08060076CITY OF CUPERTINO
�iCONTT,RACTOR , -
BUILDING DIVISION PERMIT
INFORMATION
BUII�I�+Q�V"NN ,FFORD DR
PETERSEN-DEAN INC
PER NO.
08060076
OWNER'S NAME:
PERMIT ISSUE DAIS
MANNION FAMILY REVOC INTV TRT
7980 ENTERPRISE..DR .06/10/2008
NE
SANITARY NO. CONTROL NO.
(510)494-9982
ARCHITEC (ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
IOM Description
I bermy affirm shat 1 .m li¢vcd under provisions or CMpter 9 (commcming
with Section 7000).f Davison 3 eftte Business and Pmfessiom Codc,.ndmylim.scis
RE -RF T/0 EXSTNG KDSHKS RESHT 7/160SB 30LB FLT
m full forte and rnIr
License Class �-L39 Llcg b81
LNDMK 30YRCMP SHGLS CLS A 11SQ
Dated: b g O Cenu.cto
ARCHITECTS DECL kR ' ON
I understand my plans shall W used as public accords
Licensed Pmfcssi ... I
OWNER -BUILDER DECLARATION
I lemby affirm that 1 am esempl from the Con=iofr License Law for the
fallowing reason. (Section 71131.5, Business and Prefessiou Coot: Any city or county
which rectum A permit to convect. a1w. improve, dem uiah, an rePon any suucto.
prior to its issuance. atm mquims the applicant for such Permit b rile a signed wourno t
thuWis licensed pursuant to the Provisions of the Commetnes License Law(chapter9
Sq. Ft. Floor Area
-
Valuation
(commencing wish Section 7000) of Divamn 3 of she Business and Pefessioe Cade) or
$8207
$ 8 2 0 7
That he is mempl therefrom and the basis for the alleged exemption. Any violation of
S on 7031.5 by arty applimt fora permit aubj e, to applicant As a civil penalty ofNumber
36211001.)W
Occas ane T e
P Y YP
not orae man Rae hundred dollars ($5M.
❑ 1.uownaoflltepmpeny,ormyemploymwiNwagesutebsul,eompeasadon,
will da Iheaork. and she d osaw toad, Business
chum h roes
-
Required Inspections
set a(Sec.
and eat Cade: The Canmcmfa License law dors rot apply lf an owner of
he Lica does
propertywhobuilds andwho Arcsouchwork his
my.h
ed
that croffemiNrough
i sushfinpr maBcred for silo
tut such imPso¢menoo sac not
err.
r.
arofintended
bowcksor. she Wildingar improv ementissoldwithinoroyetiofimproefortheowner-
low the Wilding
builder will fuse to buNan of proving that W did net build or improve far purpose of
sash.).
0 1. as owner of the property am exclusively contracting wish licensed contrAmn to
comment Ate project (Sec. 7044, Bummers and professions Cade:) The Comnscmr's U.
create law does not apply As an owner of pmpwy who Wilds or improm therm. and
who contracts; for such projects with a eonuactor(s) licensed pue uam to she Contrut.e.
License Law.
❑ Ise.emprunder See ,B&PCrmt1o..n
Owner Data
WORKERS COMPENSATION DECLARATION
I Earthy Affirm under Mostly of pe0ury, one of to fallowing decimations:
❑ I Estee And will maintain A Certificate of Consent An self4a,me for Work reaCompen-
swan, as provided for by Section 37011 of the labor Code, for to performance of the
work for which this permit is issued.
rave and will maintain W.ftes Compensation Insunn¢, u ruin by Section
'f00 of the labor Cude.fortheperfosanceof Neworkforwhich Wisp,miluissned.
'
My We iCompensation nrunn¢ cap ter and Policy UIer am:
1
carrier. r/ alley No.: -" `. 039 S Lf 3
CO3 '
CERTIFICATE OF EX 9 PION FROM WORKFR5
COMPENSATION INSURANCE
Clhu elm need not W completed lithe permit Is Toone hundred AOBus (Sim)
or less.)
I cetify that in to perfomarce of the work for which this permit is issued, 1 shall not
annoy any pefsun in any maorcr m As or become subject m the Woolsey otmpeva6an
taws of California. Date
Applicant
NOTICE TO APPLICANT: If. eller making this Certificate of Faemptien, yam should
became subject to she Wormes Compensation provisions of she labor Cuda you muse
foMwith comply with such gowerus or thus Permit shall W deemed rewked.
CONSTRUCTION LENDING AGENCY
I hereby AMm, that Nen is a construction lending agenry, for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Iandcr's Nauru
Lendues Adders
1 cannily that 1 have roatl this application and room that the above infomatiun is
contest- 1 agree m comply with LI city and county omlnances andsum laws msadng as
building construction. and hereby Au us sihe mmossentatim of shat city to enter upon she
above-mentiamd pmpeny for inspection purposes
(We) to indemnify
agree save, and keep humless Be City of Cupertino against
liabilities, Judgments. cam and experuu which may in any way Acme against uid City
A FLIjc4 T of the granting of Nu D WILL
APPLI NT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
SOUR GULATION
Issued by: Date
. qq,,
IV /.lu.o,a�� (i' -t ApO ?
g
Re -roofs
Shgreatum ofAPphcanVCnntracmr Dam
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future Wilding occupant atom unhands, hnam us material
As dcftncd by to Cupertino Municipal Coda. Chapter 9.12, and the, Health and Safety
code. Section 25532(.)7
❑ Yes o
All roofs shall be inspected prior to any roofing material being installed.
will the, Applicant a mem Wildin ¢cm pant me equipment il ter which
pp
If a roof is installed without first obtainingan inspection, I agree to remove
P
l
,mil havNnm air cmuminants u defined by IW Bay Arca Air Quility Managcmem
(ht Am.
all new materials for inspection.
