08020175 (2) CITY OF CUPERTINO �'* k �t ' °�` g<«3.a ° ` 'ar" �
BUILDING DIVISION PERMIT ,kC®1, ItA.GT�Oq,4-- k',0�?��T o,` y
BUILD ADDRESS: FERMI I NO.
1 MILLER AVE JIM FERKEL ROOFING 08020175
NEWS NAME: PERMIT LSSUE DATE
BUCHHOLZ ALBERT E AND MARY L 1382 WESTMONT- AVE 02/26/2008
ONE: SANITARY NO. CONTROL NO.
(408) 370-3436
ARCHI'IECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
�Op LICENSED CONTRACIOWS DECLARATION Job Description
us 1 hereby affirm Nal l am licensed under provisions of Chapter 9(commencing
with Sceaa']D00)af Divb%ian3 she Bustnevand Podlessinm Cods,and enxu RERF,T/O PERMATEK,RPLC 30LB ELKCOMP, CLSA, 50YR
m full forte and off
i�? License Class Lle.N '
AR HnEEC
QonsraLTS DEC R ION
I e< 1 understand my plans WII W used u pwhlic4cmdo
on
Liccnxd Professional
m 3 OWNER.BUILDER DECLARATION
f I hereby alTirm that 1 am exempt from the Commetues License law for the
p0 following reason.(Section 1031.5.Business and Professions Code:Any city or county
$ which requires a Permit to construct,ars,improve,demuli h.or repair any someone
-zi prier m its issuance,also mquires the applicant for such Permit o rile a signed statement
•ss< maoW is licensed a Pursuano the provisions of one Contractor's Lleonx law(Chapter9 Sq.Ft.Floor Area Valuation
ul-Q (commencing with section?00o)ofDivision 3ofthe Business and PefcssionsCode)or $11000
c _ that 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 appllunt in a civil Penalty of 61Y.Number - Occupancy Type
not more than raw hundred clORars(g58o). 3 6 9.19 0 4 9 A
❑I,uowvroftiepmpemy.mmyemployeuwithwagaume4xleeompev.dan,
will do the wook,tmd the sWCWR is out intended of offered fOraale(Sec.7(1 Business Required Inspections
and Profnsiav clan set The Commencer License Law claoat apply m e an owner of q p
property who builds mimpraws mere..,and wh0doeuuchworkhlmxlforduaugh his
awn employmes,provided Nat such improvements ax not intended oro@ed forsake.If.
however.the building orimpm nment Ismid withinam,yew of completion,the owner.
builder will Ww the burden of proving that k did rot Wild or borrow for purpose of
sale.).
0 1,u owner a the Property am exclusively comoaming with licensed wnvacton to
conatruct the pmjen(Sec.]ON.Business and Professor Cade:)The Contractors V.
cave law does not apply 0 an owner of property who Wilds or imPm cs thereon.and.
who conwms forswh projems wire a cantraaor(s)Iirusxd pursuant in the C ommemer
License law.
❑I am exempt under See .B k P C far suis mason
mer Dau
WORKER'S COMPENSATION DECORATION -
1 hereby aRrro mailer penalty of perjury arc of the following deelaratimu:
Ihsw and w0l mainuina Certificate of C�m�rotuxlf-InumfmWahcrs
work
Compen-
ian,repro far by Sedan 3]x0 of Ne labor Code.far lbe petormence of the
woh far whichh this permit is issued.
❑I haw and will maintain Workers Compensation Ivumna,as required by Seaman
3700 of the labor Cods.for me perf.......f the work for which this panni,is Woad.
MY Workers Com .a. on l umnce/carrier and Policynumber am:
cartier /f//• Policy No
CERTIFICATE OF EXEMMON FROMWORKERS'
COMPENSATION INSURANCE
mm,section need wt W completed time Permit is fecone humbeldollars(SIM)
or terse)
I certify,that in the Performance of the work fm which this Permit is issued.l slWl not
employ anypersen in any manvrso as on Income subject to the Worker'Compensation
Laws of c.ifmod..Dau
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject,o the Worker's Compensation provisions of the Labor Code.you most ,
,J z forthwith comply with such provisions or this Permit shall W deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
[-+ work
which
Wtmeu iWood(Sec.3M.Ch,C.)erhey for the performarun of
ori ti me work fur which olds permit u ivucd(See.J09],Civ.C.1
aZ Landers Name
U z lcndcis Address
J 0 1 certify that I ban mad this application and sou that me a Ww information is
LL H correct.1 agree to comply with all city and county ordinances and state laws miming 10
0 U building cmatmctton.and hembyaummirem,maerwives of this city to enter upon lW
W ahaw-meminned pmpeny for int,w purposes.
