06090087• CITY , CUPERTINO
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BUILDING DIVISION PERMIT
aC�iV ,RA&,NFORMATIO N,:.
BUILDING ADDRESS:
FAL ON ROOFING
PERMIT NO.06090087
21932 WOODBURY DR
OWNER'S NAME:
PERMIT ISSUE DATE
MERKHOFER ALICE
13088 POTTS DR
09/13/2006
NE:
SANITARY NO. CONTROL NO.
(408)225-1705
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTORS DECLARATION
Job Description
1 hereby am that 1 am licensed under provisions of Chapter 9 (commencing
with Section 7008) of Division 3 of NC Business and Profession Once,an my lkenx is
inmllforc awofw o
REROOF- TEAR OFF WOOD SHAKE, REPLACE WITH 1/2"
LicemxClass
50 YEAR COMP 30 LB CLASS A
Da¢ GOOL
DECLAMATION
ARCHITECTS DECLARATION
1 undcrsunJ my plans shall M uud u public scorns
Licensed Professional
OWNER -BUILDER DECLARATION
the Conuanah License Law for the
1 Wmhy alarm our I em uasin
following moon. (Section 703LS,Busines and Pmfevsinfi Code: c or
. an
*city
nOm.
which require a Permit re construct, alter. Improm, demolish, sir repair any swnum
to itscensed e,cels.requite the applicant forsuch Corwourniuo rile Law(summcm
Conus Limns Lawl
Sq. F[. Floor Area
ValuhlbB800
the
thathe mencing wit pursSection 7 ) of Division ProfessionsiCnEe) of
(commencing r the Business Code) or
of Diasis
(cat
p th dexompt
Nat he u exempt thertfrom and tM buts fa the alleged exmpuan Any violation of
h, is omfon r and
Occupancy Type
Section 7031.5 by airy applicmt for a permit subjects the applicant to a civil penalty of
not mos Nan five hundred dollars (S500).
3AEN�Iumber
L2 6 3 7 0 21.00
I, u owner of flue property, or my meployces with wage u their sok eompeuodon,
Required Inspections
q P
will do the work, and the suucmre u not rounded or offered for sale (See 7066, Business
and Professions Code: The Comunors License Law dots sot apply m an owner of
who ndwho Mmxlforthmugh his
Oproparrywn am aressuchwork
indfor
yaca. idsmimprovethed such impro
ownemploy semenuaxm ear
mamlf.
ofdaronertd
tis the
however. thebuilding arimprovementuhathwithin ane year of
Wilding improvement
improve purpose of
builder will have Ne burden of pressing that he did not build or improve for purpose of
scu
0 1. exclusively contoctng with Iittucd contractors x
❑ h u owner of the ,
71
the Sec. 70 , B ns Code) Conhercons Li-
canstmct (Sec. Business and PrOftiproperty
who proire
tens law dots not apply m an owner or property who builds or improves dsereon, and
es not o an
who contra<u for such projects with a conuaeteRs) licensed pursuant m the Conuanah
Licence law.
❑ 1 am exempt under Set. . B & P C for this recon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affins under peat of perjury, sate of the following declarations:
I ham and will maintain a Cmtifcmx of Consent m x117 -insure for Workers Compen-
sation, as provided for by Section 3700 of the Labor Cade, for the performance of dm
wwe& for which this Permit is issued.
ly t nave and will maintain Workers Compensation luuronce. u required by Becton
3700 of Ne labor Code, for Ne performance of the work for which this permit is Issued.
My Wmke(s Co-mpeualion rantt rticr and Policy numberare:
Carrier. Polity Ns.: —
CERTIFICATEOFE)EMPIONFROMWORKER
COMPENSATION INSURANCE
(Dtu section reed rumbecmmplc¢d if the permit is (wont hundmAdollars ($100)
sir loss.)
1 certify thar in the performance of tim work for which this permit k issued. I shall not
employ any perhan in any maonerha as in become subject m the Worker] Compensation
Laws of California Date
Applicant
NOTICE TO APPLICANT: IL after making this Ccnificare of Exemption, you should
become subject m the Worker's Compensation previsions of dm Labor Code, you must
forthwith comply with such Previsions or this Permit shall Inc deemed revoked.
CONSrRUCfIONLFiVDINGAGENCY
Net them issed(Seetinnlending agenry, for the Performance of
for whaRrtn
the work for which this permit is issued (Sec. 3097, Civ, C.)
