08020080 (2) CITY OF CUPERTINO �7, '�� - •
BUILDING DIVIS16N PERMIT CO RAG"tCC1R.INEI"TItlV,IATIQI�S` `:
SS,,
AK SPRING CT LOS GATOS ROOFING P�
BQILglylc6gD�.ESV08020080
41VER'S NAME: PERMIT ISSUE DATE
TO
TO P 0 BOX 1726 02/13/2008
PHONE: SANITARY N0. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
RE-ROOF,RMV SHK, INSTL 30#FL BLDG ELECT PLUMB - MECH
O O O O
3 O O LICENSED CONTRACTOR'S DECLARATION
EI hrueby affirm that I as licensed MBu under d Prof ss of Chapter 9(commencing ^^^^ Job Description
n is with Section]OfIU)of Division 3of dre Business and Professions Code,and my license is -
SS L full fora and -
f�9 Z Licenm✓laV Lie.N .
f, Date ] f d Conuecbr
As shall min DECLAR 0
I understand my plans shall bo used as public records
]yU
5 LicenscJ Posfcuional
OWNER-BUILDER DECLARATION
BUILDER DE CLARATION
COO hereby affirm on70 1. exempt from Nc Cssors; o :Anse Law for the
COO O following meson.(Section]armor Business and improve.
Msians Calc:Any city sur county
S$ which requites•permit re cnnmu0.dtee i t persc,h permit t or mash any structure _
Z i^ prim m les usana,sive requires the applicant Mesuch permit m file aligned statement
a IbmheislleenwJprenatal tathe pmvivians 3ofMe usimes.ridPeselaw(Chapor9 Sq.Ft.Floor Area Valuation
(cummes amouall nm Sanson]lad of but,f r M the egad co a and on.Anyana Came)est
Net he h eumpt Nmc(mm anel Ne but,
for the alleged eumption.Any vlohtion of
Section 7031.5 by any applicant for a permit ablates the applicant to a civil penalty of APN Number Occupancy Type
not mane Nen fine hundred dollars(S500). P y YP
0 I,u owner of tite property,or my employees with wages as their ale compensation,
will do Nework.ad Neamm ure is notiMended molfead formic(Sec.704,Sodium
ad Prof smlou Code:The Contrutars Liana Law eleven at apply to an owner of Required Inspections
property who bui Ida or im proventhereon,and who does such work himself or through his
own emplayces,provided thatmch impmsemau are not intended"offered forseo.If.
however.Ne building or impmwmat is mid within one year of mmpletion,the owner- .
builder will have Ne burden of proving Nat he did ant Mid in improve for purpose of
sale.).
0 1,u owner of Ne property.am exclusively contracting with Iicaesud coaactma m
construct Ne pmkct(Seo 704,Simmons;and Professions Code:)The Contractor's Li. _
mese law dans not apply in in owner of property who Wilds or Winnows thereon,ad,
who contracts for such pmjeets with acontrumr(sl licensed pumuant in Ne Contractors
License Law.
0 l an eaempr under See. ,B At P C for this moan
one
WORKERS COMPENSATION DECLARATION
1 bereby season under penalty of perjury oris of Ne following declarations:
O l have ad will mambos.CesiOam ofConsem m self-Wum for Warkcrs Compeer
nation,an provided for by Section 3700 of Ne labor Cods,far Ne performance of Ne
work for which this permit is issued.
0 1 haw ad will mainuin Wortcr's CampensNon Insurance,u required by Section
37W of Ne Labs C de,f"Ne pe armace of Ne wort far which Nis permit is load, '
My Workers a' u a caner end Policy number me:
Cartier. Policy No.:=/X2007
CERT CATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu auction mail mase completed limit pereaft Infusions hundred dollen(SIM)
or Ictal
1 certify that in Ne perfonnace of the work for which this Permit is issued.1 shall nm
employ any perms in any matter as 0 become subject in Ne Workers'Campensadom
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject in On Worces Compemi0on previsions of Ne later Coco,you mut
QO forthwith comply with such provisions or this permit shall W deemed ravelled.
Z ti
�'" CONSTRUCTION LENDING AGENCY
[r I herebyhich tan that mere is sued(Sac,3DR7,Cb, agency for Ne performance of
!Yi ti
the dark for which Won permit u issued(Sec.J09'1,Civ.C.)
