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06010165 (2) CITY OF CUPERTINO "9 ,;,^�a . ""^"1"'^•'": "` • , ''' BUILDING DIVISION PERMIT yfCQNTRrS.CTOR,TNY• 12MA'PrONa eU1LDINGADDRESS: KEITH ROOFING CO INC. PERMIT NO.06010165 10408 JUDY AVE OWNER'S NAME: PERMIT ISSUE DATE GARY MOUNTAIN 920 LINCOLN AVE- 01/30/2006 NE: SANITARY NO. CONTROL NO. (408) 295-8616 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDGMFICH O EO PLO O trop LICENSED CONTRACTOR'S DECLARATION idu1 Mxby Aram that I un licensed under provisions of Chapter 9(commencing Job Description TT IN swum 7000)afDivision 3 of the Busircss and Professions Code,and my license is j2(�)y�f II��\ �j p ^� Nfull form and ctrl– VC"#YAL r� �IlsgI---.zppp o.m xaass Lle.f ter TEAR OFF COMP ROOF & COMP RO �f g/ „{\! i�lyyrh% 3 ARCHTIECTSDECLARATION AFRI qi 1 uMcuund my plans shall W used u public mcnrN o�S AN- Licensed Professional 2006 5 OWNER-BUILDER OWNER-BUILDER DECLARATION Ihereby.(firm then I ten exempt from the C Law for y toan following (Section 7031.5,Business andprofessions Code: Anycit lircoumt which txqulrns a permit to eonswet altar,Wpew,demolish,lir repair � my structure –zi prior at its issuance,aim requites One applicant for such permit to rile a signed mit .1 C But he is licensed Pursuant N the provisions 0f the Contractors license Law(Chapte,9 Sq.Ft. Floor Area Valuati 6'007 �$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)at �.. that W I.exempt Beefrom and the basis fur Ne alleged.emptioo.My i.latles,of Secdon 7031.5 by any applicant for.permit subjects the applicant in a civil penalty of APN Number Occupancy Type am mart Nan riw hundred dollars(s501). 37510002 . 00 0 1,as owner of"property.army employees with wage.as IWh 034 compensation, .111 do the work.mdNaauucmx is.1 intended marmot formin(Sm.7044,Business Required Inspections and Professions Code:The Contractor',License Law does not apply N e an owner of q P property who builds or impmoss rherean.and who deeuuch work Mmsel f or through his own employees.provided Nal such improvements ora not Intended uranered fantasia.If. howewn cite building or Improvement is sold within one year of compledm.the owner. builder will have the burden of proving that he did nm Wild or Improve for purpose of sate.). 0 1,As miner of the property,am emlusiwly contractor;with licensed conu.ebn as construct the project(Sec.7004.Business and PmfcWm Code:)The Contnetors U- cense Law does not apply in an owner of propene who Wilda or improves Brcomm.and who contracts,for such projecav with a contractor(s)licensed pundent to me Contractors License Law. O l am exempt under Set .B R P C for W3 mason Own. Date WORKER'S COMPENSATION DECLARATION 1 hereby atBmr under penalty of perjury ane of the following dxlamlions: 1 ham and will maintain a CaAfimu of Consent inselfdnsux for Workers Compete :Nan,as provided for by S.don 3700 of the Labor Code,for the performance of the work for which this permit is issued. 0 1 have and will maintain Workces Compensation Insurance,as required by Section 3700 of the Labor Cade.fm Be performance of the work far which this permit is issued. My Workefs CamPmuWm� curia and Policy number s Carrier. F Policy No.: S�2I��37j3 CERTIFICATE OF EXEMPTION FROM WORKERS* COMPENSATION INSURANCE (This section need not W completed lithe permit later=hundred dollars(SIM) lir leas.) 1 modify that In the performance of the work for which this permit Is issued,I shall not employ any person In my manner an As An Immune sine subject to Ne Workers'Compensation Laws of Califomla.Dam Applicant NOTICE TO APPLICANT,If.After making this Certificate of Excin awn,you ahold become subject to the Worker's Compensation pmlaons at tie LaWr Codc,you muss OZ forthwith comply with such provisions or this permit"I W deemed remked. ' z'ti CONSTRUCTION LENDING AGENCY p. I Mxby slRrm Bw dem is a construction leading agency for the performance of ya> tise work for which this permit is issued(Ss..3097,Civ.C.) ' aQ Lendces Name 7 Z Lender:Addresa U 0 1 certify that 1 have read Nis application and atste that the aWve information is {Li',••' correct.1 agrte N comply with all city and county ordinances and Bute Iowa reeling N 0 rU^ Wilding construction,and hereby auNwix xpxxnutlrrs of this city to cnmr upon Ne W ahovo-memianed property for inspection purposes. LL (We)agree to saw,Indemnify and keep harmless the City of Cupertino against wry labllitiea.judgments,cow and expenses which may In my way amen against said City V 7 in co—asnee p gra^ong of Nu permit. r1. APPLICA ERSTANDS AND WILL COMPLY WITH ALL NONPOINr Issued by: Date SOUR CATIONS. 