02090086 CI BUOF
DIVISIONSINO
BUILDING CONTRACTOR INFORMATION:
BUILDING ADDRESSPERMIT NO.
21580 STEVENS CREEK BLVD ROSSETTA' S ENT. INC 02090086
e. TOM 401 LINCOLN AVE APPLICATION
` PHONE' (408) 294-4400 SANITARY NO. CONTROL NO.
'MLD ee O ARCHFTECr/ENGINEER: a BUILDING PERMIT INFO
8 w- BLDG ELECT PLUMB MECH
Brad
z H= LICENSED CONTRACTOR'SDECLARATION Job Description
o z o 1 hereby vRrm that l am licensed oder p vislonx afchapde9 fcommcIXinB - REROOF
p_I-lu wilt Se<IronwoB)of Doman 3nfthe Boanes ie Prords:ions Code..rid my 0<enu
do y is infullf eange L
X 9 d. Licenu� -39 CmnTTws* t43 b y �� J a�� �s®
do do go d. Dal ARCHITECT'S DE ENRATION
a I undersand my plain shall be usN vs public records O r T 2002
S O O,S
r C I C L
do i a z Licensed Professional
c. OWNER-BUILDER DECLARATION
1 hereby affirm that 1 inn exempt from to Conuacmr's License Law for the BUILDING
11
following reason.(Section 7031.5.Business and Prorcaians Code:Any city or county IG7 V��DI{���. $24000
{S O which rtquircs a permit to construct,alter,improve,demolish,or repair any strucmrc a u
prior to itsissuance,also requiresthe applicant for such permit to rile a signed smmment -
-
it M 1,Inserted puratiantu,the brunrisomet he C.ruadmA License Law(Chapter 9 a'J 35.�pB�'b�'}po;0?p'ea•:., Valuation
(co -ggwhh Sam -]000) (Division 3 of the Busmaxand Pmfosons Cade), �,5I:�1 1 4-., ra.. t: •r. ar3L:•i:1' fti `.ti:
or thai he ialzimpt Ihcrefrum'and the basis for the allegedexemption.Any violation
-of 5«Iion9031:5 by arty vpplicant fm a permirsabjects IM applicant to a ci.il penahy-
fofnolmnrethvnFvehundreddogarsfES(p). 305APNI4g Parent"�° Occupancy Type
CI 1,as owner of the property,or on y employees with wages as their sold compensation. _ 307 - INSULATION za
--will do th work:and fire scture'is not Intended or offered for said tirec-]OW: - 601 - ROOF TEAReejil�tiU InspeCtlOn$ X11"i
+Bu inesi a,id'Profess ons Cate The Contractorto s License Law docs not apply an
owne
rofpmpeny Whobuilds orimproves thereon,and who dues such work himself 602 - ROOF PLYWOOD NAIL
of duough his own employees.provided than such improvements mems arc nm inldndu or ----
---_
-�ijRercd'fo�sbleflf,fiuwcvcr.Ihe'buildin or im ivemenl is sold within-one ear of ----- -� ---- �'-----��--�- I
dmpleran.the owner-wilder will have me burden of proving that he did not build or
603- -----ROOF - - . ,�:\".•, •<o:
improve for purpose of sale.). 604 - ROOF IN-PROGRESS
Ol:as ownegnfthe properlY•am exdusivdy conlmning wish licenud comralonm - ---- ----_.__..._.-.__. ,_.--...____ _
- lil'li_U'•O 4aa111 I:•Fq
construct the project(Sec.7644,Business and Professions Cale:)The Contractor's �;;„ F T. _t Nit,
License Law dues not apply to an owner of property who wilds or improves thereon,
_.aod-whacontmcn.for such projects witd W
h...damoscon-W licenunum did.e. ._..___.____._._-. _.._—.---_--__.____-.__-_._-_—._-
Commen.r'sLicense Law.11<Cn.;„l.F�q':•>.., \�,
❑lam uempruMkr Sad
-. - .BPC for thio rtamn ..'?:.CfII
] _ OainBi:n. ...L .t . ;:.Dale•. �c 1"
_ WORKER'S COMPENSATION DECLARATION
'' 1 Mrtby reform under penary of perjliry onc o(Ihe followin8'tedaralionm - r
?� O I huGe'ead'will'miimam'S Cenif.aie of Cdnicut to self-insure for Worker's
Compensation, of provided for by Section 3900 of the law, Code, for the
g paxormao«'or the wad,for whi,h,hi,ppvnil;s madd..
