06080032 (2) CITY OF CUPERTINO ,y r a1, '
BUILDING DIVISION PERMIT �'()rVTRA.CTORTb, �t-rRTC „
BUILDING ADDRESS: SAYS ROOFING PERMIT NO.06080032
11105 LA PALOMA DR
OWNER'S NAME: PERMIT ISSUE DATE
COHEN SETH 3866 REXWOOD CT 08/04/2006
NE: SANITARY NO. CONTROL NO.
(408) 531-9700
ARCHMICTIENGINEER: BUILDING PERMIT INFO
BLDG EIFCf PLUMB MECH
.aro LICENSED CONTRACTOR'S DECLARATION Iib Description
i h C I Mosby afOrm Mal I am licensed under provtsiana of Chapter 9(commencing p
with Secct:ande)ecDlvi.i.n Sof the Business and Professions Cndc.and my lkenas is TEAR OFF PLYWOOD FELT PAPER TRILAMINENT ASPHALT
+�3j L son ra(tt and effect. --I Cl tL
>�? Lken a Lk.N l 1
i
Do.
' d CLASS A OR B
ARCHITECTS DECLARATION '-
i 1 understand my plana shell W used as public recards
Mu ^ /
.o� Licensed Professional
y3 OWNER-BUILDER DECLARATION
I I hereby ame .(firm that 11. exempt form Ne Cssirm; o License city
o for the
D O which
moan. (anis t 71m 1.5.Business and Probarrows.
actino Cale:Any city ar county
129 which paquima n Pnmll re construct shat kmpww,demolish,or papain any umctuw
_i y prior m its iuuaM0.esu requires Um applicant far such permit 1-kenc signed(statement
ppsG theMe liccnsedPSrsremmUtaofDivision
ialona.fthe eBuscmraUcovelaw(Chapwr9 Sq.Ft. Floor Area Valu Ibis000
$ that W is engwdth Section 70ndth Dosis frofalB mucand PmfeoioAtCode)m
the M ts exempt thepafrom and the buts far the alleged esemant W Any rluluion of ppN N
Section 70313 by any hundred
for.permit mbjem the applicant m a civil penalty,of 3 5 6 TMU"r 0 0 c upancY Type
rtes mopa Utan Ove bundpad dolts.(5500). 2
❑1,uw ofdwpmpaty.wmyempioyeowithwageuthebmlee pe don,
will do aha work,and the,suuctuse I.not intended m.ffa nal for sake Vice.7044,B113—
and Porfessions Cade The CanuacturY License law den not apply as an source of Required Inspections /
propctty who builds or lmproxvtherson,rand whodommacla work Mmsefforthrougb his /C-7
own employee,Portland Nn such improwmeau ver and Ia adea malfepad forsake.U,
however,Ne building or Impmtement Is sold Wtbin arc year of caaoptatian.due ownu-
builder MB have Ne burden of proving that M did was build or improv far puryo a of
asks.).
❑1,a ower of the property am exclusively canuusing with licensed contrusars or
constmct the project(Sec.7044.Business and Professions Cade:)TM CW=We3 U.
cane law does not apply to in owner of property who Milds or improves theme,and.
who contracts for such projects with a cormassor(s)licensed pursuant be Ute Conu mors
License Lew. _
0 l oro exempt under See .B A P C for this moon
Owner Data
WORKERS COMPENSATION DECLARATION
I Mreby aOLse under penalty of perjury sae of dm following declaruiona:
I Into,end will emitted..CeNOetaaf Conaem as self-Ilium for WorkersCampen-
ofion,as provided fm by Section 3700 of the labor Code,for the performane,a(You
work far which this permit is Worse.
[]1 here and will maintain Worker's Compeas a on becomes,as mgomd by Section
3700 of IM Labor Cade.for the performance of aha work ferwhich this permit is ioand.
My Workers Compenw)on Insurance etsin and Pull,number am:
Caraiu: ST79ae F'^ j Policy No.: `Ls Eoiyfill
CER71FICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
tilos sectico arse nctMeampleud I(tiae permit is forme homes dolla t(1110(j)
or leu)
1 ard(y Nat in the performance of the work fm which Nis Permit is Wood,I shall nm
employ any person in any mannerm u as Mame subject m the Workecs'Compenaadom
Laws of Cali(omia.Data '
Applicant
NOTICE TO APPLICANT,IC altar making the CenlOcata of Escmpm n.you should
become subject as the Workers Compensation provisions of the labor Cod%you an=
zzfoMwith comply with such provision,or the permit shell be deemed soaked.