3 Re-roofs rain o Ir HAZARDOUS MATERIALS DISCLOSURE Dete Type of Roof Will Oe applicant or future Wilding occupant Fare or handle h.sardaus material as denned by IW Cupenino Municipal Code,Chapter 9.12.and the Health and Safety Code,Section 25532(0)1 ❑Yea --4Na. All roofs shall be inspected prior to any roofing material being installed. IWill the Afri cans m future balding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove t haysrdnm our contaminants as defined by that Bay Arca Air Quality Management all new materials for inspection. Disuict7 0Y0 Ihawandtehonrdu6ASquiemntsun&r Chapter695Mte Califor• niaHl"S ode.Soc=25505.25533a255N.lunhmaM thatife Wilding dsrot haw a tenant,that It u my responsibility te anufy the aceupmi of the rcga hmnmuuWmetpriarto araccWac of Signature of Applicant Date sir tet adxd:gem / Data I All roof coverings to be Class"B"or better CITY OF CUPERTINO 1 of 1 PERMIT RECEIPT OPERATOR: bethe COPY # 3 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37510002.00 DATE ISSUED. . . . . . . : 01/30/2006 RECEIPT #. . . . . . . . . : 32994 REFERENCE ID # . . . : 06010165 SITE ADDRESS . . . . . : 10408 JUDY AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : GARY MOUNTAIN ADDRESS . . . . . . . . . . : 10408 JUDY AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : ROGER BRIGHT CONTRACTOR . . . . . . . : BRIGHT, ROGER LIC # 21477 COMPANY . . . . . . . . . . : KEITH ROOFING CO INC ADDRESS . . . . . . . . . . : 920 LINCOLN AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95126 TELEPHONE . . . . . . . . : (408)295-8616 OE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- . BPERMFEE VALUATION 5, 000.00 - 115.56 0.00 115.56 0.00 BSEISMICRE VALUATION 4, 600.00 0.50 0.00 0.50 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 116.06 0.00 116.06 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 116.06 VISA TOTAL RECEIPT 116.06 Community Development 10300 Torre Avenue ✓s Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 «1PEkTINO Building Department JOB ADDRESS: D 408 PERMIT # O j�l 6 - OWNER'S NAME: `f w PHONE # GENERAL CONTRACTOR FAX # I am not using'any subcontractor : Se SignaVare Date Please check applicable subcontractors and complete the followinginformation: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork Cement Finishing Electrical Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Omamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock O er/ ntractor Signature Date Community Development Department f Building Division i City of Cupertino I 10300 Torre Avenue tu CITY OF Telephone: (408)7773 PEI�TINO 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: l _MOLtW�,i-h Job Site Address: Roofing Company Name: Applicant's Signatur . Date: / Q� Greg Casteel Y Building Official Revised 11/2/04 Printed on Recycled Paper CITY OF CUPERTINO r REROOF C CI OF CUPEkTINO PERMIT APPLICATION FORM APN# —�D -,qDa Date: Building Address: I v q 08 T Owner's Name: Phon j: ,,_ l� l Contractor: PhoneG License #:��G Contact: Phone# Cupertino Business? ��? License#: 'dT Type of Roof Covering: . Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof Asphalt Shingles I—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. tFF,ireZone: Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ob Description: n mea✓ o P Ca esidenti Co ercial E] l /G S Yes ❑ Nogr Confirmed with Planning Dept. if there are anrestrictions: O Cost of Project: Type of Cons ction: Occupancprou� 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 •