06030096 (2) CITY OF CUPERTINO `
BUILDING DIVISION PERMIT "+a,GONTRA.GU'I2=INOItMATIGIV• :
A�ALMRV..rh.J+....,,
BUILDING ADDRESS: Kvur.LNUO PEMMO.O 3
7624 ERIN WY
OWNER'S NAME: PERMIT ISSUE DATE
LARRY LYNCH 15230 CLYDELLE AVENUE 03/20/2006
NE: SANITARY NO. CONTROL NO.
(408) 626-9320
ARCHITE VENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
1 o p LICENSED CONTRACTOR'S DECLARATION
1 I meby affirm Net 1 am Iuavcd under pmvW=of Clupmr 9(commencing Job Description
NthSatian Mf � Busirw••andPmfcalomC ntl licence isimm�to= _ 2 � ` REROOF-REMOVE (E) LAYE H�) /®TALL NEW
Licence CILIC.N t rDamconveector1/2 CDY 30LB FELT & ACrS OEC ARI undsad a tea rods
1006
u4.y� Licensed Professional w
cp OWNER-BUILDER DECLARATION
MNAK3o 1 hereby aRrm Not I am exempt room the Contractors License Law far the u
following noon.(Salon 70013,Business and Professions Cade:My city or county
$9 which requires a permit to construct,altar,improve,demolish.or repair any structure
to poor m its Issuance,also requires the applicant for such permit to file asigned
sucmenl
MSthat he is licensed pursuant to Na provisions of the ConbamorLicense
s Law(Chapter 9 Sq.Ft.Floor Area
(commencing with Section 7000)of Division 3 of WC Business aM Profasims Code)or
Nu he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty ofOGCDanC Nym P y 1YPe
not more Nen five hundred dollars($500). 3 lU l �0 0
❑1,as owner of the property,a my employers with wega u Nei,sole compensation,
will do the work and don malum u not intended or offend fa sale(Sm.70,1,1.Business Required Inspections
and Profession.Code:The Contractornsn e ns
's License Law donot apply to an owner of q P
property who Wlldaof imp,aws Neman,and who doessuchwerk khoodfor through his
own employ=,provided that such Improvements are notintanded oroffered for ale.if.
hawaver,the building or improvement is sold within cove Sear efca idetion,the owner.
builder will have the burden of proving that he did net Wild a Improve for purpose of
sale.).
❑I,a owner of the property,am exclusively commming with limned conuaaon In
construct the project(Sea.7044,Business and Profusions Code:)The Contractors Li.
cane Law dos not apply m an maws of property wed Wilds or bnpoows thereon.and
who contracts for such projects with a conuacmr(s)licensed pursuant m the Conbacues
License Law.
❑14m exempt under Sec. .B A P C far thla mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby afnrm under penalty of perjury,ac of tit following declarm oro
J Ihawandw0lmainuina Ce r mofCatsen1m.if-insunfm Workers Compere
urian,as provided for by Semon 37M of Ne Labor Code.fa the Performance of the
work for which this Permit u Tavel
❑I have and will maintain Wakefs Compensation Insurance,as require!by Section
3700 of the LaWrCede,for the performance of the wale for which this permit is i!W.
My Workers Compensation Insurance carries and Polley number—am1:�
Cartier:�-�-(I: Ytn 1/17 Policy No.:
CEnf
RTIFIC�PTION FROM WORKERS
COMPENSATION INSURANCE
(This section need oat becomplem l Btic permit is faane,hundreddollars($100)
a leas.)
I cudfy Na In the performance or the work for which this permit 51mmd,I shall not
employ any person in any manor a as m become subject to the Workere Compeat
Laws of C.Iifamie.Dau
Applicant ,
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you shoved
became subject m the Workers Compensulon provisions of the Labor Code,you must
.J 0 fmMwiN comply with such provisions or this permit shall W daemon revoked.
'Z
.,r y CONSTRUCTION LENDING AGENCY
F-r Ihanby aRnm hast Nen is a construction lending agency for the perfermuae of
a 7 the week for which this perm,,i.issued(Sm.3097,Civ,C.)
aQ Lenders Name ,
Q Z Lender's Address
1 cenify inn 1 have tend NB application and sou that the stow information is
Iy^F cones I agree to comply with all city and county mJ,runces and sou laws misting to
Q U Wilding construction.and hereby authorize mpresentadws of Nis city to enter upon the
W ah m.nomfiared propcny for inspection purposes.
yy (We)Agra,o taw,Indemnify and keep harmless the City of Cupertino against
rI.5t aj15671 jMgmemY,<asu sed consensus which may in any way ec[me sgsinstaid City
'US
7 In eaveq. ce of Ne{renting of this Permll,
rte- APPIJQA DE N S NC N(1L COMPLY WITH A NON-POINT Issued by: Date
SOU 'I RE U �I1 .