AName
lenders Address
"
1 certify that 1 have read Nis apidica m and some that the above Lot mmatiun is
comet. I agree m comply with all city and county ordinances and sure laws relating to
building construction, and hemby aulborre represemutims of this city to enter upon me
above-momwned preitcny for inspection purposes.
(We) agree m save, indemnify and keep harnleu the City o(Cupcninu against
liabilities judgments. costs and expenses which may in any way accrue against said City
SNis permit.
of the UNDERSTANDS
A APPLICANT
+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT'
ISSUed by: Date �_/
SOURCE
QF.(.�TIONS„
Re -roofs
s -'m"�
�
. s�
pale
Signewre of APPlicaHAZAR
O
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will tW m (mum Wildinghandle material
Be,Cupent
u defined by e Cupertino Municipal Code. Chapter 9.12, and the Health and Safety
k. Chapter the Health
Codc, Section 25532(a)?
C Yes �o
All roofs shall be inspected prior to any roofing material being installed.
forum tiding
If a roof is installed without first obtainingan inspection, I agree to remove
p g
W II the applicant or W mcupant use equipment or acute: which
emit hazardous air contaminants u defined by the Bay Area Air Quality Management
all new materials for inspection.
Disuic? J
❑Yu tlrvu
I have read the harardsus materials requirements under Chairre,6.95 of the Calif.,.
ria Health h SafctyCode. Sections 25505,255J3vW 25534.1 unJerwM lhazifdc Wilding
does not cumendy have a ¢nark that it is my respomibility to notify the occupant of Jz
requiremen7 whictmustbcmetprierto�'symmm<eee on Certificawnfacuponcy.
/�a��'V
Signature of Applicant Date
All roof coverings to be Class "B" or better
Owner m aamnred spent � p,rc
CITY OF CUPERTINO
om 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # : 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 32639021.00
DATE ISSUED.......: 09/13/2006
RECEIPT #••.......: 36023
REFERENCE ID # ...: 06090087
SITE ADDRESS .....
SUBDIVISION ......
CITY .............:
IMPACT AREA ......
OWNER ............:
ADDRESS ..........:
CITY/STATE/ZIP ...
21932 WOODBURY DR
CUPERTINO
MERKHOFER ALICE
RECEIVED FROM ....: FALCON ROOFING
CONTRACTOR .......: MARIO RENTERIA LIC # 22568
COMPANY ..........: FALCON ROOFING
ADDRESS ..........: 13088 POTTS DR
CITY/STATE/ZIP ...: SAN JOSE, CA 95111
TELEPHONE ........: (408)225-1705
*EE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
-------------------------------------------------------------------------
BPERMFEE VALUATION 11,000.00 180.36 0.00 180.36 0.00
BSEISMICRE VALUATION 11,000.00 1.10 0.00 1.10 0.00
TOTAL PERMIT : 181.46 0.00 181.46 0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
•
AMOUNT
------------
181.46
181.46
NUMBER
------------------
4237
1�J
CITY OF
IOUPERTINO
E
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Devartment
JOB ADDRESS: PERMIT #
,-� Z3 Z (: � t1 o a`?
OWNER'S NAME: /Z " PHONE # -:Z S
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: (2-0 Q " t/ 72,�Qr-/3-^
Signature Date
Please check applicable subcontractors and complete the following information:
66
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
Owner/ Contractor Signature
Date
SHNA
• COYor
CUPERTINO
•
0
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN #
Bldg Permit Fees
Date:
Building Address: p�
01 U2
Energy
Owner'sNa e:
/i�s,
BSEISMICRE
Phone #:
yok
Contractor:
BSEISMICOM
License #:
3 Z
BUILDING
BPLANCHK
p
Contac[: 2 25
Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built -Up Roof ❑
Built -Up roof
❑ Asphalt Shingles ❑
Asphalt Shingles
❑ Wood Shakes ❑
Wood Shakes
$, Wood Shingles ❑
❑ Other (Specify) V
Wood Shingles �r
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 With Cu ertino's Tear Off Policy: ❑
Job Descripti
Residential 9 Commercial ❑
Fire Zone: Yes ❑ No E�l
Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of project: D &oT' e of Construction:
q, 0-0 �
Occupancy group:
e- r=
_ 3
Qty. if
Applicable
Fee ID
Fee Descrintion
Fee Grrntn
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 •
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� finaltinspection 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.ofiall new material down to the,sheathing,
so a proper CiW 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: C, t'\
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: / e5 Alz k o FQ2
Job Site Address:
Roofing Company Name:
�PiIL I2n �6p %! N c
Applicant's Signature: ( c Q_ Date:
Greg Casteel
Building Official
Revised 11/2/04
•