06060269 (2) CITY OF CUPERTINO Ir k
BUILDING DIVISION PERMIT CONTRACTOR INFORMATIONJ'
BUILDING ADDRESS: LOS GATOS ROOFING PEtM1T NO06060169
1575 POPPY W
OWNER'S NAME: PERMIT ISSUE DATE
DAVID RALSTON 888 FAULSTICH Q1 06/19/2006
NE:
SANITARY NO. CONTROL NO.
(408) 298-9399
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 = (�
apo LICENSED CONTRACTOWS DECLARATION
FF I hereby affirm Nat I em licensed under provisions of Chapter 9(commencing lob Description
Z,Tj wish Section 70(110 of Division 3 afthe Business and Praltinamn Code,and my license is
in Ault roue arta arras 0 REMOVE EXISTING, INSTALL 7/16"OSB AND ROOFERS
�? License Clsss L T 9 Lk.a�Q
ago Dme_/ /��T—�Contrumr SELECT FELT. INS [RK TL SHINGLES . CLAS
� /C a/'� ARCHffELT50EClARAT10N ,� ��
�� I utWcrsunJ my puns shall he used ns public records �s -
JyU
kat, Licensed Professional
y3OWNER,BUILI)ER DECLARATION ���
'A I hereby aRsm Nm I am exempt from the Canuutor's Liccnu Law for the a�1 C,5006
00 following maw..(Section 103 1.1,Business and Profudans Code:Any city or county G
m rE which Acquires a Permit to mostruct,alter.improve.dcmotN,.r mpair any swauro
-¢a priorio iuinin....alsomquimstse."Iieant forsuch permilta0kasignedsu¢mem
< thot he is licensed Puumt 1.the Provisions of the License law(chapter 9 Sq.Ft. Floor A ' [� Valuatl�fi 6 0 8
is mCommon's
with Section 7000)of Division 3ofthe Busimairand ProfessionsCodc)sir �(-JJ
y Nal he u exempt therefrom and O n basis far the alleged eammption Any violation of
Section 7031.5 by any applicant for a permit subject,the applicant o a civil penalty ofAPN NumbeC Occupancy Type
roam
not than BK 3
hundred dollars(s5031 6 6615033 . 00
❑I.uownmofthepropeny,mmyemploycowishwa utrevmle Compensation.
will do the work,and thestrumum is not bundled or offered brWe(Sec.IDs,Business; Required Inspections
and PAofevions Cade:The Contractor's Ld+•-law s roe dot apply m an owner of q P
property who Wildsmimproves themon,and whodoessuchwark himself".ugh his
awn employees,provided Nat such improvement,are not intended aroffered fornsidC If.
howesv.Ne building or improvement is sold within oro year of mmpledon.the owner-
builder will haw the burden of proving Oat M did rot Wild or improve for purpose of
sale.).
0 14 as owner of she propeny,am exclusively...training wish licensed Comranors in
Construct Of project(Sec.7044,Business and Pmfcssions Cade:)M Comracmr's Li-
cove Law does not apply to an owner of property who Wilds or improv tWmon.and
who contract,for such project,with a convamor(t)licensed portion,to On Conuutofs '
Limns law.
❑I am amara under See .B&P C for this mason
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby Nrn uMer pnWty of pcAjury na of the falbwing dttlmaumns:
1 haw and will maintain a CeAtiOam of Conscnuo self-insure fmWmkcr'a Compcn-
ration,as provided for by Section 3700 of ter labor Cost.for the perfonnanee of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,an required by Section
3700 of the labor Code,for the perfarmamce ofthe work for which shu permit u issued. '
My Worker's omMosataio�m humrance artier and Policy number art:
Cartier. /a((N� Policy No.:00 6 Z??'J- L O 4
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu ucumn timed nut he completed lithe permit u fora..hundred dollars(gI0(1)
or lcsa)
I ternary that in the pef orrum.of On work for which this permit is issued.I shall not
cmplay any person in any mammy so as In hourrm subject to the Worker'C9Arhpennauen
Laws mf Califoroia.Date
Applicant
NOTICE TO APPLICANT:If,she,making Nu Certifhcam of Escmptimq you should
become Subject in the Worker's Compensation provisions of the labor cock,you muss
.,O forthwith Comply with ouch pmvisi.ns or this permit shall he deemed revoked,
Z� CONSTRUCTION LENDING AGENCY
[-� Iherehy atm.that there isaro.do.tusking agency,for On perfurrom.of
E
the work for which Nu Permit is issued(Sec.309'1,Civ.C.)
a0 Lender's Name
a z Leneces Address
V C) I certify that I have Aad this applicmimn and sum that the eWw inforrnaumn is
U. Comm I agree to comply with all city and county okaarsimand sum laws dating to
pU building convection,and hereby amhome mpresenhmiws of this city to enter upon the
r 6W.
above-mentioned property for inspection purposes.
