06090267 (2) [21853
ITY OF CUPERTINO x �tA
HUILDING DIVISION PF.. T �'vy��'1,( �GTVJ ,Z Q �dl\
ILDING ADDRESS: ARMSTRONG INSTALLATION PERMITNO.06090267
OAKVIEW LA
NER'S NAME: PERMIT 6511E DATE
CARTER DONALD 4575 SAN PABLO AVE 06
NE: SANITARY NO. CONTROL NO.
(510) 777-1234
ARCHII'ECTENGINEER:
BURRING PERMIT INTO
BLDG ELECT PLUMB MECH
0
o o LICENSED CONTRACTORS DECLARATION Job Description
1 barely air,.Wt I w flowed!uakr pmvirmas of Cha m r 9(cemmenclig
with Section 7")ofoivWon 3afte Bud�wss dPro ons dead;; H OVERLAY ON EXISTING , CAPSHEET, 8 RE—SQUARES OF
in full font an (e
Llom I° 9 comr y SPF FOAM ICBG #5513 . CLASS A
p Dam used a ser
e W7 ARCHI 175 DisZ"RATIO
C I understand my plans alcall be used u public rteorA 100 F/
tgN Ucepeedturchy 0ul
�G OWNER-BUILDER DECLARATION ,VC/
w
CDC hreaso .(firm on 1 am exempt from Ne Canummra License Law for the O
CDC following moon.(Section 71omm Business and e".de Profession;Code:MY city m county
$tai which requires a parsed re cores t,pi=ca knprow,demolish.t m mash ed Rronum
Z�^ pnarmiu iesedpurlw requires ft ponisilieant foe such Connector's
Oka,Law(sWemcm Valuatio80
< that he is I....liens.dpurment70th).fDiaionao the 0ftheDwcmr'sl.dPmfmiw(CMpmr9 Sq.Ft.F1oorArea
(�om a it axe wise 5eafan70nd)of basis for
theeged c sept on.Anyavi Cadet or
.. Nat he 7 exempt Aamfrom and the aper far bj cts the aumpnav Any vlolnlon of
Section,man 1 by ury applicant for,permit mbjttu the applicant m a dvll penalty of N Number Occupancy Type
not mom thm raw huMmd aallua(ssnD>. 3 2 619100 . 00
❑I.as owner ofthe property,or my ampioytt,with neo As theirmte compemsedon,
will do lbeworkend the net..Isnot(nunMdorfrered fouak(Sec.' .Butlrca, Required Inspections
and Profession.Cad.Tae Costumes License Lew does not apply m an owner of q P
property who Wilds or improve,thmseeptnd whodosssuchwmk himseifor Waugh his
own employ=,provided that such improwmenu=not Intended maRewd for sale,If.
bmvewr,the building or impronseam is mid within one year of earepkli0o,the awm-
buildm will haw de burden of proving that Its:did not raid or Improv for purpose of .
wok.).
❑1.as owner of the property,am exclusively contractingwith licensed sen trucora to
construct the project(See.7044.Business and Profession Code)The Conn=otes U.
cense Law d=pot apply to an matter of properly who builds or improves Ae=on,and
who contracts for such pmjcm MA a camuacmNa)licenced pmaexnl m the Conummf,
License Law.
❑1 am exempt under S. .B a P C for Ar mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby alrnm under pcultY of perjury we of the following declarations:
1 hero and will maintain a Certificate of Consent to,el6iesum for Worker,Cooper-
Saliba,u provided for by Section 3700 of the labor Code.for use performance of the
work for which this permit Is Issued.
❑1 haw and will maintain Workers Compeuadon Iruurana,As required by Section
3700 of the loam Code.for the perfmormec of the work for which this permit is issued
My Workers p`e-amdon nZfficr and Policy n ram'
Cartier. '4'� `�,'1�
Policy No.:
CERTIF7 TE OF EXEMPTION FROM WowsCOMPENSATION INSURANCE
mads section need nal becompkmd If the pewit Is taunt hunthedenflua(SIW)
or les,)
1 certify that in the performance of the work for which this permit is issued.I small not
employ any person in my mannerm as to become subject m the Worhri Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.afar making this Certificate of Exemption,you should
become subject in the Worker's Compensation provisions of me Labor Cede,you most
.7Z fonhwith comply with such provisions or this Permit hall be deemw
ed mkcd.
Z` CONSTRUCTION LENDING AGENCY
1-t thereby afnme Wtthem r a construction lending agency fm the performance of
ai the wotr for which this permit r issued(Sec.3097,Civ.C.)
