08040132 (2) CITY OF CUPERTINO v"7
77a.
BUILDtNC DIVISION PERMIT =-'Ct�NtY2AC RT.NFQ '�zlJi :
.Ca-+i✓a �..rx L :N„ vs,-' e c;»5�e.ea 4.
BUILDING ADDRESS: PERMR NO.
10477 PINEVILLE AVE TBD — TO BE DETERMINED 08040132
OWNER'S NAME: PBRMRISSUEDATE
GORGEN GARY A AND IRIS M TRUST 04/18/2008
NE: SANITARY NO. CONTROL NO,
ARCHITECTIENGINEER: BUILDING PERMIT INFO
T/OFF EXISTING LAYER SHAKE BO EO PLU O
30o LICENSED CONTRACTOR'S DECLARATIONReE)F, RE SHRET E)9^!-. JOlkDescrdptlon
m 1 hereby allow Net 1 was Ilcem it under provisions of Chapter 9(commencing
< withSforce
s
nandDivlaian7of the Buvneu and Profasom Co and mylicenx is
fulMCIM d
IMCIM '� C,3s user« Gbh
a p o,m c
ConTD I
a]U<f ARCHITECTS DECLARATION
I urldcnunJ my phnn shall he used As public mcoro
I 5y
{h6u Licensed Professional
S y OWNER-BUDDER m Ce Conar ON
E a C I hereby.(Rena that I em exempt from the Prolamines
Co License Law for not
O C following mama.permit
t 703 construct,
Bminas and ion,de um Cale:Any city or county
3$ which as issu a permit re uireuucL anter.Inclusns.fora,demolish,t m repair any structure
zy priwmiuissuancoJlsu requires pre inion of tho uehpenniuo cleaeLacdeummcns
�< that hc is licensed pursuant 70the of Division
of theeBusinos Mprofession
rof6w(Code)9 Sq.Ft. Floor Area Valuation
B thehe Inc ng earept Session7000)of Items s,3 oftheoned mmp PmfAny vi Code)or
that he n uempt therefrom and Mte buts for Na alleged exmpmam Any violvtlMn of
Section 7031.5 by A,applicant for a permit subjects the applicant nt A civil penalty of APN Number Occupancy Type
Am,more than five hundred dollen(SSW).
❑1,as owner of dm property ar my employtta with wages As Nen sok cmmpansstion,
will do the work and the stmctum isnot imaod or offered for sale(Sao 7041.Budnw Required Inspections
AM PrareWom Caom:The Contractors License Law danot apply to an Manor e of q P
property who builds orimprovwas lhearcort,and who donsetchwork him selfarthrough his
awnmmplaye providedthanmtohimprovememsamnotinRmdn aroffendraraana If.
b ssmoer•Ne building or Improvement Is sold within am year of compledan.the owner-
Wilder will have the burden of proving that M did not build or Improve for purpose of
sale.).
❑1,a awnar of W praperty.Am exclusively connecting with licensed comments,to
commct the project(Sea 7044.Business AM Professions Cade:)That Con ocansuY LI-
came Law draw out apply to an owner or property who Wilds or imp owt thereon.and,
who concis for such projects with a contractor(s)Iicanxd pummel m the Contractors
Lteeme LAW.
❑IamuemPtumau Sea .BkpCforthismason
Own. Dam
WORKER'S COMPENSATION DECLARATION-
I hereby illi.under penalty of perjury am ar dte following declaradonc
Mm and will maintain a Canifimmof Cameos m self-inaure f.Wedues Compen-
on,As provided for by Section 3700 of f tabor Code•for the parlomence of Ne
wart for which this permit is issued -
❑1 haw and will maintain Workers Compemadon Imurarm,as requihcd by Seeman
3700 of Ne Labor Cade.for the performance of the wart forwhich Nn permit u issued .
My Worker'.CMmpemaon Insurvme artier and Policy number art:
camiE—Sr1147e r"dNf° Policy No.: S 7/— D e!v 7 G
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
transaction reed actbacmmple ed irate permit Is forouchum ed o0an(1100)
m Int)
1 conify that in the performance or the weak for which this permit 4lssued.1 shill not
employ any parson in my mannerm As to Woman subject to the Workers CeMpanuti0n
Laws of California.Dalc
Applicant
NOTICE TO APPLICANT.If,after making this Ccrtificao:of Exemption,you should
become subject to Ne Workers Compensation prevision,of the Labor Code,you mum
.J O forthwith comply with such provisions or Nu Pascal Shall be deemed revoked.
z y CONSTRUCTION LENDING AGENCY
[-w (hemhy M.Must tart u a comme0oa lending agency far the performance of
fYr the murk for which Nn permit Is issued(See.3097,Civ.C) .
W�Q Lumber.Name
z Lender.Address
f„)0 1 cerdfy that I haw mord MJa application send sum than the abow information is
ly F comet,I agree to comply with all cry and county ordinances and scala lava misting m
-0 V Wading construction.and hereby whorix rtpreunudves of this city to..an upon the
W atmve-mentioned property,for inspection purposes.