J�f Ih Libre Work f pc u l Tone s req d by S l'i
❑Ih ad II
at
Code f theperformance of the work,for h h IA.'panni
rs MY W k }C t q 1 u c c e vnd pot<y np be - -__ ._ . _.... .__.�—.
l/
11Pti11T8 S:t ,;.l. )r �... th„• , .` a'Y Va ❑ v:"
.\4 CERTIPICAOATIO IONTROM WOR%ERS\
Ca.
"' 4f '': xC' Iti tJ1. ].Y9 [,.},p +,;p11;+,.•-�'
�... .:-<p..c.'.. COMPENPENSATION INSURANCE"'••"' a". " ..—_____._.._.—..---____.—__..._..___.___.__—.._.-._.___ -___...-.—.__.—._—_.--,.„,.,.._._
—
' ,
-MIN x.4:1}`:: � P.:...,1 >.I {,'C:'h71ii)t:'• iC:):'
vtl "'(Tbi.e tihiiin'n«J'noi 0.i'ompineJ if the permit is Tor one hundred dollars
15I001 or less.l m
1
-_ e...-..- .... -ra �...�.....n ..n-_..yiv_. d.v....,e-. ..a.n_ .....� ._.
'I nf5rlh 1, perfmi c 'f the od,f which this pci t issued.1
n`epall'nnt employ anY,Pe^an m any manner:sops 1,wcume subyee,to Mc Worker
Com, 'soilad'Inws nr C:d'nnrniv.Date.'."-'., 'n •" ..
e
_A idamL •.-. -._ __._... -. _. ._ -.... ___. _ .- .. —_. ___ _ _ .__. _. _ _._ .._.-
TIC_FTOAYPI.ICANTIf,"after idum,thkCnfcl of Exemption,you should ' ' •`r
o b3
sGnome Wmi l Cmpcnial p ns nftn Lxb Caf o mux
y '
O Y nh Ih comply with ch p tomo th pe t shall be deemed ked
Zti .. _--__ -" .._.-..- .. -__ . _._ .. ___- ............ - _ .... .- - --_— ._
�^.� •' - -T CdhSTRUCf10N LENDINGAGENCY -r I.1d "I. " 'iP
'of" I hercor which lh;pirap a inn 0unl Iced nB reg ncy f the p:rfonn ncc � 'n.T: ?''r"
he work for heti thM parrot x .sued(Si Civ.Cl
1:o No
an
:;;I;Z Lcdd rs AJdrcSs 1, •I',,•:D.'
U C
I
'ofify
_tllhaveapplicationand state
_bar
he above information ls
1 allied,or donoply with
all city and county des d state lowi reliningtobuilding dheb auducriArcpe uiaries fM.city nenter upon
,the aturve-immicmidproperty for i t pumnus„
(We) arcoho m e refyancV h Cry oa pn, against
h lbll jdg , ndexpens'”h h ,in troy 'Y' c a gai .Lid
C„ ZCity r uq cc hhegranting arih
-
/
permit •OC1V/
\PPLICANT UE ANDS ANDWIILCOAIPLIWITHALLhO OITn Issuedb Dale
S7L4
of ERFr ,.,' 1S �2)p.L y'
Signature fApprca o 1 Por /i> Re roofs
C)Y ,HAZARDOUS MATERIALS DISCLOSURE
x WII
the PPlicant orf t cw'Wi gad P'm tirc or handl h' dou emnal
Type of Roof - ... . ..__.. .:._........