W�Q lander,Name
Lnultes Add.
U 0 I certify that I haw cud this application and scale that the abow information is -
U,t-" correct.1 ag=to comply with all city and county on inances and sue laws meeting to
OU Wilding construction.and hereby Autumn mpnaenmiws of this city to enter upon the
U ahovcmemmncd pmKrty for inspection purpose,.
(Wc)ag=e to mw,indemnify and keep harmless Lou City of Cupertino agairet
CA liabilitiu•judgmcnu,cosu and exwores which may in any way accmc against mid City
U`jM� to consequence of the gaming of this pemi
APPLICANT UNDERSTANDS AND L COMPLY WITH ALL NON-POINT Issued by:S Date
soupq[gREpuun_ Q5S ,,/ o/ �
1, 'A �yractor 1 / Re-roofs
Signature o(ApplicmJC nRDO Dem
HAZARDOUS MATERIALS
partsuDISCLOSURE Type of Roof
WIII the Cupmtmforum buildinga.Chapter
or handle Health
nsd Safety As de0nea OY Ue Cupertino Municipal Code.Oupmr 9.11.and tk Hulth and Safety
Cork,Section lf533(a17 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
cm(t h%7Amkms air unumlnants pe deputed by the Bay Ama Air Quality Man,gemcm all new materials for inspection.
District?
❑Yea �15eNo
I hew read the huardnu,materials mquiremcnuunder Chapter 6.95 of the Califor.
niaHmlmkSefcty Code,Sections26501.25533-125 .lu&..dthuirthh budding
J=not curtenll aw•moat.Net h r my rcspb ry m nodry the aecupmt of W .�1 u—
require un ie m. nor r ra a iicate of occupancy. Signature of Applicant Date
owner or,uthorimd agent
rump All roof coverings to be Class"B"or better
Community Development
10300 Tone Avenue
acloF
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
*UPERTINO
Building De artment
JO ADDRESS: PERMIT #
I "?;-S 060 F704 6 �7
OWNER'S NAME: ec r PHONE #'iUd' ZST- o S5�
GENERAL CONTRACTOR: FAX # �)c. 5S_ )97
I am not using any subcontractors:
Signature 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/Coniactor Signature Date
CITY OF CUPERTINO
!m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . 1 . : 32619100 . 00
DATE ISSUED. . . . . . . : 09/28/2006
RECEIPT # . . . . . . . . . : 36242
REFERENCE ID # . . . : 06090267
SITE ADDRESS . . . . . : 21853 OAKVIEW LA
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . .
OWNER . . . . . . . . . . . . : CARTER DONALD
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : ARMSTRONG INST,
CONTRACTOR . . . . . . . : HOWARD FINE LIC # 22581
COMPANY . . . . . . . . . . : ARMSTRONG INSTALLATION
ADDRESS . . . . . . . . . . : 4575 SAN PABLO AVE
CITY/STATE/ZIP . . . : EMERYVILLE, CA 94608
TELEPHONE . . . . . . . . : (510) 777-1234
*EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 8 , 000 . 00 147 . 96 0 . 00 147 . 96 0 . 00
BSEISMICRE VALUATION 8 , 000 . 00 0 . 80 0 . 00 0 . 80 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 253 . 76 0 . 00 253 . 76 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 253 . 76 654
TOTAL RECEIPT 253 . 76
•
~ 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 ya " 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: /01 61r Yc
Job Site Address: �>S3i"11 0 .�'Iy �G �/ ��-"� _
Roofing Company Name: 14149"54-, Z ue.l o h
Applicant's Signature: Date: tG/�
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO ��2��
REROOF
• CUPERTINO PERMIT APPLICATION FORM
APN# Date: n/a��U 6
Building Address:
2/ -63 C N
Owner's Name: Phone#:
r /,/
Contractor: 11 License#: g�
Contact: Cupertino Business License #:
Ce tai. qIK- 7a 0_
Type of Roof Covering:
Existing: Proposed:
'IM Built-Up Roof JU Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) 15bOther(Specify)'e" A
Number of existing coverings ❑ Provide I.C.B.O. Report# G 6i
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: pllerl, � � SJ�F earl
ol!'
Residential Commercial ❑
Fire Zone: Yes ❑ No-?!I- Confirmed with Planning a t. if
there are an restrictions
Coof Project: TT of Construction: Occupancy group:
� UVG
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