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06080068 (2)CITY OF CUPERTINO•+m.�a CO TILa,�TUR�iI�FORMATIQ BUIUDInamvlslon PERMIT ��T,v •t ✓&ci?'iY 'tin�z ,. o . b'l'�'i' BUILDING ADORES': OLD COUNTRY ROOFING PE"""""""06080068 22028 LINDY LN OWNER'S NAME: PE1tM17 ISSUE DATE DOZIER JOHN P AND PEGGY A 125-B GROBRIC Q1 OR/09/20OG NE: SANITARY NO. CONTROL NO. (707)864-5557 ARCHIlECT07NGINEER:BUILDING PERMIT INFO 'BLDG ELECT PLUMB MEC14 LICENSED CONTRACTOR'S DECLARATION Job Description hereby affirm that I am IlmnseA under provisions of chapter 9 (commencing with IO)af Divltlon3a(Ue Business eM Profcwium Code,snd my license is Licanm "99 Lk.. b�•273 nI TEAR OFF SHAKES RESHEET ADD 50 YEAR COMP SHINGLE LASS A Dae Ca r ARCH dN! 1 understand my plata l he d as public records shall Licensed Pmfeummal OWNER -BUILDER DECLARATION I hereby alarm that I am MEmpt from the Comacmh Liecnm Law for the fallowing mason. (Section 703 1.3, Business and Professions Cade: Any city Of county which require; a Permit m consumer, after. improve. demolish, or repair any urocture prior an its issuance. also raparea the applicant forsuch permit to file a signed va¢ment the Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valua$W OOO that he is licensed panuant to the provisions of (commencing with Section 7000) MDivision 3 of the Ba rressand Prafuulans Codd or that be u eaempt themfmm and the basis for the alleged wmptiom Any violation of APN Number Occupancy Type Secdon 7031.5 by airy applicants far a permit subjects Use applicant to a civil penalty of Ma more than Ove hundred dollen (5300). 35627007. 0 0 1, as owner of the property. a my employees with wag" as their Sale compenesdon, Required Inspections P Said da Umwark, mdUte 704x.ormarof daanertues USE apply. he CoelamvsI me ret apply cat owwr and Ro Cade The Cantracmra Lures Taw q wort f Waugh his property who builds aimprovrs Umrm dors uch is who bis r vement E in "Offfa awn employers, provided that web improvements am not intended aoReted fa We ll, 4 Um owner builds the building ter ore year of mpnow, fal.r an of pmms s dwitid builder will law the buNm a! proving mat he did ret Wild a impmw, fa purpose of that uleJ. ❑ I, as owner of the property. am "clmively contracting with licensed cmnOwmas to construct the project (Sec. 7044. Business and Professions Code:) The Camncmr`s U. ever law does not apply te an a mer or property who Wilds Orimpmw thamen, and / who castanets for such projects with a mmmucl r(O liartsed puraant to to COetrwmr`s Oi Liemuts Law. ❑ l nm eamhps under See , B & P C far Shu mann- Owe Wte WORKERS COMPENSATION DECLARATION I hereby aRirm under penalty of perjury mm of Use following declaretons: (� I haw and will maintain a Certificate of Cement to self -Imam far Worker`s Compact- talion, as provided far by section 3700 of Use Labor Code, la the perfonmes, of the "USE for ssu for which this mit is ied. i bave and will maintain Worker's Compeation Insurance, u squired by Section 3 00 of W labor Coda. far due performance of the work fa which Shia permit u issued. My Wort�/(/� Co pOemation Inwnmm ami" and Polity number as: Caller. Policy NO.: )I % ti $ 7 -L-- CERTIFICATE OF EXEMPTION FROM WORKERS' CERTIFICATE COMPENSATION INSURANCE (This se"inn wed notbecompleted if the Permit u fmranc hundred dollars ($I(D) M, less.) 1 eenify that in She perfommaoee of the work fa which this Permit is Waned. I than na employ anypermn In any manwrm u an become subject to the Wmlmn' Compematlon Laws of califoreia. Dam Applicant NOTICE TO APPLICANT: If. after making this CaAOcate of Exemption, you should became Subject m the Workv's Compcmation provisions of Use Labor Code you most forthwith comply with such provisions on rob permit mail he demand! evoked. CONSTRUCTION AGENCY uscumnLENDING I kr Shu mem V s agenry forme Iurmrmanm of ed (Sm. 30 7,Wing whichthi � the work for which Shu permit u issued (Ser. 7097. Civ. C.) ' Lender`s Namc Under'Add. iI easily dust I have read Shu application end sum Shu dw above inronnsdun W ' correct. I agree to comply with all city and county oNinsmm and sum laws relating to building contraction, and hereby autharim mpresenutivet of oris City to cner ulmn the above-mentioned property