08080022 (2) CITY OF CUPERTINO a+m x&:4 vwa..�,�t�x' r*" `''� ' �• "
BUILDING DIVISION PERMIT INFORMATION
CONTRACTOR
BUILDING ADDRESS: PERMRNO.
1 ? ii8 / FALLCREL'K SPRIN CT LOS GATOS ROOFING 08080022
OWNER'S NAME: FERMTT LEVE DATE
./, ! V NATAN AND MARGALIT P 0 BOX 1726 08/04/2008
NE: SANIfARY NO. CONTROL NO.
ARCHITELT/ENGINEER: BUILDING PERMUINFO
REMOVEEXISTING SHAKE ROOF BLDG ELECT PLUMB MECH
0 0 0 0
300
LICENSED CONfRACTOR'SDECLARATION
u I kmby&M m that I am licensed under Provisions of Chapter 9(commencing -•-^ --- ^------- ^-----^- IO 'Description
gZ rich Section 70M)of DIAmm 3oftha Business and Prafessimu Code.and my license is
^?uan6i i=ac.and effoc D
l
t- Dam Contsacur
EE ARCHITECTS DECLJkRA1f1ON
W< 1 undersand my plans ahall W used as public nouds
g G t; ti-.d Professional
5 OWNER-BUILDER DECLARATION
y 1 hcreby union that 1 am attempt tram the Convenor's License Law for the
ZOO following mason.(Section 703 1.5,Business and Professions Code:Any city or county
$ which requires a Permit te emmncL her.improw.demolish.or repair my structure
_Z< prior an its iss..al.residues to applicant for such Permit to III easignedautcromt
F
that heishemsedpursuant totheprovistnmofth,Conumbr'sLiteenuLaw(Chapter 9 Sq.Ft. Floor Area Valuation
yds (commencing with Section 70]))of Division 3 of the Business and Professions Code)or
`< that he is eumpt tkmfrom and the basis fm the alleged samption Any viduii,on of
Section 7031.5 by arty.pplicsm(ora permit aubjecu me al,ican,to a civil Penalty of APN Number Occupancy Type
nm rom man Bw hundred dollars(M
1,u owar of tie pmpcm.m my maploym wins wagm u deb sok compenadon.
will do be work and the structure is no,intended ondRred formon(Sm.7044,Business
and Profesdans Code:The Contractors License Law saes rot apply to m asrnm of Required Inspections
pmpeny who WilN orimprows thmcon,andwhodoettmeh wmkhmeomforthrough his
awnemployces,provided con such improvemmta art not intended oraRemd for sale.If,
however.the building or improvement is cold within one year of compkoon.me owner,
builder will Itaw the burden of proving that k did wt Arial or improve fm purpose of
sale.).
❑1.u owner of dee Property.am"elusively enamoring with licensed considers to
construct the project(Sec 7044.Business and Pro(euions Code:)Tae Commewes U. .
coma Law saes not apply m an owns of property who books or improves thereon,and.
who canuacta for such projects wide a eonmacieds)licensed pursuant to the Contraetoes
License Lar's.
❑lam"emplunder See .B&PCfarthisd
owner Date-
WORKERS
amWORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury,but of Ihe following declarations:
1 haw and will maintain a Certificateof Consent to ulf-alum fa Waucea Compete
radon,all provided for by Second 3700 of the Labor Code.for the perform.of the
wort for which thin Permit is issmd.
1 have and will maintain Worla es Compensation Insural u required by Section
37110 of the labor Code.fed the parformam.of be vert fm which this permit is Wood.
My Workaei ampemati P Bsar co c+mr and Policy miaow
Carrier. l PollcyNo.:_LL�`4—
CERTLP7CAM LIP EXEMPrION FROM WORKERS'
COMPENSATION INSURANCE
(This=mh need not W completed If me permit is Imam hunNeddoBan($IOU)
or less)
1 carol that in to pmfarmarAe of the work fm which this Permit is issued.I shall not
employ any pcnan in my manreru u at become subject to the Worken'Compensation
Laws of California Data
Applicant
NOnCE TO APPLICANT.If.after making this Certificate of Eacmplum.you should
Eecmne abjm th the Wodam's Compensation po isions of dee Labor Code you most
.J z feMwim comply with such Nene nm.this permit shall he deemed revoked.
z O CONSfRUCnON LENDING AGENCY
(•r 1 hereby of mal that more is a constructinn[ending agency forme Performance of
rL
One work fm which this permit Is issued(Sec.3097,Civ.Q
0 Lundeen Name
z Leviers Address
U O 1 ersofy that 1 haw res l anis application and sum that the above information A
gy E comma 1 ague m comply wins all city teed county Orth.and stain Awa relating m
0 Wilding construction, u repnentatives ofthu city to moor upon the
tion,and hereby autbori
g21 above-mentioned pnopeny for inspection purpoles
g1s (We)agree m ave,indemnify and keep hanmlm the City of Cupertino again,
In h1dullblMiddgmmu.cola and"Persom which may in my way accrue against said City
t.)sZ in consequence of me granting of this permit.
^ APPLIQANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: az Date t'f
SO EREGULA S.
O
1 94�1r)7 Re-roofs
blifelium of ApplrcanU ouuactorate
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant m futhm building uccupant smre Orland].matured.,material
at defined by the Cupertino Municipal Cade,Chapter 9.13,and dee Health and Safety
ce Nan
,S 255324)?
04 All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building amup ret use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
ismiciardons air...lamirunu ss dcfimd by the Bay Ana Air Quality Management all new materials for inspection.
aY" D.146�
I haw read the huardmu maeria]s mWimmcros underClupterb.95 ofthe Caster-
ria Health A,Safety Code,Sections 25507.25533 real 5534.l urrdrstmd Lha if the Wilding ` t'✓( A-' _ elf(_
dam rot rmmly haw•tenant Out it u my responsibility m rectify me occupmt of do
reept orwnkhmavkmnm,peinra' nocmtireatenr a ter. Signature of Applicant Date
/l�l¢J All roof coverings to be Class'W'or better
owner tee mthorvcd agcot nam g
CITY OF CUPERTINO
• 2 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36651019 . 00
DATE ISSUED. . . . . . . : 08/04/2008
RECEIPT # . . . . . . . . . : BS000005674
REFERENCE ID # . . . : 08080022
SITE ADDRESS . . . . . : 11587 FALLCREEK SPRIN CT
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ZIV NATAN AND MARGALIT
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5118
RECEIVED FROM . . . . : LOS GATOS ROOFING
CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481
COMPANY . . . . . . . . . . : LOS GATOS ROOFING
ADDRESS P O 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
-- ------------- --- - ---------- ---------- ---------- ----------
1.13SEI.SMICR VALUATION 5, 898 . 00 0 . 60 0 . 00 0 . 60 0 . 00
1REROOFRES SQ FEET - 22 . 00 286 . 00 0 . 00 286 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 286 . 60 0 . 00 286 . 60 0 . 00
VOICE Ill DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- - -------- ----------------------------
601. ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
��� CITY OF CUPERTINO
REROOF
•CUCMOF
PERTINO PERMIT APPLICATION
otogooaa
APN# Date:
Building Address: C !
Owner's��N��ame: Phone #:
Contractor: /L_L_C S L1 Phone #: z10 6, -2 3 e`) g'_ 4) 1
CrcL. 'v S � U 0 � ✓? q
LJ Fax #: .41oF _2 J -
Cupertino Business License #:
;23 L` / Contractor License #:
i 0 70
Type of Roof Covering--
Existing:
overing:Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) >( Other (Specify) 30 ST 2
Number of existing coverings ❑ Provide I.C.B.O. eport#
To be Removed ❑ ProviiddeMfgr. Installation Specs.
S S — Roo e l4 s s7"—
Jot Description:
Residential Commercial Lj
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
Valuation:
there are any restrictions: El��
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
17
S a
tiyre
RAM
CITY OF CUPERTINO
IM REROOF
aclor
•CUPERTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FC0M Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
1RER00FRES Re-roof Residential B 1SFDWLR00F
J 1BSEISMICRE Seismic Residential B
1REROOFMRES Re-roofMulti-FamilyB 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC 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 comryila
the above stated policy on re-roofing.
Homeowner's Name: "t) Z/
Job Site Address:
Roofing Company Name:
Applicant's Signature: ///�� , 43 Zn -pate: 6/ 6 1
• Greg Casteel
Building Official
Revised 11/2/04
Community Development
.,. _ 10300 Torre Avenue
yy Cupertino CA 95014
Telephone(408) 777-3228
CI71 OF Fax (408) 777-3333
O.UPERTINO
Building Department
JOB ADDRESS: �7 () ' PERMIT # U Ue2:;�
_ OWNER'S NAME: J V PHONE #
GENERAL CONTRACTOR: S FAX #
m
I anot using any subcontractors:
Signature % D e-
Please check a22licable subcontractors and com fete the followin 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
t
Owner/C tracor Signator
"�_______.___--� Date