(We)ague to saw•indemnify and kmp IumtlEn 7u Clly of Cupertino Against
i,y y Iiebilltim,JudgmcnW casts and expenses which may in any way aOcroe aganrul said City
()z in coax cc of the granting of this permit,
.. APPLI A UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
Sol GULATIon¢
rdn-l� c zap V-dl1? Re-roofs
Signalem of ApplicaonConuactor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupantanom arbanmc hav,mom material
ss de7ned by the Cupertino Mu 'cipal Cao.Chapmr 9.12.and rhe Health and Safety
Cade•Section 25533(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yea No
Will the Spplicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
hw.andnu,air contaminants ss defined by the Bay Amo Air Quality Management all new materials for inspection.
7
ora
Ihaw mad Mteenc! iabmquiremenu underchincrb.95 afam Cahlar- 1 ` �!�
nu HcalthkSarmyCooos
de,S.d25505.25533.d25534.1.n .dthmifthc building �l UY
does a randy have A hmhanL that It u my nexpensibi7ty to redly the oeeupent of the
meet whicIs acme ' to issuance Mfa ccrufwate of Occopenry. Signature of Applicant �tobe
Date
d:�:� , %�
Owner or awboriac a I Dax
All roof cov 'V'or better
CITY OF CUPERTINO
• 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36913035. 00
DATE ISSUED. . . . . . . : 04/18/2008
RECEIPT #. . . . . . . . . : BS000004519
REFERENCE ID # . . . : 08040132
SITE ADDRESS . . . . . : 10470 PINEVILLE AVE
SUBDIVISION
CITY CUPERTINO
IMPACT AREA . . . . . . :
.OWNER GORGEN GARY A AND IRIS M TRUST
ADDRESS 10470 PINEVILLE AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4523
RECEIVED FROM EDWARD GREGORY
CONTRACTOR TBD - TO BE DETERMINED LIC # 00096
COMPANY TBD - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
--FEE ID UNITQUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------ ---- -----
---------- ---------- ----------
---------- ----------
BSEISMICR VALUATION 91000. 00 0.90 0. 00 0.90 0. 00
1BUSLIC FLAT RATE 1. 00 110 . 00 0. 00 110 . 00 0. 00
1REROOFRES SQ FEET 25 . 00 325 . 00 0. 00 325. 00 0. 00
---------- ---------- ----------
TAL PERMIT
435 .90 0. 00 435 . 90 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
-----------------
CREDIT CARD 435 . 90 MASTER CARD
---------------
TOTAL RECEIPT 435 . 90
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
•CUPEkT1NO PERMIT APPLICATION
8"0 o%3a
APN # . Date:
JM 13 0 3 S ob .
Building Address:
/Dyro �741e vr`/e 4ve
Owner's Name: Phone#:
� M � ercqe.� yDd'- ZSZ -8 59
Contractor: Phone#: 65VI 6TH 5-0¢
� i� ha '�u �evi �ders .
Fax #: — 6S9-3'y'Z 6
Cupertino Business License #: Contractor License #:
A; 464P
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles K Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ( ❑ Provide I.C.B.O. Report#
To be Removed Ve x ❑ Provide Mfgr. Installation Specs.
Job Description• �(� ��"
Of� e K t`S�i.ts l Clow -
1�eB Os L3 `:elf roa. de. r/ce( Co. e154.'aol.-
� 3016 � �
Residential Commercial El
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Valuation: Few)
I Have Read,Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
CITY OF CUPERTINO
aloREROOF
CUPkTINO FEE SCHEDULE S
Number of
Squares Fee ID Fee Description Fee Group Permit Type
REROOFCOM Re-roof Commercial B COMML-ROOF
BSEISMICOM Seismic Commercial B
1S41RER00FRES Re-roof Residential • B SFDWL-ROOF
BSEISMICRE Seismic Residential B
REROOFMRES Re-roof Multi-Family B MFDWL-ROOF
BUSLIC 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 Raid 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: l g O f 2rL
Job Site Address: l D Yj(J ��e V Ile- A// ve-
Roofing Company Name 4'TVK �4'�,r dE/-1
Applicant's Signature: Date: y"fda-v?
• Greg Casteel
Building Official
Revised 11/2/04
,- Community Development
0
Cupertino0 Torre Avenue
CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
6UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
�0 /QV e- p o ( � z
OWNER'S NAME: & pr PHONE # VOP-ZS-Z-S
GENERAL CONTRACTOR �• .ti vn� f,,rjdpLr FAX # . 6SY 3YZ(o
I am not usin g any subcontractors: �i�--/f, Z&
Signature Date
Please check applicable subcontractors and complete the following information
65 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 tj n r
Septic Tank
Sheet Metal
Sheet Rock
Tile
7,CPO
Owner/Contractor Si ature Date