06090120 CITY OF CUPERTINO fi c<%$
`BUILDING DIVISION PERMIT CONTRACTOR INFORMATIQN '
BUILDING ADD0. OF ING PERMIT NO.0 6 0 9 012 0
1059 W ILL CT
OWNER'S NAME: PERMIT ESUE DATE
Aft HASEGAWA DAVID 1900 DOBBIN DR 09/15/2006
14 NE:
SANITARY NO. CONTROL NO.
(408) 254-7904
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
X00 LICENSED CONTRACTOR'S DECLARATION Ib Description
U C - 1 In eby grim that 1 am licensed under pmvivnsoof ChaOI
pmr 9(commencing p
t, with Scnion]IXID)of Division 3 ofthe Business and Profusiuv Code,and my license is
' h in full force andcffeoy9 �.5-jay REROOF- TEAR OFF SHAKES, ADD GERARD STEEL TILE,
,gym Date class LJ Lk.a 1 . 5#PSF , 4
;H nam co sur CLASS B 34 SQUARES
ARCHI O
i < 1 undo ramnJ my plans shall th
)yU
O H Licensed Professional
5 OWNER-BUILDER DECLARATION
I<f I hereby a(Rm that I am exempt form the Currencies License law for be
.cic following reason.(Section 703 1.5,Business and Prefc.m ns Code:Any city or county
5: which requires a permit to emauuc,almr,improve,demium,or repair any structure
prior in its issue=.aLsu mquires the applicant for such permit to Me a signed stammcun
-�i that he is licensed pursuant to the pmvisionsor the Coomclors License Law(Charm,9 Sq.Ft. Floor AreaValu Ia)f7000
I�$ (commencing with Section 7")of Divuim 3n1'NC Business and Prefessiom Code)Or
_ that be is eaempt thomfmm and the basis for the alleged exemption.Any violation of
Secure 7071.5 by arty appliurt fora permit subjects the applicant m a civil penalty ofppm Np beC Occas anC T e
not more Nan love hundred dollars(1500). 1 3 622 7 U�1 . 00 p y yp
❑I.as owaa of the property.or mY,.Pl.y.with wages as their role compensation.
will do thework.and theswnu no
ure t intended or offered foe min(Sce054
.1 ,B ssineu
and Pmfessiom code:The Conummrs Licenm Law dose not apply b an owner of Required Inspections
own cmyww wildsorimprovvchimpr and who me not
intended
oroffe or through his
ownemployees,Ding or i Natsuchimporwmmtsin not intended oroBertA for owner..
however,the buildingor improvementissoldwithinone ildorimprovfortheowner-
saki.)
outlier will have she whim of proving that be did sur wile Or improv for purposes of
saki.) � - w/ '
❑ h as owner of the property.am armh siwlY contracting wish licc=d contractors to I /
construct the project(Sec.1044,Business and Pmfeasioas Cade:)The Conuana's Li
ecus law does out apply b an owner of property,who wilds or improves thereon.Nd
who comm
mment for such pmjecm with a conmcmr(s)licensed pursuant m dm cimmeloes s�
LlacnLaw. (��
❑1 am exempt under lee ,B&P C for this mason
Owner Dame
WORKER'S COMPENSATION DECLARATION
1 bemby aflim under peuW ty or perjury enc of the following decuretiou:
1 haw and will mai uWn n a Cu r3camo(Comenuo self-imuum far Worker's Compen-
mttw,as provided for by Section 3100 Of the labor Code,for the performance of she
work for which this permit is issued.
I haw and will maintain Werkees Compmeation Insurance,ss required by Section
300 of the Lmor Cade,for blue perrymmee or the work for which this permit is issued.
My Workeri Com--ppTTensation lupy mnce carrier and Policy number am:
Carrier. S�:V— ^-� Policy No.:OOQO SS'Sr6^�•O L
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu seems.,d not he complcmd if the pewit u formic hundred dollars(SIM)
nr less.)
1«rufy but in the performance of the work NO which this Pewit Is issued,l shall wt
cmploy my person in an,...or m as m become subject to the Workers'Compensallon
Lemur Califomia.Dam
Applicant
NOTICE TO APPLICANT:It.after making this ccNfcate or Eacmp5on,you should
income subject to the Workers Compensation previsions of the Labor Code,you must
.J z foMvoch comply with such provisions or this Permit shall be deemed mvoked.
Z '-'-' CONSTRUCTION LENDING AGENCY
mNw Ihemb aRm that Nem is a construction lending agency for the f
(~ Y B .) Y per uwauoce of
6i the murk for whim this pewit u issued(Sec.X19],Civ.C.)
