08090169 (2) CITY OF CUPERTINO
BUILDIf1G DWISION' PERAUT CONTRACTOR�INk'OILMATIQ,N
x x�3';, ..� fid. ..• T+ * rise:
BUILDING ADDRESS: PERMIT NO.
11111 BUBB RD LOS GATOS ROOFING 08090169
OWNER'S NAME: PERMIT ISSUE DATE
KIMITSUKA GLEN H AND LESLIE P 0 BOX 1726 09/25/2008
SANITARY NO, CONTROL NO.
ARCHITEC iENGINEER: BUILDING PERMRINFO
RF RF RMV EXT SHKRF INSTLRF BLDG EO PLUMB MECH O
u o o LICENSED CONTRACTORS DECLARATION
F . 1 hmcby IMM that I sin liacesed ander PiovWOM of Chapter 9(commercmi --•• ----^-------- --_ ,. - ..,.„ ob Description
n� with Scetion 7=1)o fDivision S of the Business and Noressions Code,and my license is
O y in full force and of
j z Licerue L'e.g 0
k, Dam Com 1C
QQ AMELTS DECLARA ION
�3U 1uMM
understand my plans slullthe usNupublic taMNs
6
40fe LumucJ Profasionel
OWNER-BUILDER DECLARATION
I bunchy affirCh that I sm exempt from the Con"Con's License law for the
Mfollowing mason.(Section 703 1.5.Business and Profebiom Code:Any city or..my
which mquira a permit b con^^ alar,improve,demMlu e.m repair any Conscious
-i6 prior rsb ice issuance.also mquiros the applicant far such permit to filoasiined=dement
£ dust heislicensed puuasttothe provisions ofthe Contalici
ctor'snaeLaw(Chapor9 Sq.Ft.Floor Area Valuation
y�0 (commencing with Suction7000)of Division 3 of this Business and Professimas Code)or
Yi'3 9 that K is eumpt therefrom and the basis for the aliged exemption Any violation of
Sebivn 7031.5 by say applicant fm a permit subjects the applicant to a civil penalty of APN Number Occas pry,
nut mom than five hundred dollars(5500). Occupancy Type
I,u owrty of the pmpusy,a my wployma anpb W.gn ss then role compensation,
and de th cion,and the sh Com is n es Lica
a or Law
doxknsk(Sex.7014,weer of
and orty who
ons Code:The CMntrxlnrs Laccase law dila not apply b an awncr of Required Inspections
propem W ymos.pro orimprowach Improvements
ved who doastmh mist or self orthrough his
Mwnemt.the Wilding
providedorI that such impmsemenu tie not intended mCBered fa We 1L
however,the building a improvement b sold within one you ofimpro a for
the purpose
of
build¢wi0luse Um bundut Of proving out K did Out bold or improve for puryoa of
ak.).
❑1,as owner of the progeny,w exclusively contracting with licensed contractors he
constant the project(Sec.]tied,Business aced Professions Cada:)The Contrxmh U.
cense Law doe not apply in an Manor of property who builds or improve memos,and
who contracts for such pmjecu with arnnuactons)licensed pursuant to the Contractors
License law.
❑lam exempt undm See ,Bk PCfmthtsmason
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hembl alarmunder penalty of perjury oro of the fallowing dmlaadom:
1 MK and will maimaln•Certificate of Covent b self-imam fee Wooers CMNW
Mion,as provided fm by Section 5700 of the labor Code,far the performance of the
wan for which this permit is issued,
❑1 have aro will malnuin Words Compensation Insurance,as rryvimd by Section
37W of the Labor Code,for the performance ofthe won for which Nu permit is issued. '
MY Workers Crmwopamnedon 1.arlm and Policy number am
61
Cartier. an a'vT/✓I Policy N.:
CERTIFICATEEXEMPTION R �CC
S
COMPENSATIONINSURANCE
(Thuueuoo mN Trot be completed if the Permit a forms hundred Milan($I00)
or loss)
1 anufv out in pm pmformarce of the rorlifor which this Permit is issued,I sludl nm
employ anyperbn in any manner se as b became ubjmt in tM Won<rs'Compemation
laws Mf California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become abjcm to the Wands Compensation provisions of Into lab¢Cede,you bbt
.,O forthwith comply with such provisions Of this Permit shall be deemed revoked.
g%J CONSTRUCTION LENDING AGENCY
[� IWelty M.that then is a construction lendingagency for the pMormarcs of
C' dm won for which this permit u issued(See.3(y97,Civ,C.)