Q
Leaders Name
�z
Landers Adelren
U Q I notify Nat 1 have mad Ws animation ad sum Nat Ne above infonnatim is
Lga F coneeL I agree in comply with all city ad county oNinacen and sum laws renting in
QU building construction,ad hereby sumomerepresenuuves of Nis city to enter upon Ne
above-mensimned property for irupeNon purposes.
(We)agree in mw,indemnify ad kap hmmless the City of Cupertino against
Tq liabilities judgments.coats ad expenses which may in my way acc=against midCity
U z in co mita nce of Ne granting of this permit.
^" APPLICANT RQSTA�NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RE NS
tie Re-roofs
Signature of ApplieanUConpath—
HAZARDOURDOU S MATERIALS DISCLOSURE Type of Roof
WillftMe Cupatar future building"cupau 9.12, ad the
Health ad Steed ,
defined io 25 Cupertino Municipal Code.Chapter 9.13,anel the HesIN aft Safety
Jc,Section 35532(x)?❑Yes No
All roofs shall be inspected prior to any roofing material being installed.
�
Will the applicant or future building«spam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
..It havardou at,cmmhrirv� defined by de Bay Area Air Quality Management all new materials for inspection.
Dimmer.?
0y.
u
1 haw mail the hsraNuus astonish requirements underChapter 6.95 of the Califor.
ria Halm&Safety Code,Sectors 25505,35533 ad 25534.1 uidcsauvld then if the Wilding
Jasant cu by haw a tenant Nat it'u my responsibility m ootify the par of the
mqulmmc ichmutWmet Poor mlssmanceoraCover..of0c Signature of Applicant Date
Owner or marindagcm ✓ All roof coverings to be Class rBm or better
o�oa logo
CITY OF CUPERTINO
REROOF
•CUPEI�TINO PERMIT APPLICATION
APN# Date:
c(p �OD
Building Address-
a p n C+
Owner's Name: Phone #:
`f 2-5'3- 2y o 7
Contractor:
-_ �, Phone #: 2cj� 4399
Lo S (71�f Uwe Fax #:
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles < Asphalt Shingles
X Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) X Other (Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report #
To be Removed Prov le Mfgr. Installation Specs.
Job Description: I
Sh.�,� • Irs-��II 3 � �� Thal �l�..
QM4) U-u
Residential Commercial
Fire Zone: Yes No Confirmed with Planning Dept. if
there are any restrictions: ElValuation:
•I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
CITY OF CUPERTINO
REROOF
0
•CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type .
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
1REROOFRES Re-roof Residential B 1SFDWLROOF
IBSEISMICRE Seismic Residential B
1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
IBUSLIC Business License B
•
CommunityDevelopment Department
P P t
r
Building Division
• ' City of Cupertino
10300 Torre Avenue
CITY Of Telephone: (408)777-3228
(U P E kT'A I O 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.
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: / /TVt#Da'te'
7'� / -
Job_Site Address: ..Roofing Company Name:
Aplicant's Signature: W/t
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
• CITY OF CUPERTINO
2 ITEMS OF 8 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36652066.00
DATE ISSUED. . . . . . . : 02/13/2008
RECEIPT #. . . . . . . . . : BS000003929
REFERENCE ID # . . . : 08020080
SITE ADDRESS . . . . . : 11624 OAK SPRING CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : TOM TO
ADDRESS . . . . . . . . . . : 11624 OAK SPRING CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : LOS GATOS ROOFING
CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481
COMPANY LOS GATOS ROOFING
ADDRESS . . . . . . . . . . : P O BOX 1726
CITY/STATE/ZIP . . . : LOS GATOS, CA 95031
• TELEPHONE . . . . . . . . : (408) 298-9399
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- - -------- ---------- ----------
1BSEISMICR VALUATION 4, 800 . 00 0. 50 0. 00 0 . 50 0. 00
1REROOFRES SQ FEET 27. 00 351. 00 0. 00 351 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 351 .50 0. 00 351.50 0. 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
605 FINAL REROOF
Community Development
r- 10300 Torte Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
WUPERTINO
Building De tment
JOB ADDRESS: �/�2 y PERMIT#
JO 2620) ed
OWNER'S NAME: PHONE # fo eS3 0
GENERAL CONTRACTOR: F1AX
�#
I am not using any subcontractors: /I��G22�%�✓ 02 Z O �.
Signature ate
Please check al2plicable subcontractors and com Tete the followin 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
Z GY
Owner/Contractor Signature Date