06040074 CITY OF CUPERTINO
BUI:D!"cD) SIONRTI PERMIT CANT=RAGTOR�INPORMATION
BUILDING ADDRESS: MICHAEL LUNNEBORG ROOFING PERMIT"0.06040074
10669 N STELLING RD
OWNER'S NAME: PERMIT ISSUE DATE
Ik CINDY FELDE 1328 WHITE OAKS RD 2006
NE:
SANITARY NO. CONTROL NO.
(831) 278-1837
ARCHREC(ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
Too LICENSED CONTRACTOR'S DECLARATION - Job Description
�u 1 hereby affirm that I am livened under provisions of Chaper 9(commencing m" with Scaum]O(10)of Division Sof mm Business and Prufessiuna Codd.and my licence is
+'1a in full fame and eo If TEAR TEAR OFF WOOD SHAKE .AND INSTALL LIGHTWEIGHT MET
LiccnmCLiat
fro Dem Com xmr TILE
5'J` ARCHRECI-S DEC FINALE
I eA pal Lam®
f i U 1 undersand my plans shunt he ux0 u uhlic nears 'e$a®r■
c W Licensed Pmfccl LEiane
OWNER-BUILDER DECLARATIONontrac
0 f I mrso ase thin I ern uempt from dee Conexmrl License taw for the
t]O following uncia.(Stt6on](D sir Business and Profession Code:My oily m county MAY `+� 2006
5$�i which its W.a permit to construct,th. alter,mfar such
demolish.t or a a,ir any stronum 1 v {7
-zy pher mitscensed pursuant to
pre ilio of fm Conararmi Limse Law statement
< ruxt he is racing
wit Pursuant b Ne provision of de Commo i License law(Chapter 9 Sq. F[. Floor Are VaIU Ib�D.5
00
R (commennng wide Section 7")of Division 3a the Busi^<..and Profnsiom Cade)or y Nat M u escmpt therefrom and the basis for the alleged ciamption.My violation of Thl
Section]031.5 by any applicant for a permit subjects the applicanuo a civil penalty of p,pN tuber ecupancy,Type
tar mart man BK hundred dollars(M), 3 2 6 0 8(�48 . 00
0 I,as owner of the Property,or my employees with wages as their into compenudon,
will do me wart and me nmcture is not intended or offered for eae(Sec.1044,Business Required Inspections
and Professions Cade The Coneactordoes him Limits Law does apply un an hwof q P
property who builds or improvnmereme,and whodaessmhwohhtmself or through his
however.
da,Wiprovidedrpro improvementsartnot intendedmpecrod for comer-
builder
me building act d.Of pmenl is dust
within e,your of improve
far me owms-
builder will have the burden of proving mar k did nor AtiW m improve for purpose of
sale).
❑1,as caner of dee property me nclusimly contracting with licensed mneamors to
contract the project(Sec.7014.Business am profession Code:)The Coneazlars IJ-
can=Law don not apply he in owner of Property who Milds or improv memon,and
who convects fm meh projects wide a conumose(s)livened pursuant to Ute Contractors
License Law.
❑ Iamexempturder See .B@PCrurthisreavon
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby afloat under Penalty of perjury an of dee fallowing decicaticat
1 have and will maintain a Cartificau of Consent to self insure for Workers Compen-
satian,as provided for by Second 3700 of the Labor Cadnt for de Performance of out
wast for which runs permit is issued.
CI I have and will maintain Workers Compensation Insurance,as required by Secdon
3700 of the Labour Code,for me performance aide wort for which this permits Issued. '
My Workerss ccom/fsmaiii hsaarvc esnler and Policynumberare:
casriev ✓/^fJY Pmiry Na27Z'f
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE -
(ITu section mad not be completed if the permit Is foranc hundred dollen($100)
or lest) ,
I ccnify,Nat in thc performance of the work far which this permit is issued.l shell not
deploy any Person in any mannerso as to become subject to the Workca'Compensation
laws of Caifomia.Date
Applicant
NOTICE TO APPLICANT:IL after making des Cert of Exemption.you should
became subject un the Worker's Compensation provision of the,Labor Code,you mus
.J O foMwlde comply with inch provision or mu permit shall M dammed revoked.