Z CONSTRUCTION LENDING AGENCY
[-a 4 1 hominy ailms that them is courn.0.lending agency for the performance of
�i 7 the work for which this permit is issued(Sec.3097,Civ.Q
W Q Lenders Name
7 z lander's Address
U C) i certify that I have rand Uds application arnd now that the at information e
I, cermet.I.gore be comply with all city and cmmy mnl.,and sots laws palating in
O C.) building conaruuion,and hereby authurim mpresenutives of this city to enter upon the
U above-memiumd property for inspection purposes.
gy (We)ages pa naw,indemnify and keep halmlexS the City of Cupertino againat
any fn liabilities.judgments.Carso aha expenses which may in any way amec against sand City /-
V z in consequence of the granting of this Permit. y Y�
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date CJ
SOURCE REGu}ATTONS.
W •-rf CGP h jr-,+ g Lf/4 lotRe-roofs
SigatumafnppftanVCon Dare Of Roof
N LS MATERIADISCLOSURE Type
Will the applicant W forum Wilding occupant sorearhandle comments material
as claimed by the Cupenino Municipal Cade.Chamber 9.11,nab the Halth and Safety
Cade.scevaa 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yrs Na
Will the applicant or future building occupant use equipment a devices,which If a roof IS installed without first obtaining an inspection,I agree r'0 remove
emit hvardnus it,contaminant,as disposed by the Bay Area Air Quality Management all new materials for inspection.
Uimict7
❑Yes
I have mad the hazardous materials requirements underchaptar 6.95 aide Califar.
.is Health&Safety Case,Suctions 25505,25533 and 27534.1 undermad Wtifde building
dors amt currently haw a uncal,that It k my responsibility a notify Ow occupant or the
requlremenuwh'ch mum Mmol pdorm Issuance ora certificate oro
ccas anry. Signature of Applicant Date
All roof coverings to be Class"B"or better
owncrmautharind.ant Data
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. Allroofs 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: S e �1/` Ch V-0-h
Job Site Address: ����Sr UA �asn+ti D YL- . Cx.e-� -"D t CA Q (N
Roofing Company Name:
Applicant's Signature-'-(�X–d 4 tQ 'U Date: AA
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN 35616032 . 00
DATE ISSUED. . . . . . . : 08/04/2006
RECEIPT # . . . . . . . . . 35523
REFERENCE ID # . . . : 06080032
SITE ADDRESS . . . . . : 11105 LA PALOMA DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : COHEN SETH
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : SIMON SAYS ROOFING
CONTRACTOR . . . . . . . : DARRYL SIMON ' LIC # 23053
COMPANY . . . . . . . . . . : SIMON SAYS ROOFING
ADDRESS . . . . . . . . . . :3866 REXWOOD CT
CITY/STATE/ZIP . . . : SAN JOSE, CA 95121
TELEPHONE . . . . . . . . : (408) 531-9700
•FEE 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
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 286 . 46 0 . 00 286 .46 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ----- ------- ------------------
CHECK 286 . 46 4581
TOTAL RECEIPT 286 . 46
•
Community Development
10300 Torre Avenue
.' ✓ Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
40UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT #
W() �-G Qc. lon ' PR . 6OC 0 032_
OWNER'S NAME: PHO ( (ob)S I
GENERAL CONTRACTO • s' ar (z r;_ FAX #
d g�
I am not using any subcontractors: �")`�` 'e-� �'a. �� �
Signa 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
Owner/Contractor Signature Date
CITY OF CUPERTINO
CCp�1Z-
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# _ I ID Date: 6' ,4 l to
0
Building Address:
II I S S 1.P P ti l i w..` ro c�-��•1=t,r.� c,�4 2 Y/u g'
Owner's Name: Phone#:
( `+��13t3 -
Contractor: License#:
Contact: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles .b Asphalt Shingles
�t Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide 1.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: 'T-fa
i
' arrA orQ
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions:
Cost of Project: Type of Construction: Occupancy roup:
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