04060041 CITY OF CUPERTINO e 'a"a^`.sz;,*' Rin n,
BUILDING DIVISION
PERMIT
ONTRGT,QI2INEORIVIATION
Bu1LDINcnooREss: RESPONSIBLE ROOFING INC PERh11TND04060041
OWNER'S NAME: PERMIT MUE DATE
GOHRING KURT
SANITARY NO.
E: CONTROL N0,
650 969-6151
ARCHITEC IENGINUER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0 0
�Oo LICENSED CONTRACTOR'S DECLARATION
I hereby afrirm than 1 am Excused under p®vision of Chapter 9(commencing Job Description
O� wims 70(10)of Division 3 ofthe Busioe>Y d Prokssiom Code.and my lhcenx is
Imm�ld anae t q REROOF-TEAR OFF OLD .
pfaZ Lieenu Clav LIc.N
[z o.w contrera; a APPLY 50 YR COMP W/7/16 OSB BOARD
1g- ARcxrlEcrsD
2 I undersand my plans shall M used as public menrda
JK!U
`0 LironredPmfessanal
OWNER-BUILDER DECLARATION JUN
E 0 0 I arc ro afOrm on I am exempts an me C pions d License city
o for the 21 2004
OO sy
00 following moon.Permit
i 11D Lm Business and vex, un demolish.ae:Any city or county / Y
k S E which rtyus u a e,anit re crores the almn Impmw,hPermittm a sig ed struclutatcamm
y_sN that Ire its issuance, requires the for mchpcnr's Lima.
E�0 thmmencin with
puaaom lame pro vision of thea Busicmhnd Profession
(Charm,Code)
Sq.Ft.Floor Area O1Q Ej•Q,
x $ that
(commencing exempt
pt Sectioneon add the
Division?of theeged ess axoppo Profcainudati a sir
Nat he u eeempt any ap li and dam aper it me alleged esempnt to Any it penalty
of
hot
art man fwh'unaand dolllars(S5 of Itabjeca me applipnitaacivll penally her APN Number Occupancy Type
❑I,uowurafthepmpeny,mmyemployceswithwageuftkmlecampenudon, 34250020 . 00
will do the amk,md the structure is notimended or offered formic(Sec.1064,Business Required Inspections
and Profession Code:The Contrmmes License e Law does not apply to an owner of q p
property who buildsorimpravcs themon,and who docasuchwork himself ormrough his
own employee,provided mat such improvements art Unintended or offered forak.IL
however,the building or improvement is mid within aro you of completion.me owner.
bulkier will have the burden of proving man be did not build or improve far penthouse of
ale I,
❑1,as Owner of me property,am exclusively moor song with licensed conmacu rhe to
convect the projen(Sec.1014,Business and Profession Code:)The Contranmr's Li-
cense Law docs not apply to an owner of property who Wilds or improv daemon.and
who contracts for such pmjecm with a conuutor(s)hemmed pursuant an the COmmmOYa
License Ltw
❑Tun mocarmR under Sec. Bk PC fm this recon
Owper Date
WORKER'S COMPENSATION DECLARATION
I thereby afRrm under penally of perjury ane of the following dousraaone:
I have and will maintain a Cen0am of Consent to mlf-iuum for Worked Comism.
abort,u provided for by Section 7100 of me Tabor Code.for me perfonapee of dam
woh for which this permlt is issued.
❑1 ban and will maintain WorkcYs COmpeuaaon luuranm,u required by Section
3100 of the labor Code.far lW pmformance of Ne work forwhich this permit is issued.
My Wml me,Camperomm.Insuntae anise and Policy number art:
Ca ie C 7c ��Po�li�cLy N�o.:-7/3 7 y ori
C.RTIPICATE OF EXEM),� OM WORKERS'
COMPENSATIONN77NNSURANCE
(Thrsecdon need not hecomplemd If the permin is i.e.hundred dollars($100)
or lust
I modify mat in the perfarmapa of the work for which this penis is issued,I shall not
employ any person in my mapper an as in become subject to the Workcai Compensation
Laws of Calilmam.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject an the Worked Compensation provisions of me labor Code,you must
O forthwith comply with such provisions or mi,pe nit IDNll be deemed revoked.