Z N CONSTRUCTION LENDING AGENCY
[-+ Ihereby&Man Wt inert is a emsmrucorm lending agency for the performance of
the work for which ids permit is issued(Sec.31197,Civ.C.)
f3) Lenders Namc
,a z lenders Addicts
U Q 1 ccnify that I have read this application and sae dist the above information is
D, (~ coma I agree to comply with all city and county omitwees and some laws relating m
C) building construction.and hereby aathoris mpnxnarives of this city to enter upon the
r W aWm-asentichad property for inspection purposes.
gy (We)agree to sass.indemnify and keep harom dee City of Cupertino against
nF..y Iiabitidn,judgmcne.toss and expenses which may in any way accmc Maim,mid City
t.)Z in consequence of the granting of this permit.
APPLICANT UNDER NDS AND COMPLY WITH ALL NON-POINT Issued by: Date G�/
SOUR REG
Z�G Re-roofs
S' nm o(A lion an acmr Date
HAZARDOus A ALS DISCLOSURE Type of Roof
Will the applicant m futum bis occupant more or handle hvardous material
az defimd by that Cupentna Municipal Code.Chapter 9.12,and de Health and Safety
Com,So be 255320)? , All roofs shall be inspected prior to any roofing material being installed.
Yes o
WBI dee a (cant r futum buildin ocro ant use m ut If a roof is installed without first obtainingan inspection,I agree to remove
PP g P q it Qu act JMana which Pe
emir ha'raNnus air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
District?
Yv
l hav1reel the tier. alsre
= teriquimmcrosundcr Ch2Nar6.95ofmcCahrm-
maHcalthASa5055533w 534.1Mmmifc building
docs tet currently have a tenant that i y maponthility m unify me occupant of the
mqu' none telta- c � he denccor ioeorOcapmcy, Signature of Applicant Date
caner act sumo zed ages, — sae. . All roof coverings to be Class"B"or better
CITY OF CUPERTINO
�m 2 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32608048 . 00
DATE ISSUED. . . . . . . : 04/13/2006
RECEIPT 4 . . . . . . . . . : 33979
REFERENCE ID # . . . : 06040074
SITE ADDRESS . . . . . : 10669 N STELLING RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : CINDY FELDE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : WESTERN ROOFING
CONTRACTOR . . . . . . . : MICHAEL LUNNEBORG LIC # 25896
COMPANY . . . . . . . . . . : MICHAEL LUNNEBORG ROOFING
ADDRESS . . . . . . . . . . : 1328 WHITE OAKS RD
CITY/STATE/ZIP . . . : 'CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (831) 278-1837
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 16, 000 . 00 234 . 36 0 . 00 234 . 36 0 . 00
BSEISMICRE VALUATION 16, 000 . 00 1 . 60 0 . 00 1 . 60 0 . 00
---------- ---------- ---- ------ ----------
TOTAL PERMIT 235 . 96 0 . 00 235 . 96 0 . 00
•
Community Development
10300 Torre Avenue
t Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
40CUPER,TINO
Building Department
JOB ADDRESS: PERMIT #
J ro N S el rNAd 421 Cr `7
OWNER'S NAME: PHONE # 73--i6
GENERAL CONTRACT S FAX#
I am not using any subcontractors: Z o
Si ature Date
Please check a m applicable subcontractors and cofete e fo win 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
6wner/ o tractor Signature Date
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 " 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: X61, U, �^%S /
Roofing Company Name: loerTP/n1 Ai ,A j -S.,4K S
Applicant's Signature: ' Date: -4(-124L"
• Greg Casteel (/
Building Official
Revised 11/2/04
0(_Ow oll
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# �2l0 018 Date:
Building Address:
Owner's Name: J Phone#:
C-tNJ flocs
Contractor: I License
Contact: Cupertino License #:
Lvtne6 7F—Irr5
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) r_ Other(Specify) [M,0+(
Number of existing coverings ❑ Provide I.C.B.O. Report# ,S-(,1,
To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Descri tion:
Residential Commercial ❑
Fire Zone: Yes ❑ No 2Confirmed with Planning Det. if
there are any restrictions:
Cost of Project: Type of Const{uction: Occupancy group:
AJO
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