Diattln7
❑ Yes
l have mad the huardma materials reymWmems under Chapter 6.95 oftme Caliror,
Wilding
nim Health &Safety Code, Seems"15505,25533it ]myrospAnd! 234. Iibili"
to
Andcnl, ,mines
ly hewatenant. tutitu my mspofacetybnotifyticrcsety. of Ne
reurotc
rtyuimmc ihmuuWmet armpy�y�„�t«arac,nlrtrtearaa--ra
Signature of Applicant Date
e /�s"Ile (7�10'Cia
Owner or author!7zd afcn-;r Date
All roof coverings to be Class ';W' or better
a(ii1a,
CITY OF
CUPEkTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION
Qj�-Ob D 07 6o
APN #
3 /00/ . cl
v
Date:
Buildin Address:
/� 8 Sys d7,
CL) CA FE0 I
Or
er�,'.4a
Owner's Name:
Phone #:
AA 1'0 1-1
Contractor:
Phone #: j79 94d, -z
Fax #: Seo— f'RY—�o»
Cupertino Business License #:
Contractor License #:
Y a'// 7
Type of Roof Covering:
Existing:
Proposed: °"'� P+4.
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
X Asphalt Shingles, 3 o yr
� Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report #
�1( To be Removed /«
❑ Provide Mfgr. Installation Specs.
Job Description: 7/ds�,�s w�oE s1wsti Pe dre s� �� OSQ 3 O/� i e //j
l�e � 7
�Qn3D y,- 000 to
9ti"y ler a/-/gsi, 64
// SsS
Residential [�
Commercial ❑
Fire Zone: Yes ❑ No ❑
Confirmed with Planning Dept. if
there are any restrictions: ❑
Valuation: O�p ZCJ7
r 1
L_ J
I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy:
Signature
SRO -
CITY OF
CUPEkTINO
CITY OF CUPERTINO
REROOF
FEE SCHEDULE
Number of
Squares
Fee ID
Fee Description
Fee
Group
Permit Type
1RER00FC0M
Re -roof Commercial
B
1COMMLROOF
1BSEISMICO
Seismic Commercial
B
1REROOFRES
Re -roof Residential
B
1SFDWLROOF
1BSEISMICRE
Seismic Residential
B
1RER00FMRES
Re -roof Multi -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) hl -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.
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:
Roofing Company Name:?, 4 e/' Se -L �D¢a
Applicant's Signature: Date: �7_&)- fir/) CP
Greg Casteel
Building Official
Revised 11/2/04
' 2 ITEMS OF 2
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36211001.00
DATE ISSUED.......: 06/10/2008
RECEIPT #.........: BS000005059
REFERENCE ID # ...: 08060076
SITE ADDRESS .....: 1178 STAFFORD DR
SUBDIVISION .......
CITY CUPERTINO
IMPACT AREA ......:
OPERATOR: patg
COPY # : 1
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT
AMOUNT
---------------
143.90
---------------
143.90
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
REFERENCE NUMBER
--------------------
VISA
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS 605 FINAL REROOF
OWNER ............:
MANNION FAMILY REVOC INTV TRT
ADDRESS ..........:
1178 STAFFORD DR
CITY/STATE/ZIP ...:
CUPERTINO, CA 95014-4952
RECEIVED FROM ....:
EDWARD A GREGORY
CONTRACTOR .......:
PETERSEN, JAMES LIC # 14030
COMPANY ..........:
PETERSEN-DEAN INC
ADDRESS ..........:
7980 ENTERPRISE DR
CITY/STATE/ZIP ...:
NEWARK, CA 94560
TELEPHONE ........:
(510)494-9982
FEE ID
----------
UNIT QUANTITY
-----------------------
AMOUNT PD -TO -DT THIS REC
NEW BAL
1BSEISMICR
VALUATION 8,207.00.
------------------------------
0.90 0.00 0.90
----------
0.00
1REROOFRES
SQ FEET 11.00
143..00 0.00 143.00
----------
0.00
TOTAL PERMIT
---------- ----------
143.90 0.00 143.90
----------
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT
AMOUNT
---------------
143.90
---------------
143.90
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
REFERENCE NUMBER
--------------------
VISA
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS 605 FINAL REROOF
CITY Of
rUPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS: S�9
// 17Y ✓� �l
PERMIT #
(:)6 / -7(j/
OWNER'S NAME:
PHONE # yDB- Z5-L-ZG6
GENERAL CONTRACTOR. cJ«.se- -d
FAX # 5-4o- V9K- 9077
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
- �c a� - LO-�y� P
Owner/Contractor Signe Date
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
- �c a� - LO-�y� P
Owner/Contractor Signe Date