Ota Re-roofs G7lZ—
'� Slgnas�ApplicantK.bnmamf' Dat
HAZARDOUS MATERIALS OISCLO 11RE Type of Roof
Mllthaappliantafuumbuildingacupanu,omor dle hvsrdous mamrsd
a deffnod by IM Cupertino Municipa.Code,Chapmr 9.12,and the Health and Safety
Cede.Section 25532(4)7 All roofs shall be inspected prior to an roofing material being Installed.
peen u P P Y g g i
Will the applicant or futum building occupant ver equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It heevdoas air canuminau u recd by the Bay Area Air Quality Management all new materials for inspection.
atriCl7
0Ya Nu
I have noel the Wardaus mamrlalsooquirementsunder Chapmr6.95 ofthe CAlifef.
nSHylthWiety Coed oro 2550534.lodcsts ifthe Wilding
d nacumer� bow a meant VP
ihility m notify IW occupant of the
-1,11 F .bwmek roofOccupa �o(, Signature of Applicant Date
owneraramnmsi>edsenl ;�Il� Dam All roof coverings to be Class'B" or better
CITY OF .CUPERTINO
'1 of 1 PERMIT RECEIPT OPERATOR: suem'
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35921018.00
DATE ISSUED. . . . . . . : 03/20/2006
RECEIPT #. . . . . . . . . : 33634
REFERENCE ID # . . . : 06030096
SITE ADDRESS . . . . . : 7624 ERIN WY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LARRY LYNCH
ADDRESS . . . . . . . . . . : 149 VIA DE TESOROS
CITY/STATE/ZIP . . . : LOS GATOS CA, CA 95032
RECEIVED FROM . . . . : RE ROOFING
CONTRACTOR . . . . . . . : PROCTOR, PAUL LIC # 20615
COMPANY . . . . . . . . . . : R E ROOFING & CONSTRUCTION INC
ADDRESS . . . . . . . . . . : 15230 CLYDELLE AVENUE ,
CITY/STATE/ZIP . . . : SAN JOSE, CA 95124
TELEPHONE . . . . . . . . : (408) 626-9320
WE 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 AMOUNT NUMBER
_________________ ------------ ___________-_---__
CHECK 181.46 9872
TOTAL RECEIPT 181.46
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
" Telephone(408) 777-3228
CI OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS: r 2 I '/_.RI. ( W (J PERMIT #„ r — j 3 QCJ I
M
10
OWNER'S NAE:, f t,DLKPI-M C/L- I4 C* PHONE # �G Z - '3 2--D
GENERAL CONTRACTOR: u J¢i N FAX #
5CON T -f9N 1 1(`(C.
I am not using any sub ntractor ZO t) 6
Si' ture ' Date
Please check applicable s, .—ntra ors-and complete lete the followinginformation:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &r 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
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
• IAIW, Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
Building Department
4
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: tl�—ng C '�'y� • /
Job Site Address: 16 2 4 I �� 1 Vy
Roofiompaname: �% Indo(N 4— ' Ovi
Applicant's Signature:^' \ Date: �2 y 10 b
i
• Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CITY OF
•CUPEkTINO PERMIT APPLICATION FORM O �<300
APN# ,359 ai oDate: n/2010(0
/� 2''�1
Building Address:
q6 2-q L�I �j Y V M
Owner's Name: Phone#: 40k-
1 U� 2 y
Contractor: LAW L-�10 6� Phon ' C
e#: 4u�_ 626 _ License#: z q
�dx 1S 91�2-Phone#: O Cupertino Business Lic nsle#:
Contact��W 1
2-0
/_�SO�� Type of Roof Covering:
Existing: C U S 7ZjS fS�Prsed:
❑ Built-Up Roof ❑ Built-Up roof
El .Asphalt Shingles Asphalt Shingles
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�
C, SS
I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: 'F,CHJW C tkw wq l � b woLA) �MP�<� tN5-rA-L lu cti l 'Iz„ Cvy
3-u it kSIN
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Proje �� Type of Construction: Occupancy group:
l� YZ,3
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
•