NO PERMIT NUMBER (4) CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32613040 . 00
DATE ISSUED. . . . . . . : 09/25/2006
RECEIPT # • . . . . . . . . : 36184
REFERENCE ID # . . . : 06090226
SITE ADDRESS . . . . . : 22354 CARTA BLANCA ST
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HELEN ING
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : PRINCIPLE ROOFING
CONTRACTOR . . . . . . . : DERECK LOI LIC # 27564
COMPANY . . . . . . . . . . : PRINCIPLE ROOFING &
ADDRESS . . . . . . . . . . : 1700 NORTH 1ST STREET, #154
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 436-1681
WE 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
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 246 . 86 MASTERCARD
TOTAL RECEIPT 246 . 86
•
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 2n LOr 1-3-040 Date: 09 25'/06
Building Address:
22354 cam, a
Owner's Name: Phone#.
Pyji J�2Cr C4o�) 7,7 _ � 27d'
Contractor: License#:
,,Win G' v - �u7✓S 8/63 9
C ntact; Cupertino Business License#:
-DE2EG,� la i
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ i t-Up roof
❑ sphalt Shingles fid Asphalt Shingles
1 " Wood 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 With Cu ertino's Tear Off Policy:
Job Description:
R.c,iHov6 & ' ti.✓y tyno� SHu/� /� Ca �;frc t sG.,;� 3�
Residential Commercial ❑ �f r
Fire Zone: Yes ❑ No ff- Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy groupr—�
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
CITY QF CUPERTINO
BUILDING DIVISION PERMIT ,-
BUILDING ADDRESS: PRINCIPLE ROOFING & P"B""NO-060902215
LIT
2,2354 CARTA BLANCA ST
OWNER'S
WNER'S NAME: PERMIT ISSUE DATE
HELEN ING 1700 NORTH 1ST STREET, #154 09/25/2006
NE: SANITARY NO. CONTROL NO.
(408) 436-1681
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�oo LICENSED CONTRACTOWS DECLARATION
I hereby afflm that I mi licensed under provisions Of Chapter 9(commencing Job Description
wide Section 7000)ol'Divisairso 3 of the Business and Proicosion,Code,and my license is
lif airREROOF- REMOVE EXISTING, INSTALL ASPHALT COMP
iqz C'31 C? Uc.as :j 16 it gr
Dow SHINGLES, 38 SQUARES, CLASS A
OW BO PtRCHITECTS DECLARA&Idl
I understand my plans Mall lic=it or public war&
51
MLicensed Prefusimml OWNER-BUILDER DECLARATION
MI Ocralty fr,.that I AM Counipt train d Commebor's License Law for the
:0 following rumors.(Section 7M 1.5,Business and Predications;Code:My city at musty
jl� which requires a Permit In construct,also,improve.dOmollem.Or repair any structure,
zC prior k)its issummus,Mae niquirm;the applicant for such permit to Ille a signed monsoon,
that he Is licensed passional.to the provisional of the Contractor's Ucc.Law(Chi 9 Sq.Ft. Floor Area ValiFC 5 l 0 0 0
(commencing wish Session=
ession 7=)of Division 3 of dom Business and Prollossions Cosic)or
That he is menial chounifinerat and the bom;far the alleged cumption.Any viodadon of
Section 7031.5 by any applicant for a permit subjecus the applicant us a civil penalty ofOccupancy Type
Out mom an.five handled dollars(SM 3NMN 8cr 0 0
C3 1,to noviver offt Property,Or my employees wish"gnu their sets compenudon,
.ifl&d."&..dthesmvumbn.tL.W.dedoroffmdrw-k(S=.7044.BLainess,
d Poolession"Code;The Committees License Law dorsnot apply in an owner of Required Inspections
an
Property who buildlacrimprowsuismarn.andwhe docesusel,work himselfor through his
Own emplaysm,provided that such lespormasomeng on,not Inuournoted oroffered forside.If.
however,the building ortraperowment Is said within am year ofourropleflon,the mormer.
builder wig have the burden of proving shot he did set build Or Improve for purpose of
cals.).