for inspection purposes. (WE) agree to Save, indemmfy and keep harmless the City of Cupertino against liabilites.ludgmenu,cosu and expenses which may in any way acerae against aid City ire consgww ( tie gnntrng of permit. ' APPLICA NQE0.5;pIN AND WIL OMPLY WITH ALL NONPOINT SOV�77�g5. / Issued by: Date Re -roofs Type of Roof Signs= or ApplicantlContrwtor OEM HAZARDOUS MATERIALS DISCLOSURE Will the applianta future building occupwtms ahandle hr"adom material as detned by Ue Cupertino Municipal Cade, Chapmr 9.12, and the Health and Wcty Code. seen.. 25532(4)? All roofs shall be inspected prior to any roofing material being installed. ❑ YOU If a roof is installed without first obtaining an inspection, I agree IO remove Will the applicant or future bending Occupant use equipment a devices which emit hWardom if contsmim arts as de0ned by me Bay Amo Air Quality Management all new materials for inspection. District? ❑Yea Ihaw Mail the h.S.a muerlW5533 w5534.1rChePler undersande OuirheCalding nus"IShkeafuyhawAsavamhat +3• 9 Q �p ItU2MYresp125534.I cu Ifihe da" Inst currently how a enm4 Net It u MY responsibility m noUl'y the repent of me require a hicharstbee� L 'naiuu araCeNfeawar Signature of Applicant Date 9106 All roof coverings to be Class "B" or better Pv Gybe cyemy om 3 of 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35627007.00 DATE ISSUED.......: 08/09/2006 RECEIPT #.........: 35572 REFERENCE ID # ...: 06080068 SITE ADDRESS .....: 22028 LINDY LN SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OPERATOR: amyw COPY # : 2 OWNER ............: DOZIER JOHN P AND PEGGY A ADDRESS ..........: CITY/STATE/ZIP ...: , RECEIVED FROM ....: BONITA JENKINS CONTRACTOR .......: FOLK, DIETER LIC # 20389 COMPANY ..........: OLD COUNTRY ROOFING ADDRESS ..........: 125-B GROBRIC CT CITY/STATE/ZIP ...: SUISUN, CA 94585 TELEPHONE ........: (707)864-5557 •FEE ID UNIT QUANTITY ---------- ------------- ---------- BPERMFEE VALUATION 13,000.00 BSEISMICRE VALUATION 13,000.00 TOTAL PERMIT : METHOD OF PAYMENT ----------------- OTHER TOTAL RECEIPT • AMOUNT ------583.29 583.29 AMOUNT PD -TO -DT THIS REC NEW BAL ---------- 201.96 ---------- 0.00 ---------- 201.96 ---------- 0.00 1.30 0.00 1.30 0.00 ---------- 203.26 ---------- 0.00 ---------- 203.26 ---------- 0.00 NUMBER ------------------ MASTERCARD 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 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: Job Site Address: Roofing Company Name: O!� Applicant's Signature: Date: • Greg Casteel Building Official Revised 11/2/04 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: Job Site Address: Roofing Company Name: O!� Applicant's Signature: Date: • Greg Casteel Building Official Revised 11/2/04 air �UPEkTINO 9 JOB ADDRESS: 22va8 Community Development 10300 Torre Avenue Cupertino CA 95014 Telepbone (408) 777-3228 Fax (408) 777-3333 Building Department / ' 9 / _ I PERMIT # OWNER'S NAME: gqg I PHONE # 2'6 S—/7 L4y GENERAL CONTRACTOW r7 /d t�.�... _ f/. I FAX # I am not using any subcontractors:01d C&, r(5 .� tgnature Date Please check applicable subcontractors and complete the following information: 60 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 • Gid C& T&a - O er ontractor Signature 64a G Date • 0 US CUPERTINO o c�o800c�3 CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM APN # 3 5 L 2 1 D O -1 Bldg Permit Fees Date: 9/0 6 Building Address: Energy 2-2-0 2 $ I BSEISMICRE Owner's Name: n ^ fV-t-c.`J BUILDING Phone #: �6 5 � � 7 � 4 Contractorb BUILDING License #: 6 2- Z? 3 Contact: W VCupertino BUILDING Business License #: Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles )! Asphalt Shingles ';t Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings > ❑ Provide I.C.B.O. Report # "0I To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Co%ply With Cu ertino's Tear Off Policy: Job Desca'R n: J oti a G1GP 1Q G, Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning D10t. if there are any restrictions: LJ Cost of Project: oz� Type of Construction: Occupancy group: 13, DD Qty. if Annlicahle Fee ID Fee Descrintion Fee Grout) BPERMFEE Bldg Permit Fees BUILDING BENERGY Energy BUILDING I BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING