUtl pursuant to the Contractor's assapti
Licence Lew.
❑taro exempt antler Seo .BA PC for mu rtpeon __-
cr . ' -
Data
WORKERS COMPENSATION
DECLARATION'
I hereby affirm under pralty of pedury one of dnc following declarations:
0 1 haw rnd will m•inuin a Cin rl"M of Conlenl m Ulf-ivum fmwoftescompen-
sstion,As provided for by Section 3700 of Me IaW,Code,fm the performance of the. _ ..-
work for which this Pemlit is owned,
0 1 have and will maimuin Worker's Compensation Ins u' va,As required by Schon - .-
3700ofinelaborCode.fortW performanee of Ne work for which this permit is issued. -
My Worker,Compensation Insurance omet and Policy number art:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS' I �
COMPENSATION INSURANCE M -
mub,mount need not W completed If the permit 4 for ons hundred dollars(Sip))
or las) _
I cattily than in the perfmM4nee of Me work for which this permit is Ipeued.I shell not ;p
employ any person in any ma besooMc jecua Ne Workers'Compensation
Laws o(CAI' am
o
Applicant
NOTI of Exemption,you should
me male N chefs Cempen nprovluona bf .you mum
.J 0 feMwith y
o;:
i such provisions or Nis permluhall W dcemcd mw c .
y(Z) CONSTRUCTION LENDING AGENCY '
).w IWrtby ch nm Wrmero is•rovSm.30lending agernry rnr um performance of
R �„ Le wort for which m4 permit is issued(Sec.J097.Civ.CJ t
M A Lender's Name
Z)z lantler'sAddmu -'
C.)Q 1 certify met I have reed this appliestum utd state that the Above information is
k7. correct,1 agree to comply with all city and county eNimences and some laws miming to
Q SV^ building construction,and hereby•uthodre mprvenad s or this city in enter upon the
[77 shove-mcMbnsd PMPcny for Inspeotiot purposes
gy (We)Rime or saw.indemnify and keep humless the City of Cupertino against
V1 liabilities,ludgmonu,thou and expenses which may In my way accow,Almost said City
U 7 in wnuu uence of the granting of this permit.
rte- APPLICANT DERSTAND AND WILL COMPLY WITH ALL NON-POINT .Issued by; Date -
SOUR LA
Re-roofs
Si wumorA
HAZAR ATERIALS DISCLOSURE Type of Roof
capplicanlo u building uccupentewrt orhantllc herallous materiel
As der, by Me Cupe unicipal Cade.Chapter 9.13,and me Health end Safety
.Section 25532(a)' !All roofs shall be inspected prior to any roofing material being installed.
Will the applicant els future Wilding occupant MIC egotpment or devices which 'If a roof is installed without first obtaining an inspection,I agree to remove
cmlt hpe,who,oil arms nmIm u d ncd by the Bey AMA Air Quality Management all new materials for Inspection.
District?
DYcs It
IIIave road the huindous materials requimmenu under Chapter 6.95 of the Califon
nla Health A SafelyCrde,Secliom 255(15,35533 W 25534,1 undmmd muirds,Wilding
does not currently have a n hon thm it itmy resporw hllily m notify Me occupant of the
mqe' dor miwomce or.ccomficambromi,pancy. Signature of Applicant Date
Owner eta err.docent Dote All roof coverings to be Class"B"or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
OCITY! Telephone: (408)777-3228
CUPEI�TINO 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: AMM, &T e✓tber9
V
Job Site Address: 6hyre [oV r-t—
Roofing Company Name: 0'4 .l 06el i OT17e j�S'l
Applicant's Signature: te: 7
•
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO OSO'ro 1(90
((d REROOF
�UPEfI;TINO PERMIT APPLICATION FORM
APN#,U(.0_ 1 �— Date:
7-Z6 -oS
Building Address:
//681 '50"A Ayre &Vr4-
Owner's Name: Phone#:
Av+a AeeevL
Contractor: Phone#: License#:
hA cn 's 6-e-em (Dwtt, ot,5 Am, q0 SZy�'ya
Contact: Phone#: < , Cupertino Business License#:
w
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Of Asphalt Shingles
e 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.
Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: /
e'Wove
Residential ommercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning D_pt. if
there are any restrictions: LJ
Cost of Project: ^^A / 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
CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 36653003.00
DATE ISSUED. . . . :. . : 07/26/2005
RECEIPT #. . . . . . . . . : 30512
REFERENCE ID # . . . : 05070160
SITE ADDRESS . . . . . : 11681 SOUTHSHORE CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ANNA BERENBERG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5144
RECEIVED FROM . . ... : ANTHONY'S ROOFING CO
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : ANNA BERENBERG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5144
• TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 7,000.00 137.16 0.00 137.16 0.00
BSEISMICRE VALUATION 7,000.00 0.70 0.00 0.70 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 137.86 0.00 137.86 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 137.86 1132
TOTAL RECEIPT 137.86