0 1.as ownse,of use Property son muclusively comb ing with licensed convactars as
constract the project(Sec.70".Business onal Professions C0,10 Its cormalm's U.
comes Law it=not apply in an owner of property who builds or broprom do®rman.and,
who comosm,for such projects with smouramor(s)licensed moramial w the Commissars
License LA.,
0 1.neap,under Sme. B As P C far this resort
Incir Dow—
WORKERS COMPENSATION DECLARATION
I hereby affm under penalty of perjury am of the following canclannedona:
son I how and will maintain a Certificate of Consent to self-Knon for Worixo's Comport.
sation,u provided far by Sutton 3700 of the Labor Code,for the performance of da
win
wouir for which this penult is lease.
0
0 1 how and will mushissin Worlect'i Compensation loomsim,om required by Scatter,
37M of the Labor Code,for the pcorforcrarom ofthe work rat which this permit Is bound.
My
My Warimes co,sposmatiour carric,and Policy monitor anne:
Can
Carrier k&agrAJPmicy N..:_1&/qR1
TE 0MEM MON FROM WORKERS'
COMPENSATION INSURANCE
(This voodoo need Out reconstituted If the permit is forms hundred drallars($100)
or ko.)
I cardify that in the performance of the work far which this Knolls Is house,I shall as,
employ any person in my mannan as u,become abject to the Worienro'Compensation
Lows of C.Illia.l.Dow
Appleton
NOTICE TO APPLICANT:If.after making this Certificaw of Exemption,you should
became subject in the Worker's Compensation provisions of the Litior Codc,you am
Z forthwith comply with such provisions in this permit shall as seemed revoked.
z a
C/1 CONSTRUCTION LENDING AGENCY
Fv I limcb,4111M Our fts is a construction to,the"forromerm.r
> the orm):for which this Permit Is issued(Sec.3M,Ch,C.)
Undoes Nunn
Lomim's Addiress
U Q I ccdfy that I heve read this application and mrs,thou the above informitim,is
il.' consuct.I as=ta comply with all city and county ordinances and SLALC 13M Totaling ta
0 V building consumetion,and hereby aummito refuncesiouim of this city to order upon the
above-mmunmol pmperty for insfaccumi Purposes.
(Wo)agree to saw,militantly and loop harmless the City of Copenino ogamst
limilificajudgmentAmeas and expenses which may In any way acrue agAinsusaid City
V in APPLconIC pseence or ft DEZooming of this rmit.
NT UNRSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date -z-
SOURCE F.&CULATIONS.
Re-roofs G/
Sigodum ofAimficala/Comoushor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will ft applicant or fat=touldin;Occupied slose or handle hazardous mallonal
as defined by she Columbia Municipal Code,Chapter 9.11.and ft Health ad Safety
coda
Somas 13531(+)7
-*� All roofs shall be inspected prior to any roofing material being installed.
ova alN. If a roof is installed without first obtaining an inspection,I agree to remove
41 Will the applicant or future building Occupant use equipment or i1twims which
emit hii/Andirma air conumaloares at i1c[bim!by the Bay Area Air QuAily Management all new materials for inspection.
0Y. CfN.
Item.read ft
.i.H.I"Safety Code.S.d.255W.25533od25534.1 understand and ifthe bufE.1
does but currently how B uscrou.that It s my responsibility to ratify the actimart Of the
requincinced,which mass be ML prior M issuance a($Certificate of Signature of Applicant Date
VIn - M/N/1 7/1 All roof coverings to be Class "B"or better
I Owner or authorized Agent Dam
Elk
Community Development
Torre Avenue
It,
t k C pOertino CA 95014
aTelephone(408)777-3228
CITY OF Fax(408)777-3333
I&MkTINO-
Building Department
JOB ADDRESS: a PERMIT #
ZZ3S4 L , zN-e,- ,cep S! 6 (5,? d2 L
OWNER'S NAME: y;,C PHONE # 6aog) t _ Iy
GENERAL CONTRACTOR rk,�;c+' FAX #
I am not using any subcontractors: a9/24-?/C�z
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
Septic Tank
Sheet Metal
Sheet Rock
Tile
• 49l 2-f ate
Owner/Contractor Signature Date
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: 4LaZe'12 C,-
Job Site Address: 22 35-4 ti 57`
Roofing Company Name: g::L4�'4ZP /Zaatiy, C�vC*s�/�
Applicant's Signature: ) - Date:221__"1c' 19
•; Greg Casteel
Building Official
Revised 11/2/04