03120044 CITY OF CUPERTINO 17oz7u�' "' `'
BUILDING DIVISION PERMIT C®NTR'ACTQR INFORMATION S
BUILDING ADDRESS: PERMIT NO.
LOS GATOS ROOFING 03120044
OWNER'S NAME: PERMIT ISSUE DATE
E: SANITARY tttOL NO.
(4QA) 99R-919C)
ARCHf1ECUENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
upp LICENSED CONTRACTOR'S DECLARATION
1 by afRm slut I un licensed u�r pmrisioss of Chapter 9(commencing Job Description
with Section of Divioion 3 of the BUMi end prafcsvum Codc.ond my fee.I. �������
in full force erten.
En"11Clus Q' Lk.M REROOF-REMOVE EXISTING. INSTALL
a oak TSD L SB & 30# FELT & SHINGLES
A e-an a „ DEC 1 8 2003
A
Nall be d c recards .
i
3
1.1hoossM Professional
OWNER-BUILDER DECLARATION BUILDING
0 y 1 mosso .Tom Nat 1am 1. .exempt from Um C.n ons Co e:Any c Law for the
p o following meson.Permit
1 11131.5.Business and improve.
de projections demolish.
Any city m county A
$ which mquims•permit m enntue4 alter.improve,h Permit
t t or repair ed urmcture 'i
FZT ptloWits mune. also powismiesnf for ohpemitmcc.Lle a udsts¢mem
a (fast he commesccewith Section
to the pmviiom ofdonMe (Chapter 9 Code)
Sq.Ft. Floor Area Valuation
¢ $ (cat he is(commencingwithSalman 700 0)th Division l (in M the Business And I'mon.Any
Codc)o 3 6 0
du Nn he Is sumps Ncm(rom and the Esau fm Ne alleged eumptlan.Any vlolatlon of �
Section 9031.5 by my applicant for a permh subjects the applicant W a civil penalty of APN Number Occupancy Type
not mart Nan five hundmd dollen($500).
❑I,uoww of Uk pmprny,tar my ernplayas with wguuthehmle compew0an, 355910043 , 00 t
will de thework-end theswnure tsnotinMnded orortemd foutle(Sm.701q Busi•...
and Professions Code:The Continuities LiamLaw does not apply u in owner of Required Inspections j]
property who bulldsentmpr.ves themon.and whodoestchwokhimulforthriugh his y�
own employees,provided Net such improvements are not intended or offered for sale.If.
however,the building or Improvement is to whirl sou your of completion,Ne owner- },
Wilder will Mw the huNm of proving that W did not Wild or Improve for purpose of
Asia.).
❑1,as owner of Ne property,am exclusively contracting with licensed conuocun to
construct the project(Sec.7044,Business and Professions Code)The Consomme,Li. qq
cemea law dos not apply in an owner of pmpmy who Wilds or improve thereon,and, Y'
who contracts for such projects;MN a mnu cuu(s)licensed photons to the Convaesoee
License law. _
El I un eacmpt under Sx. .B A P C for this recon
Owns D
6
WORKER'S COMPENSATION DECLARATION �
1 hemby Nim under Nosily of perjury one of the following declarations: a
I have and will mountain aCeNftek of Consent to self-insum for Warkees Comism.
sation,As provided for by Section 37M of de labor Code,for the Performance of the
wak for which this perms is issued. i
❑1 have and will maintain Workees Compensation Imurana,At required by Section
37M.f Ne laWr Code.for Ne perfamancc of Ne (."which this permit is Issued.
My Work Cam wdon lntmna .no sod Poli mW'. .11
PoII a.: Z.