CL A
Lenders Namc
D Under's Address
U0 1 certify that 1 have mad his city
and county
ymd sum that and
aWe im misting is -
0 H comm.l agree m comply and with all city and county ominanccf and sum laws relating to
QU movinyentimccsion.and hem
ns,rcu purposes.
sof Niscity mcmerupon the
annvC-rotor amd to san(On count flan keep ho.
F 0. (We)agree m saw,indemnify and kap nayin an they sy of a,airsno against
Z incoitiesjudcofidecoau and expenses which may in anyway acerae againslsaid City
(..7 z in conmgancc of the grmung cit Nis mit.
'-' APPLICANT DERSTA S WILL PLY WITH ALL NON-P NT Issued by:
SOURCE ULATI /�fS Dale
AcG Re-roofs /
Signature of ApplicaHAZAR O Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the Cupsmor rMuni wildinge.Chapter
havmommaterial
u defined by the 324), Municipal Cao.Chapter 9.11,and the Health and Safety
caJc,section zss3z(a)? All roofs shall be inspected prior to any roofing material being installed.
41 ❑rax $I�
Will the applicant or future wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit bitumens air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
D'mict?
❑Yes
la��/�A'Tl
1 have mad the lunmrms materials re 33 and 55 a,1 u derean d.95 oftheWilding
ria HulN&SafctyCodc.Scevoas25505.25577 mJ 25574.1 undersand shazi(shc wilding
docs not currently haw a tenant,that it is my respomiM1ility or notify dm occupant of the
mquiectemw chmustbemetpu issuw2aCcmficamor&ca cy. Signature of Applicant Date
Own Dat
All roof coverings to be Class "B"or better
CITY OF CUPERTINO
em 1 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36227051 . 00
DATE ISSUED. . . . . . . : 09/15/2006
RECEIPT # . . . . . . . . . : 36059
REFERENCE ID # . . . : 06090120
SITE ADDRESS . . . . . : 1059 W HILL CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : HASEGAWA DAVID
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : BONITA JENKINS
CONTRACTOR . . . . . . . : GRAEME BLACKBURN LIC # 27125
COMPANY . . . . . . . . . . : SMS ROOFING
ADDRESS . . . . . . . . . . : 1900 DOBBIN DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95133
TELEPHONE . . . . . . . . : (408) 254-7904
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------ - - - - ------- ---------- -- ----- --- ------ - --- ----------
BPERMFEE VALUATION 17, 000 . 00 245 . 16 0 . 00 245 . 16 0 . 00
BSEISMICRE VALUATION 17 , 000 . 00 1 . 70 0 . 00 1 . 70 0 . 00
---------- ---------- ---------- - - --------
TOTAL PERMIT 246 . 86 0 . 00 246 . 86 0 . 00
•
Community Development Department
e 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 t`her above stated policy on re-roofing.
s;/
Homeowner's Name: Q.� QA
V 6tlk�
Job Site Address: /067CAP—
Roofing Company Name: j11 S �i� �li w ctX'rf 22ci G
Applicant's Signature: - Date:
• Greg Casteel
Building Official
Revised 11/2/04
i
Community Development
10300 Tone Avenue
Cupertino CA 95014
Telephone(408)777-3228
F Fax(408)777-3333
&JPEI,TINO < 5/r��S3Fs - �zsZ - 1�oaN
Building De artment
JOB ADDRESS;Os9 441� C� PERMIT#
OWNER'S NAME: L&44� IPHONE # Z S 3— / 7 �L
GENERAL CONTRACTOR by #
sY I am not using any subcontractors-EMS .1 - �. 9 / � 0 6
Signature Date
Please check applicable subcontractors and complete the following 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
OE/Cont
Xgftire
Date
CITY OF CUPERTINO
REROOF
• CUPEkTINO PERMIT APPLICATION FORM
APN# z^ n� Date:
Building Address: /0-5—,7
OS ,7 /"^
/ -
Owner's me: / roc Phone#:
Co � ! �/ License 44:
ii// '' b� //a,�, •
YXS 33 Lf
Contact: Cupertino Business License #:
', Q
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) Other(Specify)6a4CL-, Q S-ti5. m
Number of existing coverings Provide I.C.B.O. Report#
❑ To be Removed f Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job essccnp On-
Residential
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: 0 Type of Construction: Occupa cy gr
000 V. — {
Qty. if
Applicable Fee ID Fee Description Fee Group
1 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
•