..........,- -...
Iud( Nby th CurnpMun<WIC Chapter9.12.and Nc Hcahhand safry -. .'`.. f1x'.1�11 :.Ca
-.Cod Sm n2553$)vA[pfii" t 0 rep r c t P`', 1 Fi.7 1 �� I Z :•...8
All roofs shall be inspected prior.to,any.roofing_material-being installed.,.- .
w u Ire;ppl< 1 ml rc n 1a g _e p 1 awe eq p 1 a ce n n If a roof is installed without first obtaining an ifispectiom'4+agree`[o remove
e l h b c t i deli y th Pry Area A Q I ly M nageme t
•D e, _ all new,materials for inspecnon.._Applicant understands and will,comply_with_ : _
n� r
Dyes a i - ' '- all non=poili[sourcc rer/eguu ations ,
1 ha c re s the wa d p' m eq t d Cib pi r o
Cal f m H Lth&Safety CM Sections;25505 25533 and 25534 1 understood that
"if he 6pountJ gdn<snot cu currently have meal troyresponsibilityl notify the
IXNpa 1 Of Ire r[qa[e,M IS which most 6[met p,lOf to instrans,co
f a CCnlf Cal 'Or
r o< p y ,
9 13 D _.Signa_tu_re of Applicant _ . . ._..,. _Date. - -
r TAll roof coverings to be Class B or better
D ulhoraed g f.", .'p . ,; -Date 1., ,
_ -. . .OFFICE-
1 � '_ .'(� ,, a . .., .. .. ._ _ _. 1 • ' ! .. u r ,n
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY40 Fax: (408)777-3333
CUPEkTiNO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of V"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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name:
Address: 7I -8o
IIII �
Reroofing Company Name:
Applicants Signature: 'sCLfd %v Date: z 3 0 z
Joe Antonucci
(Chief Building Official)
6/25/01
CITY OF CUPERTINO
BUILDING DIVISION PERMI CONTRACTOR INFORMAT�
BUILDINGAI) FSS: PERMIT NO.
21580 �STEVENS CREEK BLVD ROSSETTA' S ENT. INC 020,s90�0TE86
W� AW:TOM 401 LINCOLN AVE APPuc09N/ 13/ 2002
j PHONE (408) 294-4400 SANITARY NO. CONTROL NO.
'
0 0 ARCHTEC(ENGINEER: < BUILDING PERMIT INTO
w BLDG ELECT PLUMB MECH
H Z LICENSED CDM'RACIOR'S DECLARATION Job Description
=OZNC I hereby aRam that lam licensed under, isiomof Chap<r9(commencing REROOF
IN$auon 7000)of Division3or the Bolide Id Rofeasiow Code,andmyliceme
6Nt laid fallt ar.4 t. O'74 y
O n O DasEE �W
�7 ARCHITECT'SS DE
orpuARATION
S�„"0<<r� 1 understand!my sh
mY Pleall be used u public rtc°NS
'
Mi S❑p Licemrd Prof essioaul
OWNER-BUILDER DECLARATION
uL�-' I hereby arum Nat 1 am comp firmanNe ConwmN
cr's License Law for e
L
z following reason.(Section 7071.5.Business and Proreuimes Code:My city or county $24000
SF o which mlu res a Permit to construct,alrn,improve,demolish,or repair any structure
assi3$ Peormiu issuance.aUu requves dr appli�antforsuch prmiit mfibasigrcd suwrcm - - - - -
d(.ltdiEtlhdcoiedpir(s�q,rq{h-ePmviu°ns ofNcConvactar'sLiamclaw(CTaper9 , :3t5'*2b 1f)20"�ry��ea-.; Valuation
(eonm¢pcinyywWSquo..]000)of Divisionlof Ne BaSineaNtnd Proliuionr Code) .sl n _y,e I1'Y!�a);U•+fl� ���".\ .