(we)agree to sawn.indemnify ask kap hay in
the City of against
against
.Uh inCOiues.gUCuC Of anus.
Costs and ex this Pewhichmryin any wayaasuc agalm said City
V Z A APPLICANT
Cor thegraining of this Permit.
/
`-'
SOURCE
RE UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REG TIONS.
/ � (a�g^OC Re-roofs
Signazum of lien mnuanor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will she applicant Or form building acupwlstom or handle havhdous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code.Section 13533(x)7 All roofs shall be inspected nor to an roofing material beim
❑Yea apT4u P P Y g g installed.
Will the applicant m flu`wAc Wilding occupant use equipment or tkvices which If a roof is installed without first obtaining an inspection,I agree to remove
erI havakous air contaminant,as defined by the Bay Am.Air Quality Management all new materials for inspection.
Disuict7
❑Yes {aNu
I have mad the hazardo
us
materials rec dorroms ummC'hap,m6.95.rdv Califar-
.iaHealth&SafmyCode,Sauon25505,25533 and 25534.I understand tmifhM building
does not cunently hoc a rem,Nat it Of my hememihiliry in notify On scup.,of the
rcyuiremw/ nh'Cn W ClpAimr mmKCo(aCatfmateofOCCapamy. � Signature of Applicant Date
Owner or authosind agent Q Dam All roof coverings to be Class "B"or better
Community Development Department
Building Division
` City of Cupertino
- 10300 Torre Avenue
CIT,OF Telephone: (408)777-3228
C O P E RU I N® 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 buildingmspector. 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 LC.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: �� V/, �Cc,�S7 �Jz
-_____.___.._Job_SiteAddress:___-.-_____ �Q _ -_ Gv
A plicant's Signature: Date:
Greg teel
• Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
.m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36615033 . 00
DATE ISSUED. . . . . . . : 06/19/2006
RECEIPT # . . . . . . . . . : 34928
REFERENCE ID # . . . : 06060169
SITE ADDRESS . . . . . : 1575 POPPY WY
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : DAVID RALSTON
.ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : LOS GATOS ROOFING
CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481
COMPANY . . . . . . . . . . : LOS GATOS ROOFING
ADDRESS . . . . . . . . . . : 888 FAULSTICH CT
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 298-9399
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 7, 000 . 00 137 . 16 0 . 00 137 . 16 0 . 00
BSEISMICRE VALUATION 7, 000 . 00 0 . 70 0 . 00 0 . 70 0 . 00
--- ------ ---------- ---------- ----------
TOTAL PERMIT 137 . 86 0 . 00 137 . 86 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 137 . 86 1745
TOTAL RECEIPT 137 . 86
•
-" Community Development
f,
i 10300 Torre Avenue
N ' `' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
CUPEkTINO
Bui.ldin IDe artment
JOB ADDRESS: PERMIT #
/S 75 /� 66 6016 9
OWNER'S NAME: PHONE #
GENERAL CONTRALTO G 6,5 FAX# `/0 2 9 93-711
�J
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and com fete 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/Contractor Signature Date
y
CITY OF CUPERTINO 0(47wpl
REROOF
CUPER INO PERMIT APPLICATION FORINT
• APN# .31,6—/ 6-03-3 Date:
(.0119 IOU
Building Address-
L5
Owner's Name: Phone#:
`d f 252--y S -7
Contractor: r Phone #: O License#:
a - �OO�Io
Contact: �- Phone#: Cupertino Business License#:
% SaIV2G.,
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt ShinglesAsphalt Shingles
C) Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
'i6 Other(Specify)C4 S//�tk �8( Other(Specify) C 0 S E
Number of existing coverings ❑ Provide I.C.B.O.Report#
To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Under tand and Will Comply With Cu ertino's Tear Off Policy:
Job Desc 'pti n: 2•a i�P QiYz�Z, �i z ol, / 7 iG U S13 « :c� ,o
Residential Commercial ❑ r
Fire Zone: Yes ❑ No Confirmed with Planning De t. if.
there are any restrictions:
Cost of Pr t:6"4, /' j Type o Construct, Occupancy group: /
o p k
Qty. if
RFee ID Fee Description Fee Grou
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Ener BUILDING
- - — -• --
__.__ ..._..__ _SeismcEeeRD. BSEISMICOM--- - Seismic Commercial-___._--..-• -.- -_, .- BIJIIDING -
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
•