06050083 (2) CITY OFCLIPERTINO :� m {,wk "t+ ^�'"'" "'� '
BUILDING DIVISION PERMIT CUlYTRACTOR INF.URMA'PION
Sn mSz-`F3R �'u'^ Tl�°' 1CtSS.k`6"':E.,r'i.�Y ..
BUILDING ADDRESS: s MARGARET TINDLE KLUGHERZ PERMrr N0.06050083
7677 NORMANDY WY
OWNER'S NAME: PERMIT ISSUE DATE
MARGARET TINDLE KLUGHERZ 05/10/2006
E: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMITINFO
BLDG O . ELECTO PLUMB
MECHO
io0 LICENSED CONTRACTOR'S DECLARATION Job Description
iI hemhy affirm Nat 1 are llwued under provsions of Chapter 9(Commencing
x
with 5uividon3ofNeBudnmendProfeniumCode.andmylicenseia
I.full fares,me and ).f 40 YEAR ELK SHINGLES (FIBERGLASS) 1/2" CDX PLYW
< enffect.
;�= uanmC Lb.a 35181 8
Conaxur MARK A-ra.+ !„tr30LB FELT UNDERLAYMENT, CLASS A, 3 SUN TUNNELS
ARCHITECTSOECIARATION C.9E-r1t-r MARANATHA ROOFING PAID FOR BL 5/10/06
E U I undersand Coal Pluu NJI be umd u public¢cords -pU rvl j(L�L
e6
sea Licensed Professional
hm OWNER-BUILDER DECLARATION
i I hereby affirm that 1 am exempt from the Contractors License Law for the
a o following mason.(Section 7113 1.5.Business and Pmfwsiom Calc:Any city or county
SSE which mquiru a permit to canmuct,elks.improve,demolish,or¢pair any structure
-iy prim m
its issuance.also requires the applicants rorsuch permit to file a signed statement
< that he is licensed pursunt to the pmviYom of the COMeatera Uecme Law(ChaPkr9 Sq. Ft. Floor Area Valuation
5100 (eommDivisioning with Section 7000)of Division 3 oflhe Businamand Profession.,Code)u $17000
that he is aumpt thonc(rom and the basis for the alleged wemption My violation of
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil pcoalty of APN Number Occupancy Type
net mom then floe hundmd dollars(53001
0 I,an owner of the property,or my cmpkycw with wage u d e r ack carepemauon,
will as the work and Ne swaurs Is net intended or offered for ale(See.7014.Businw
and Professions Cods: tom
The Customers Lim,Law doer a Owner Or
apply an Owof Requ
properly who builds or w proven Leonean.and who dou arch work himself orthrough his
Own employees,provided that such improvemanu am net Interacted araResed fersaie If.
however,the building or improvement is said within one year afmmPledon.the owma-
builder will haw the burden of proving that M did not Wild or improve for purpose of MAY 2S 2006
sek.l.
0 1,as owner of the property.am exclusively connecting with licensed Contractors to
..La d project(Seem an Business and ,who
Code:)The Cutrxmrs U.and. �p r}'r �
come Law does not apply m sn.Beerse property who bullde deimprovns Leeman,and U L
who contracts far such projects with acontnctarta)licenced Immumu a the Conuacmh
L.icnma 4w.
LJ
0 1 am aempt under Sec ,B at P C fon this newer,
Owner Dam
WORKERS COMPENSATION DECLARATION
1 touchy affirm under penalty of perjury ane of the following declarations:
I haw and will mmnuin.Certificate ofCanaent to elf-Imum far WorgersCampen-
setlon,as provided far by Section 3700 of the labor Code,for the perfomtm of the
work for which this permit is Issued.
0 1 haw aim will maimson Warkrs Compensation lasurantt,u required by Sectio
370Eofths,Labor Code,for the parfarmume ofthe work for which this pormit is issued
My Workers Compensation humruce artier and Policy number tae: .
Cartier, 5-7-pr7--c'FN AfD Policy No.: 18321\Q-2005—
CERTIFicATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This metirn need notbeecmpkted if the permit is formic hundraddollars(SIM)
or less.)
I cenify thot in the performance of one work for which this permit is issued,I mull am
employ any perms in any manners,u e became subject on Ole WorteK Compeuadso
laws of CAifamu,Date
Applicant
NOTICE TO APPLICANT:IL after making this CertiOwm of Exemption,you should
became subject or the Workers Compensation provisions of dm labor Cade,you met
,J O forthwith comply with such provisions or this permit shall be deemed tewkcd.
z= CONSTRUCTION LENDING AGENCY
ai
E I hereby affirm that deem iscn
anuomm.lending agency ance for the performof
> tic mark for which this permit is Wood(see 3091,Cis.C.)
WE Q Lenders Name
0.z Lenders Address
U Q 1 certify that 1 haw and this application aim state Nu the above Information Is
IL carted.1 gime to comply with all city and county ordinances and sem laws miming to
Qr, building construction,and hereby authorim mpmmnutives of Nis city to enter upnn the
W above-mentioned property for inspection purposes.