to Net ria
lilmpi sb aufiom'iN she basis for Ne alleEed demotion.any violation
of Section 703 1.1 by arty applical5t for a Permit subjects Ne applicant to a civil penalty ••'• aq T
Inf.1 mare Nan Bre hunar<d del.(55(10). 3 0 5 APN S •' QCCLL anC P Y YPe
Ol,sa own,MAo property.ormy<mployaa3 with wages u their role compensation,: 307 — INSULAT ON
"willdo'the wort,'and to suucrose'is not intended or nReaed for sold(Sw:70aa; 6 01 — ROOF TEARe(1�}II'�Inspeetitins' •
Busiocu ahs!Pmfeuu ioCode:The Contractor's License law does not apply to an -
owamr of property who builds or improves thenen.and who docs such work himself 602 - ROOF PLYWOOD NAIL
or Nmugh his awn ployrea,provided that such improvements are not intended or
completion.taTor;h�If,er,ladec Ne l Wilding et arden of pros n role beNin dna ild of --- 'ROOF 'BATTENS
ipvelr the os",Of e.).will have the Wrdrn of proving Nat he did not Wild or
improve for puryme of We.). 604. - ROOF IN-PROGRESS
>,r.
of Je-_ ownegproperty,it;exduclYm
xivcarv<tin8 with licensed rotne
nton m ---- - -- �- --_- -- - -_ _- -- .';'Hit
:'• '
'„ coniwn the psjwt(Sec.70".Business am Pmfessiou Cad":)Tho Commor's i rip
. 01 am cacm t odea'gk. Y who Wilds or improves Hereon.
_ _ License law dm noes 1 men owner of n 1
apply pros
avd�vlm covuuu fm....,.pmjcuwiN.a cnmmct
01 am so License Law. .•r..,. :,,.
C for Nu rtaron
Owner r.WORKER'.
S COMPENSATION DECLARATION
" �I hereby aRrm uMa peaialtY of perjury oriq o[,Jiefolloving dxlarvtioris: •
O 1 hive and will mdnui.Canifrcme of Cement to self-brore for Worker's
Compensation, u provided for by Section 3700 of the labor Code, for Nc
_ peiforrwicebf Ne work for which Nis Permit is issued.-
0 1
.,01 have and will'mkmain Workers Corgs nauuoo imitirunle.A required by Section
'7700 oFNe labor Codc For the perfonsunc,of duc work fur r wsuch this pcmair,
issue My rk r' Co.
-ton Insure c« er rid PoI ry umber tic: _
CN[i#cc ib "il�'Qi - :7�.., �''.: 1 rl ;•,4 i;• •t• .•t•t., :':L.:.`v ,
✓ 10ERTIPICATIONOFEXEM IONFROM WORKERS
• ' COMPENSATION INSURANCE
(Thiss sedtion need nai bo complctad if she Permit is for oris hundred dollars '
(51(gll ar less.l ,
1 r Nat in the Peafonhnnce of the work'for which Nis Permit is issuM,l •, �, ., •;;5 i,.�. -
'sti.11 not ekpluy'anj•Peron in any manner m as m become subject m Nc Workeri
Compenutian lam of C3lifomid.Date'
• pliant .. _. . .. _ . .. .. .. .... .. _
�9AIpD1'ICE TO APPLICAM;If.afmr making Ni.i CcniOcam of Excmpdon,you should '
Tsccame subject m N<N'orker'a Cumpnsauon provisions of N<Lobor C°dc,you must
0z forthwith'comp%with such pmrisiom os NispemJt shell be deemed revoked.