°C CERTIFCATEOFE%EMPf10N FROM WORKERS'
COMPENSATION INSURANCE
rlbts seniat need not bceonpleted If the perms is foram hundred dollam(510o)
or less)
1 certify that In the perfomanee of Ne work for which this permit is issued.I shall not
employ any person in any meaner an As in became subjects.she W°rkeri Compemation
Laws of Callfamie.Data
APPllemt
NOTICE TO APPLICANT:IL after making this Ccr ificam of Eaemplion.you should
became subject to the Worker's Compemution provisions of the LAW,Code.you most
3z forthwith comply with such provisions or this permit shall be doomed rooked. J
z y CONSTRUCTION LENDING AGENCY I
(� Thereby atom WS Nem is a construction lending agency for the Performance of
y'> the work for which this permit is issued(Sec.3099,Civ.C.) 1
Leader
ILi 0 co=t.',Nune
o Lmd,,s Addmss
z z I coni,Net 1 have mad this application And Mute Nes the above information is
UV comet 14roe in comply with ell city And county ordinances and sok laws to
on
O building convection,and hereby smhorit mpmunutiws of this city in enter upon tine:
4 ahmm-mmunned property,for impeco m purpmev
(We)egme to ave,indemnify and kap may
in m she City of Ca gamin against - �
o-Fi h incoisequenc of
grassing expenses which may in my way acerae against mid City
t„)7 in APPLICANT
U DERSTAN of this perms. J
r7 APPLICAM UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
S U,R,SREGU ONS
1 Yy __;A
- — �� Re roofs
namm of ApplicaMConttmmr De .I
Type of Roof
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building.ccupmt store or handle hnarious material
As deeded by the Cittimma Municipal Code.Chapter 9.12.and Ne Hea da and Safety
Cracks,Sadao 25572(.)9 All roofs shall be inspected prior to any roofing material being installed.
CYes °
Will the applicant or future Wilding occupant tit equipments devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haaaNmM air contaminants As defined by the Bay Are Air Quality Management all new materials for inspection.
Dishicti
11 Yea �No
I have read the hassrd.us,materials rcquircmenb under Chapter 6.95 of the Califor-
his Health ASofclyCadC,Sections 25505,25533 and 25534.1 undemmnd Ma if f Wilding
due
not eummly haw a tenons that it is my responsibility to notify de nc<upmt of the
requircmenu whin mesa be at 'sort bimAson,.f.Ccni6cakof0, racy. Signature Of Applicant Date
Oar.t,atn.rir<dasent m All roof coverings to be Class "B"or better
• CITY OF CUPERTINO
I• 1 of 1 PERMIT RECEIPT OPERATOR: Suem
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35910043.00 i
DATE ISSUED. . . . . . . : 12/08/2003
RECEIPT #. . . . . . . . . : 23998
REFERENCE ID # . . . : 03120044
SITE ADDRESS . . . . . : 20556 SUNRISE DR
SUBDIVISION . . . . . . . i
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
9
OWNER . . . . . . . . . . . . : TOM HOEGEL
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014
d'
.RECEIVED FROM . . . . : LOS GATOS ROOFING 41
'CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481
jCOMPANY . . . . . . . . . . : LOS GATOS ROOFING "_' ,_-
.. - ADDRESS . . . . . . . . . . : 1771 SMITH AVE.
. 'CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 '
' TELEPHONE . . . . . . . . : (408) 298-9399 _
I
4
*E ID +' . ,UNIT. QUANTITY AMOUNT PD-TO-DT THISREC NEW BAL
__________ __________
BPERMFEE VALUATION 7, 000.00 127.00 0.00 127. 00 0.00 !
BSEISMICRE VALUATION 7, 000.00 0.70 0.00 0.70 .. 0.00
---------- __________ __________
TOTAL PERMIT 127.70 0.00 127.70 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ __________-______- 1
CHECK 127.70 1331
TOTAL RECEIPT 127.70
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CITY OF CUPERTINO
0 REROOF ���
• CUPERTINO PERMIT APPLICATION FORM
APN# 55 /, Date:
7 1 2 3 d 3
Building Address:
OS u
Owner's Name: Tory) Moeme- 1 Phone#
Contractor: Phone#: License#: �y 7
GL 0 RO 0 707
Contact: Phone#: h Cupertino Business License#:
G( 0/1 I C �G
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
)t Asphalt Shingles * Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
A Wood Shingles ❑ Wood Shingles # a
❑ Other(Specify)�_ )d Other(Specify) e 7 623
Number of existing covenngs ❑ provide I.C.B.O.Report#
XTo be Removed IE( Provide Mfgr.Installation Specs. S Sr"
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy,Job Description: Z
Residential Commercial ❑
Fire Zone: Yes ❑ No M Confirmed with Planning DePt. if
there are any restrictions: u
Cost of Project: r Type oConstru 'on: Occupancy group:
Qty-4f)
A 1• a le 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
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: P/
Job Site Address: o5-576 GI/7///S /� /n•
Roofing Company Name: Q (J.c�f O S
A plicanYs
C�l/a6lillDC�O
• Greg teal
Building Official
Revised 1/30/03
Printed on Recycled Paper