I<ndds Name
z Lenders Address
U FO 1 coolly that I have d this application and sum that the above information is
L,E Correa 1 proe b Comply with all city and county on inances and are laws relating he
O building cMtarseion,and hereby authmiae repreenutiw Clines city in color conn ft �3
mtY
for
CL
rW show-mentioned prop costs
and calumet
which may
V`��d VC/V
(We)agree to save,indemnify and keep harblw the City of Cupertino against
h incoisulmengmcnia.,ofthe asuang of
Which may in any way accrue against=it City
U z A PLIC core of tide Rnntini of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued b
SOURCED 0 Y Date
Signature arrApolte�ntic nmacmr Ot Re-roofs
Dam
H ARDOUSMATERIALSassomOSURE Type of Roof
Will the applicantmfMuni buildinge.Chapter
or andda Health and
as dented by pc Cupertino Municipal Code.Chapter 9.IT,and the Health roti Safety
Code.cation uslz(.)7
DYa 'No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occapam use equipment or derica which If a roof is installed without first obtaining an inspection,I agree to remove
a Ia:omit"air contsmina�[u as de0ucd by the Bay Ama Air Quality Management all new materials for inspection.
❑Yo D No
I,&SafelyC the daaections 2550,2553hi 3mmentsuMder Clupur6.95of h,Wilding
Chia Halth&Safmy avc a smart,
ESi it
M 33amI2553J.I undcrsmLthin ifthcbuilding
docs out maxciarrindy hast a¢nam.put it u my.of.cc u b notify tic mcupmt of
myuircmenu anti deuce logon to ivuancu ofa CetiOau of Ocev
P Sign�opll ant Date
yg7l 9_ o
Oanner m mbemad qcm Dau'
All roof coverings to be Class'A!'or better
CITY OF CUPERTINO
• 2 ITEMS OF 4 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35620005 . 00
DATE ISSUED. . . . . . . : 09/25/2008
RECEIPT # . . . . . . . . . : BS000006184
REFERENCE ID # . . . : 08090169
SITE ADDRESS . . . . . : 11111 BUBB RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KIMITSUKA GLEN H AND LESLIE
ADDRESS 11111 BUBB RD
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4956
RECEIVED FROM . . . . : LOS GATOS ROOFING
CONTRACTOR . . . . . . . : RANDY BLOWN LIC # 23481
COMPANY. . . . . . . . . . . : LOS GATOS ROOFING
ADDRESS P 0 BOX 1726
CITY/STATE/ZIP . . . : LOS GATOS, CA 95031
TELEPHONE . . . . . . . . : (408) 298-9399
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 7, 447 . 00 0 . 80 0 . 00 0 . 80 0 . 00
1REROOFRES SQ FEET 30 . 00 390. 00 0 . 00 390 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 390 . 80 0 . 00 390 . 80 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 742 . 70 #2691
---------------
TOTAL RECEIPT 742 . 70
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
CITY OF CUPERTINO
REROOF
CM of
CUPERTINO PERMIT APPLICATION
APN# .3S6- 2z—dOS, o c-) Date: 9I IO
Building Address:
I I I I I *-
Owner's Name: Phone #:
Glen Imi�S'u ct, (050) 2141-1603
Contractor: 1 ` v Phone #: 61 < 9
Cupertino Business License #: Fax#: 416),? off- JL3 -Ii
P r� 3 LI g / Contractor License #:
h / , ov ') 07
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt ShinglesAsphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shinglesp_� ;�, �
❑ Other (Specify) Other (Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report #
To be Removed Provide Mfgr. Installation Specs.
�• s
-2 _5
J C00Y l%Ig SS
Jot Description:
D
Residential Commercial L]
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
Valuation:
there are any restrictions: ❑
� , /
I Have Read, Understand and.Will Comply with Cupertino's Tear-Off Policy:
Si re
CITY OF CUPERTINO
`�` REROOF
CITY OF
• CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
IREROOFCOM Re-roof Commercial B 1COMMLROOF
113SEISMICO Seismic Commercial B
3d 1RER00FRES ERe-roofResi den tial B 1SFDWLROOF
1BSEISMICRE Seismic Residential B
?1BUSLIC
OFMRES Re-roofMulti-Family B 1MFDWLROOF
MICRF; Seismic Residential B
Business License B
•
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 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:
Job Site Address:
Roofing Company Name: (J S
Applicant's Signature: L Date:_J d
• Greg Casteel
Building Official
Revised 11/2/04
Community Development
x1 �. 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
*CUPEkTINO
JOB ADDRESS: BuildingDe artment
/! 6� L'�� / —' PERMIT # 0 (/ 0/ 0
� � (0
OWNER'S NAME: ej� PHONE #
GENERAL CONTRACTOR: S S FAX #
I am not using any subcontractors:
Signature Da e
Please check a licable 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
Septic Tank
Sheet Metal
Sheet Rock
Tile
ner/ ontracto ignature Date