.Vl ."�ONSTRUGTION LENDING AGENCY
'� I hereby aRrw Jut Dick is a conswction kiMin6 agency(w the Perfamunee °'
�' w sof Ne work For which Nls..:_•": permit ii issued(Sed.7097,Civ.C.)
eList. ..Londe?,Name . ......-_. •1-t _ __. _.: _. . .. _ .._ . . . _ .. . . ........ .. .. . ... . . .. ... . -_..._ .._
Z Lorder'3 Addrets'
U 1 ani(y"at'
have mad this.,pliciam end guru t a Ne above infommtion u
tr+-E.a 'coni<5.I.gree Ip.comply with all city and gountY ordinances and state laws mining
in ouve racri aredP and h<rtbyauNorixe reprcsenutivw of Nis cny menmrupen
_ Ne abovcm<ntioncJ ro n for inspection p harms
y (Wc)alu,uZ%fcnnify and keep harmleca Je City of Cup,
against
4.r ZZ) liabilities,judgments,costs and expemes'which may in any way ucmv against,said
U.^ City in consequericb of Ne graining of this ppccmat,
SPULICEMU'DEyy SNDSAND WIL1.LCOb1PLYWITH ALLNp L'T I$$LLed by, Date
gwm 1'Ap,hca UCo wcmr. - a¢ i , Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
- WON appl ant or Runk W Id ng acupant'vert r handle hn„an au manderul _Type of Roof
as def ed by the Cuprnum Mun mPel Cydc Chapter9.17 and the HWah and Safety .:s. L.• "
Cad Sect on 25533(6) - / _ r'. 1 3.: t -ly ,-e• l ' !4{ - 1 t '
oY<a•'•: LCiNN° AlLroofs shall be.inspect6d pdor to any roofingmaterial.being installed,. .
Will the appliwnt of fumm Wmon"
epant use equipmeequipmentor devices which If a roof is installed without fust obtaining an inspectioli;fiagree`to remove
nt.mit haraadous ah mmaminantsudoll yN<Bay Aau Air Quality Management
D all new materials for inspection. Applicant understands and will comply_with
.' t - all non-point
source-rregul—atibns. .
1 h ve fwd N Safety
Code. eed.materials regmremenu under Chapter 695 f the
ifhemaing duct not
Code have
a teant.tht it
andZ534.1itytonud Nat
p Y. pct ro t ry Ne" J" 4
cements currently
mustnbaensTtc at tat m responsibility
'circa bf a Cemfcam
- FNeb Iltlingdrcsn y y po y
occupant f he rcqu _-t
= °run Signature of Applicant Date.
9 l9/01,-
r;r - .Dae All roof coverings to be Class"B" or bettei
O r r euNoni>Fd 6gem;';
•:: ,..• . -:r'.-.:'•i;...'1 . .. ".,.._, .. .. .. . . . .OFFICE .... .. ..... .. ...... ....
.1UL-04-20182 45 :43 Am • • F_ bl
ASBESTEST, INC.
• ;530 Det)Avenue,Suits G CiMpbel4 CA 95008.6912 (408)374-3362 Fax(408)374-7269
MEMARIE ASSOCIATES July 3, 2002
20480 BLAUER DR. STE. B Job No. A-23546-01
SARATOGA. CA 95070
PROJECT: 22771/22781 STEVENS CREEK BLVD
ASBESTOS IDENTIFICATION BY
POLARI E�MICR SO COPY
Non-Fibrous
Fibrous Asbestos Other Fibrous Materials or
Sample Identification i era Materials. % Minerals. %
22771 STEVENS
CREEK BLVD
FRONT HOUSE JUL 0 ° Z02�
1 KITCHEN/UTILITY NONE FIBERGLAS,: BINDER. 65%
• ROOM FLOORING, DETECTED ORGANIC
TOP LAYER FIBERS, 35%
2 L I CHRYSOTILE, ORGANIC
BINDER, 50%
ROOM FLOORING. , FRIABLE. FIBERS, 25%
ABOUT 210 SO.