0. (We)agme to save,indemnify and kap harmless the City of Cupertino against
t„t ti
in eomequrnc.of the jamming of this permit.liabilities.judgmenu,emu and expenses which may In my Coy acme against said City
UZ
^" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date /0-0
SOURCE REGULATIONS.
Re-roofs
Sighatom of
HAZARDOUS
AZA IiaRDDOO
HAZAUS MATERIALS DISCLOSURE Type of Roof
WIII the applicant or forum Wilding mapantatore or handle hewNau manurial
as deRnN by the Cupenine Munleipel Cade.Chapter 9.11,and the Health and Safety
Cade.Section 15531()7 All roofs shall he inspected prior to any roofing material being installed.
0Yu ON.
WIII the applicant or future building a:cupant uw equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
.mit bacadnus I,comaminanu as defined by the Bay Moe Air Quality Msugemeni all new materials for inspection.
District?
QYw VNO
I haw mad the bwardous materials requirements under Chapter 6.95 of the Califor•
.in Hat"Safety Code.Seetiom 15505,25533 and 75534.1 untkrstand that If the Wilding
does not currently haw•momm.that It Is my mspomihllity to notify the occupant of the
mquimmcnu which met be mel prior to Issuance of a Cemlicam ofOttupvmy. Signature of Applicant Date
�j q/s,sy y„e-'t nT, �J�!Lafa4 All roof coverings to be Class"Bt'or better
Owner a owed agent Dow
CITY OF CUPERTINO
em 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36611165 . 00
DATE ISSUED. . . . . . . : 05/10/2006
RECEIPT # . . . . . . . . . : 34333
REFERENCE ID # . . . : 06050083
SITE ADDRESS . . . . . : 7677 NORMANDY WY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : MARGARET TINDLE KLUGHERZ
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . :
RECEIVED FROM . . . . : MARGARET KLUGHERZ
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : MARGARET TINDLE KLUGHERZ
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 17, 000 . 00 245 . 16 0 . 00 245 . 16 0 . 00
BSEISMICRE VALUATION 17, 000 . 00 1 . 70 0 . 00 1 . 70 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 351 . 86 0 . 00 351. 86 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 351 . 86 3327
TOTAL RECEIPT 351 . 86
•
May 09 06 06: 56p H N LOCKWOOD IMCReot Dept 530 336 5326 p. 3
wr OF-os r:oo F(w- t-eta P.002/t03 F-755
t:mamumtr ueveu➢mcar
10300'rmm I.v. 'w
;l. 11 Me r�.y.. CV%Pddgp ti.n ;5044
T4*b=(40th M)2n&
• Fut(40sp"�t 7•
CU ` : f1.N
Building
artment
JOS AddRl399: PSR.hLlr
"WW 1 �)6 0 -�-6* __..�.—.6 EL-
OWN f. ^+.vAM&: M�2F!tr?s 1 u PHO., !,<a., M^ LMI
GCNirk�4LCON7Y�ACTOIt PioG2 7(9ti`RR � '•FA_!Cd Y.3 n.7 so- ss�.zE
I.-.m not using any subcontractors:
Sigmture ;ato
Please check a l:cable sub,-ornractcrs ard complete the following information:
4r ..jS--1_''BC0?JTR Ar'ry—mV- .r�v'.Ci«:r�ri✓ ILF iii. �vVi'XILB 7
I wl C'a�rinn�c.4.1�.f11..,M4' —
C2ment Finishingj
t�------ Electssm' �—
j Excavation j f
._..__I Fen��
Floorht :Car
L.inylIMUm Wood
Gu-' -
• : ?naulation
r,
' Latkdn'
j
I {('hn�mpn*nt Shnetttg. ni I �— 1
Painting/ Wall ---....._........
Pavia
Plastering
'DIu�•k:.. � i
--
It0oting rtt3�c►+�
I, Septic Rank—
j 15tte!�t;\ictal i
Sheat Rock I
I
Q3 w.,a/C:orumrtor Signature
•
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: M A g G A9 6 T Ti nl p L E K I. u G l,`E-( ?=
Job Site Address: 7!0 77 No RM AN DY WAV
Rof3E2T «'�RRy� DuNCICEL
Roofing Company Name: M Ft R A N ATH A /Z o o F/A!G
Applicant's Signature: K. Cu.�, Date:--zp M,.. zoo 6
LT
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO 0(005 0093
- REROOF
• CUPERTINO PERMIT APPLICATION FORM
APN# 3LOS Date: /O IVA Zo06
Building Address:
-7 67 7 A/0 X 1 J A C E RT lAld
Owner's Name: Phone#:
MA-RG " E iMDLE: K I- LA G I Ef?z Od'- 77 9
Contractor: License#:
065-9 6RRY) 1 u c E 3 y9/ LJV
Contact: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
)I Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
?k Wood Shingles ❑ Wood Shingles
Cl Other(Specify) ;K Other(Specify) /eta" G L A 5 S
Number of existing coverings 7. ❑ Provide I.C.B.O. Report#
I19 To be Removed ElProvide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: y0 YR FL-K SNiAIGLE-S (F18E2GLAS5)
y2 n epx PLYWOoD O'er EL I A55 A T44 #04
Et1
Residential R Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
'y17 ODd WeeB F/Cq-me 5Tacc0 7t,VC1E mIU
If
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