( e)agree to save,indemnif a d keep harmless the City of Cupertino against
Iiabili0 'uagmcnu,cosu mcicap which may in oma asrvc agilnstsaid City
U z in con ens th g ting of is cit. 2-
^ APPLI UNDE0.5TAND D WILL WI ALL NON-POINT Issued by: Date w
SOU E EGULATIONS.
y' Re-roofs
Signalurc of ApplicanVCanxuor Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
ill me applicam car future building acopam Itone m handle hmallous maudal
as do d by the Cu krfirm Municipal Code,Chapter 9.11.and me Health and Safety
ectYon 25531(.)] ��— All roofs shall be inspected prior to any roofing material being installed.
Will the applicant,or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,.l agree to remove
emit hrvrdmus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District? !
❑Yes a
I em ad me harardous m rets putrcracmau rChapur6.95ofdu CaliIor
nice Heal almycedc,Scedov2 115 5533.,125 un Wtifmc Wilding
does no cu rely haw a unam,th t my rzapo , say wuf me axupant of the
a yule enl whichmmtbereet reiuum Cc Thea e0ccuperes,. gnature of Applicant Date
Owner car thorisa ascot Date U]T'-,�'jAll roof coverings to be Class"B"or better
• CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: B1k: . Lot:
APN . . . . . . . . : 36919049 . 00
DATE ISSUED. . . . . . . : 02/26/2008
RECEIPT # . . . . . . . . . : BS000004039
REFERENCE ID # . . . : 08020175
SITE ADDRESS . . . . . : 941 MILLER AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BUCHHOLZ ALBERT E AND MARY L
ADDRESS . . . . . . . . . . : 941 MILLER AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4661
RECEIVED FROM . . . . : JIM FERKEL
CONTRACTOR . . . . . . . : JAMES C FERKEL JR. LIC # 25476
COMPANY . . . . . . . . . . : JIM FERKEL ROOFING CONTRACTOR
ADDRESS . . . . . . . . . . : 1382 WESTMONT AVE
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE (408) 370-3436
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 11, 000. 00 1 .10. 0. 00 1 .10 0. 00
1BUSLIC FLAT RATE 1. 00 110.00 0.00 110 . 00 0. 00
1REROOFRES SQ FEET 36 . 00 468.00 0. 00 468 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 579 . 10 0. 00 579 .10 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- ----- --------------
CASH 579 .10
---------------
TOTAL RECEIPT 579 . 10
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- --------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
605 FINAL REROOF
•
CITY OF CUPERTINO
REROOF
•CUPERTINO PERMIT APPLICATION
APN # / 9/ �O7 9 o o Date:
Building Address:
L
Owner's Name: Phone #:
1-7
Con actor: Phone #:Afflft
Fax #: �7O /3�0
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) � T�.� ❑ Other (Specify)
Numb °f existin coverings ❑ Provide I.C.B.O. Report#
a� o be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: 5� A•
Residential Commercial
Fire Zone: Yes ❑ No L—j� Confirmed with Planning Dept. if
there are any restrictions: ❑
Valuation:
I Have Re , Understand an i Co y Cupertino's Tear-Off Policy:
Signa re
' CITY OF CUPERTINO
REROOF
•CUPEI�TINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
1RER00FRES Re-roof Residential B 1SFDWLR00F
1BSEISMICRE Seismic Residential B
1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
IBSEISMICRE 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 comply with the above stated policy on re-roofing.
Homeowner's Name: Z//24 /46 G Z
Job Site Address:
Roofing Company Name: G7-q,L
Applicant's Signatu Date: g
• Greg Casteel
Building Official
Revised 11/2/04
Community Development
J 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
OUPEkTINO
Building Department
JOB ADDRESS: PERMIT # 6 O O va
OWNER'S NAME:L Z PHONE # -L-J--2Ccf
GENERAL CONTRACTOR:--. FAX #
I am not using any subcontractors: -
Signature Date
Please check applicable subcon c and com Tete 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
1p
7 Owner/Co tractor Signature Date