13O-rOM LAYER
3 BATHROOM CHRYSOTILE, NONE BINDER. 90°io
FLOORING 10%
4 SHEETROCKiJOINT NONE ORGANIC BINDER, 980/c
COMPOUND DETECTED FIBERS, 2%
COMPOSITE
5 SI UCCO NONE NONE SAND; BINDER,
DETECTED 100%
6 ROOFING, TOP NONE FIBERGLAS. MISC
LAYER DErECTED 20% PARTICLES,
BINDER, BD%
•
/2002 05:50 AM • • F'.02
•
A-23646-01 PAGE 2
7 ROOFING, BOTTOM NONE ORGANIC BINDER, 10%
LAYER DETECTED FIBERS, 90%
BACK HOUSE
8 SHEETROCKMOINT NONE ORGANIC BINDER, 98%
COMPOUND DETECTED FIBERS, 2°F
COMPOSITE
9 KITCHEN FLOOR NONE NONE SAND, BINDER,
TILE DETECTED 100%
10 BATHROOM CHRYSOTILE, NONE BINDER, 65%
FLOORING 35%. FRIABLE,
ABOUT 30 S0.
FT.
L
22781STEVENS
K BLVD
JUL 0 l� P002
F�V.
• 11 SHEETROCKiJOINT NONE ORGANIC BINDER,-98%
COMPOUND DETECTED FIBERS, 2% -�--�
COMPOSITE
12 KITCHEN/ NONE FIBERGLAS; BINDER, 50%
BATHROOM DETECTED ORGANIC
FLOORING, TOP FIBERS, 50%
LAYER
13 KITCHEN/ NONE FIBERGLAS, BINDER, 60%
BATHROOM DETECTED ORGANIC
FLOORING, BOTTOM FIBERS, 40%
LAYER
14 ROOFING, TOP NONE FIBERGLAS, MISC
LAYER DETECTED 20% PARTICLES,
BINDER, 80%
15 ROOFING, NONE ORGANIC BINDER, 10%
BOTTOM LAYER DETECTED FIBERS, 90%
/'2002 05 -5N AM • P.3:
•
A-23546-01 PAGE 3
NOTE: There are transite pipes in the attic area.
This teat repor, relates only to the it tested. The materials were examined by
polarized light microscopy according to Environmental Protection Agency methods.
Reported asbestos percentages were estimated based on comparison to test samples
provided ty the EPA. Samples will be stored for six months and then properly disposed
uniess prior arrangements have been mads.
Respectfully submitted:
ASBESTEST. INCORPORATED
Robert h9, Kumagai
Microscopist
JULVb -=—I
2002
•
Ey OBJ
1
LYNN M CHING.
22442 WALNUT CIRCLE SOUTH e
CUPERTINO,CA 950143541 t
0109
• PAY To THE
'` /// o�,c
ORDER Of G
Washington Mutual DOLLARS @ g-
MYu B FA
�M�vatlOw.iIlO - T1
UY TOMER
auom°e1tl"`" r►�em
CUSTOMER
_ osrn„
' FOR j���
1:3222716271: 429245335Bu• 0 9
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•
City
C 10300 Torre Avenue
Cupertino,CA 95014-3255
CITY OF A Telephone: (408)777-3228
SCU1-pCkTINO FAX: (408)777-3333
•Kl BUILDING DEPARTMENT
DEMOLITION REQUEST
�/s/
Date 3 vL Q f H,r1 Z '�
J
JUN 4 2002
Addresses of all interested parties: Y:_
.WP640r (,-Nft) fhu'(InRL -
C(A$Tcmt?� Segvi C
P•U ,(�jOn IOG ?
No l2LrftC � 1 -lodl3
Reference : Loan number(if applicable)
• L`(n%N c Kr��
Dear Sir or Madam:
Please be advised that the owners at as-75 I 54dtn5 C(Ikk 1J Ud
Cupertino, CA 95014, Assessor's Parcel number are requesting
demolition of their house/building.
Please notify us within 15 days if you have any objections.
Our address is: City of Cupertino
Building Dept.
10300 Torre Avenue
Cupertino CA 95014
If you have any questions, please call me at (408) 777-3228.
Sincerely,
Susan MacGowan
Administrative Clerk, Building Department
Printed on Recycled Paper