06020011 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CON`TRlktTORINFORMATIO
BU.-LDING ADD ESS: KEITH ROOFING CO INC PERMIT NO, 06020011
22667 VOSS AV
OWNER'S NAME: PERMIT ISSUE DATE
HALLER RICHARD G AND SHERYL I920 LINCOLN AVE 02/02/2006
IMINE: SANITARY NO. CONTROL N0.
(408) 295-8616
ARCHI'IECT]ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
°00 LICENSED CONTRACTOR'S DECLARATION Ib Description
.w 1 hereby affirm but 1 am licensed under provisions or Chapter 9(commencing OfSCPI p
Z with Sation]000)ufOivivonJof the ButiW.•aM Profosium CoM.aM myliccrsset
r`oh In lull forme and .ee TEAR OFF SHAKE ROOF TO INSTALL 40YR COMP CLASS
j il2 License Class Lk.a
�Fp Dau: Centocor, -
f'J'
ARCHFTECTSDECLAR4111�—
I understand my plans shall W used as public records
6
gQ Licensed Prosssinnal
OWNER-BUILDER DECLARATION
Z< 1 hereby,Inlm on I ore exempt from the Contractor's :Any c Law ran the
p o following rtuon.(Suitt 7031.5.dun Business nW pr,de oli Code:Any city or county
i m which requires a permit m ConstucL aloe impmw,demolish,m repair any structure - $10000 prior mils issuance.also requires lW applicant for such permit to file a signed statement
££s<
that he is licensed pursuant to the previsions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
YH$ (commencing with Section 7")of Division 3o Ne Beat.atW Pmrai lens Code)or
that he is exempt therefrom and the best for the alleged eumption.Any violation or
Section 7031.5 by try applicant for a permit subjects the applicant or•civil penalty of
not more than five hundred dollars($500). r Occupancy Type
❑I.w owner of the propeny,or my amploym with wages u their talc compensation,
will do the wrote end thesoucturt isnot intended a.froal for rate(Sec.]Ota,Busineas
and Professions Code:The Contutor's License Law does not apply or an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
own employes.provided thin such improvements ate not muct dcd moffertd for ble.It,
however,the building or improvement is wild within one year of Completion.the owrcr.
builder will have the burden of roving that he did not Wild or improv for purpose of
buil.).
❑1,as owner of the propeny,am exclusively contacting with licensed Corrasion to
commoner the project(Sec.7040,Business and professions Code:)The Contours U.
come law does not apply or an owner of proPcnywW Wilds or improve thereon,and.
who contracts for such projects with a eonractor(s)licensed pursuant m the Contaetufs
License1 ono IoW.
0
slam exempt under See ,Bk PC for this rcsson /
ownerData
IO .✓�\�
WORKER'S COMPENSATION DECLARATION
40 1 hereby an=under penalty of perjury one of the following declarations: r ��
❑1 haw end will maintain aCenifiou of Conxm orxlf-insane far WohefsCompcn-
anden,u provided for by Section 3700 of IW IaWr Code,for the perfmmance of the
work for which Nis pnmit is issued.
❑1 have and will maintain Workcfs Compeasmam Iwrut¢,as required by Session
3700 of thc Iceter Code,for Ne performance of the work for which this permit is boded.
My Workers Comp" ton 1 orrice and Policy number art:
Carrier. Polity No.: 'i`f,
CERITFICATE FEKEMPION FROM WORKERS'
COMPENSATION INSURANCE
This section need not he Completed if the recruit is foroc hundred dollars(5100)
nr Imo)
I cenify the,In the pcffanmanec of be work for which this pmmit u issucd.I shall am
employ any person in any mamerwi as in become subject to the Worwit Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this Ccnifose of Exemption,you should
dxome subject or the Worker's Compensation provisions or the Labor Code,you most
.JOformiu
forthwith comply with such Provisions or this pcnhal]W dmed orevoked.
z
CONSTRUCTION LENDING AGENCY
[–� IWmbyalRrm Nat there is a comtmctinr lending agency for the perrormancc of
G's7 the work for which this permit u issued(Sec.309'1,Civ,Cd
Qtenders Name
=z Lenders Address
V Q 1 certify that 1 have mad this application and sine Net Ne above inrmmadun u
F -MM I agree or comply with all city and county,o xinance,and sou laws relating m
�(•J building construction.and hereby authnrlm lcpfexnstives of this city to Cour upon be
V) aWvrmemiunedpmperry for imry
paction puoua
(Wil)agree to save,indemnify and keep humlcss the City of Cupcnino against
.F.�h liabilities.judgments,Crisis and eapcoes which may in any way same against said City
V z inconuiuncc fthcgrantingofthispermit.
" APPLIC UNDERSTANDS AND WILL COMPLY WITH ALL ON-POINT Issued by: Date
sou EGULATIONS.
Re-roofs
Si ort ser AppucanUContumr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the,applicant or future Wilding occupant store m handle haoNous material
u defined by ire Cupertino Municipal Code,Chapter 9.13,and the Health and Safety
Code.Cy. NoAllroofs shall be inspected prior to any roofing material being installed.
Yo
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit W.crmnus air canaminanu as defined by the Bay Area Air Quality Management all new materials for inspection.
Diane,? 4
❑Yes �Nu
I have rod the Nutritious materials requirements under Chapter Q95 or the Califor.
ria Health h Safety Code,Sectio.25M5,25533 and 25574.1 undcrsund rhe ifthc Wilding
dose not C%mrmo w•Wont,the it t my beamsihildy he notify the Occup rm of the
mquiumen Chmustbe me(poor to ssueueoraC'MfiesteorOcen ' y. Signature of Applicant Date
o in uIht dagem ,te All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA
14
Telephone 08)777-3228
CITY OF Fax(408) 777-3333
CUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
C} 6026a�l
OWNER'S NAME: PHONE # /
GENERAL CONTRACTOR: ei FAX # r 7
I am not using any subcontract
Signature Date
Please check applicable subcontractors and complete the followinginformation:
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
NlRoofing
kl
Owner/Contractor Signature Date
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: bethe
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 34215046.00
DATE ISSUED. . . . . . . : 02/02/2006
RECEIPT #. . . . . . . . . : 33048
REFERENCE ID # . . . : 06020011
SITE ADDRESS . . . . . : 22667 VOSS AV
SUBDIVISION . . . . . . :
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HALLER RICHARD G AND SHERYL I
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2672
RECEIVED FROM . . . . : ROGER BRIGHT
CONTRACTOR . . . . . BRIGHT, ROGER LIC # 21477
COMPANY KEITH ROOFING CO INC
ADDRESS . . . . . . . . . . : 920 LINCOLN AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95126
TELEPHONE . . . . . . . . : (408)295-8616
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ---------- .
BPERMFEE VALUATION 10, 000.00 169.56 0.00 169.56 0.00
BSEISMICRE VALUATION 10, 000.00 1.00 0.00 1.00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 170.56 0.00 170.56 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 170.56 VISA
TOTAL RECEIPT 170.56
•
Community Development Department
Building Division
p ' " City of Cupertino
10300 Torre Avenue
TCITY OF Telephone: (408)777-3228
UPEkTINO 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 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: ✓ (J)y I l �}
Job Site Address:
]r
Roofing Company Name: !
Applicant's Signae: Date:
• Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
ca-la
REROOF
.41 CUPEkTINO PERMIT APPLICATION FORM 00 0;Z001 I
APN # Z 5^D Date:
vb
Building Address:
a 6
Owner's Name: / Phone
Contractor: Phone#: License,,
Contact: Phone#: Cupertino Business License#:
C
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
JjLWood 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 Witb Cu ertino's Tear Off Policy: /
Job Description-
/ , - -7
Residential {z� l�k Commerc' ❑
Fire Zone: Yes jO No ❑ Confirmed with Planning Dept. if
there are any restrictions: U
Cost of Project: Typeof onstrucgon: Occupancy group:
Pi V 160
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
•
I