z'DiCONSTRUCTION LENDING AGENCY
[—� IWreby a(Rrm mu dart is acoukuction lendingagcmy fm On,peormanuceaf
C the work for which thts permit is issued(Sec.3097,Co,CA
QIsnder's Name
z Lender's Address
U Q 1 certify that I have read this application and state mat the above infr nt a of is
I7n E comms.I agree to comply with all city and county ordinances and area laws misting to
O building construction,and hereby authonm representstiv of this city to moor upon me
W save.mentioned property for inpecaon purposes
(We)agree to save.indemnify and keep harmless the City of Cupenino agarol
i,l llabilitie,judgments,casts and expena which may In any way accme against add City
(„),;Zf in mostmeruchm of me Sounding of this Permit.
" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR GULAn S.
_� Y�� �� v Re-roofs
Insure ofAppli HRcorcuractor AZARDOUS MATERIALS DISCLOSURE Data Type of Roof
Will the applicant or future Wilding Occupant nom orlandle hundous material
tl flood by the Cupenlno Municipal Coda Chapter 9.13,and the Health and Safety
Case. Dyes 25533(a)7 t3<. All roofs shall be inspected prior to any roofing material being installed,
❑Yea
Will tihe applicant or future building Occupant use equipment her devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit haysrdnu aircmlmminanu u fined by the Bay Area Air Quality Management all new materials for inspection.
Disuietl
❑Yu Nu
1 have mad the huardnusmateriab mquimmenu unser Chepmrb.Ys of the Caldior-
doesnolth&Safely haa aSccaouheliti myhmd25534.1 In nouytenamp Wilding
does not cunnaly how a mnen4 mat IL is my mapouiM1ility m nasty the Occupant of me ! T
requimmutirwitic1b&mUstheme brwissuanceOraOcrtifmaheOfOccup rose. Signature of Applicant Date
" �'� All roof coverings to be Class "B"or better
Owl at amhoriud agent Ds¢
• CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN 34250020.00
DATE ISSUED. . . . . . . : 06/04/2004
RECEIPT #. . . . . . . . . : 25751
REFERENCE ID # . . . : 04060041
SITE ADDRESS . . . . . : 22995 STANDING OAK CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : GOHRING KURT K AND ERIKA A
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2660
RECEIVED FROM . . . . : RESPONSIBLE ROOFING
CONTRACTOR . . . . . . . : ELMORE, PAUL M. LIC # 105
COMPANY . . . . . . . . . . : RESPONSIBLE ROOFING INC
ADDRESS . . . . . . . . . . : 2882 SPRING ST
CITY/STATE/ZIP . . . : REDWOOD CITY, CA 94063
TELEPHONE . . . . . . . . : (650) 969-6151 _
4BE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
__________ __________ __________ __________ __________
• BPERMFEE VALUATION 15, 000.00 207.00 0.00 207.00 0.00
BSEISMICRE VALUATION 15, 000.00 1.50 0.00 1.50 0.00
__________ __________ __________ ----------
TOTAL PERMIT 208.50 0.00 208.50 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ ________________-_
CHECK 208.50 10426
TOTAL RECEIPT 208.50
CITY OF CUPERTINO
REROOF � ��06 �
. CUPER INO PERMIT APPLICATION FORM
APN# Date:
3.42- so -ozv e o4
Building Address:
22'ft5 U
Owner's Name: Phone#-.
Er i > 6A(31-w V) 1406 2S2- I
Contractor: / Phone #: License#:
R C hl C - cl -90
Contact: Phone#: Cupertino Business License#:.
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Ig-`Asphalt Shingles
me'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:
Job Description:TecAr $ dispose e4iSt1nWj ro . NPPittrt.¢tJ SO"K- C0rnprJS)+)f7i1
rd6c W as v-d
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are anrestrictions: i5
Cost of Project: Type of Constructio : Occupancy group:
3 u' P.Q-ruo S• �-
QW-if
A&ijae 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
h,
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
. Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
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.
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: GrIKC\ Go h✓IYIq
Job Site Address: 22_9C(s S (XAMGI(nc4 QQIC CL— ,
Roofing Company Name: Fefj 0r1,5IY7D R6d 'yl!;) �TnC .
A plicant s Signature: Date: Co
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper