06090206 (2) CITY.OF CUPERTINOi.>F-Aa+E
BUILDING DIVISION PERMIT CONTRAtwo INFORMATION,
BUILDING ADDRESS: OLD COUNTRY ROOFING PERMIT NO.06090206
11558 RAINTREE SPRING CT
OWNER'S NAME: PERMIT L£SUE DATE
VERKROOST ROBERT 125-B GROBRIC CT 09/21/2006
E: SANITARY NO. CONTROL NO.
(707) 864-5557
ARCHITEC LENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0 0 0
p a LICENSED CONTRACTOR'S DECLARATION -
i Les,C 1 hereby a?red that 1 am Iicnscd under provisions of Chapter 9(commencing Job Description
i7 Lwide section 7").f Division 3aflhe Business and Prafcssiom Code.Lod my licence is
I.fanrameander�g3q (�Z273 1 REROOF— TEAR OFF SHAKES, ADD 50 YR
a•t2� L1CL.9 `'
�Quu"cuur COMP SHINGLES . CLASS A. 17 SQUARES
�Fo Dam
l y UrwRCN aM "4�
i < I and nJ my plans s I' rtedis
°off Licensed Pmfessianal
5 OWNER-BUILDER DECLARATION
f I hereby affirm that I am exempt from the Conuamora Lieen=Law for the
❑O following mason.(Section Rn 1.5,Business and Professions Code:Any city or county
3_Pi which roquines a permit to cmaram alum.improve,demaliab,or repair any swnure
¢i prior Lit its issuance.also requires the applicant forsuch permit o file a signed statement
�G
that he is licensed pursuant to she previsions of Ne Contractors License law(Chapter 9 Sq.Ft.Floor Area Valuati (](](]
(ca
mmencingwth Sccsm]000)o(Divksion3ufm Bosnecsand Profusions Codc)or
$
that W is exempt rWmlmm and tW basis for the alleged exemption Any violation of
Section 7031.5 by any applicant for a permit subjects Na applicant in a civil Penalty of ' r&ber Occupancy Type
nam ream sun five hundred dolWL(S5M. 36b54 48 . 00
1,m mmr of Ne pmpeny.m my employm wiN wagu n N6r solc comp melon,
will da Newark.ands, he Crmistor'sLicenseuraided aw cd does apply In an,Badness Required Inspections and impacts,who
W Code The ves traemh Littre law dots Lounot apply lf an gh is q P
propertywhobuilds i intpmwthereon,and who desouchwork Himselfor mhmugh Hf.
awn cmploym,pmvior Na such improvements old wit arc oat ear ofc mplelmoroffeuad for ole If.
However.Ne Wildingordersof moving
cast withinoneyeaofcompletion,puawner-
Wilder will have the Wmm of proving That W did not Wild or improve for purpose of
salt.). /^ ,
co 1,uownerorct Sec.7 property.am uGus and contractingesss with:)The
eCcnvacmrs U.
cons,Lo d PmFn(Sec.]011,Business and property
wh Professions Code:)TW Contractors d
ceue Law docs ore apply m an owner of proper(who Wilds or improves Comon,and.
who License
contracts for such projects with a canvacmar(s)licensed Pursuant in use ConvusoYs r0
0 1 ann Law. O
❑lam exempt under Sec. .B&PC far Nis reason
Owner Data
WORKER'S COMPENSATION DECLARATION
40 1 hereby affirm under penally of perjury arc of the fallowing declamtimts:
❑1 have and will maintain aCcnificate of consent to self-in o m for Worke/s Compere
cation,as provided for by Section 3700 of the labor Cade.for the perfarmanc of the
work for which this posit is issued.
ave and will maintain Worker's Compensation Insurance,u required by Section
I] of Ne Labor Cade,for the performantt of mW work for which dila Permit is issued. '
My War ems Compeuauon Insurance maim and Policy number are:
Carrier. Om{ �it/Wo/s.+ Policy No.: "211 SS 7Z
CERTIFICATE OF EXEMPDON FROM WORKERS'
COMPENSATION INSURANCE
miss scetim mored not W canpimed if the permit is fmone hundred mutant(SIM)
or less.)
I Cost Lem in we performance of the work for which Nis Permit Is issued.1 shall not
employ any person in any manner m as in become subject to theWorkersCompensasim
Laws of California.Dare
Applicant
NOTICE TO APPLICANT:IL after marng this Certificate of Exemption,you should
became subject to the Wmrkees Compensation pmvisims of des tabor Code,you most
,J Z raM With comply with such pmvisona or this permit shall W deemed revoked.
zCONSTRUCTION LENDING AGENCY
[-+ IWmby alarm that Nem is a construction lending agency for the Performance of
!Yi .�•s 0e work for which this permit U issued(Sec.3097,Civ.C.)
aQ Lender's Name `
a z Lattices Add.
U Q 1 certify that 1 have road this application and Lute Leat Lm above information is
correct.l agree to comply with all city and county on inan¢s and state laws relaning to
�O building construction.and hereby aulhorim represcnutives of this city to enter upon the
abovementiooed properly for inspection purposes.
Fy (We)agree to save,indemnify and lump harmless mW City of Cupcnine agaitut
cn liabilities,judgments,casts and expenses which may in any way acme agoras,said City
U Z in con"LL of the granting of this permit.
APPLICANT U ERSfAN A ILL CO PLY v3(IT�14 AqLLJiON-POINT Issued by: Date
SO ERE ATIOIJS
L Re-roofs
signaurt rnvv� IianUConuanor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will that applica ar future Wilding occupantamre or bondlc haaamoumatesil
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Heilmh and safety
Code.Section 255320)? All roofs shall be inspected prior to an roofing material being
40 C]Y. ujN,, P P Y 8 ginstalled.
If a roof is installed without first obtainingan inspection,I agree to remove
Will Lm applicant m future Wilding occupant use equipment or devices which P g
emit Infamous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Dutrim]
❑Yu
I have read use hvamewsmamrialsrequirements unJcrCWpter 6.95 afthe Califon
nix Health&Safety Cade.Scmiau 25505.25533 and 25531.I undersundLw ifCe Wilding D Q
does ret contend,have a tenant chat it is my respomnibdity In out,the mVopant of me
requirements which mustW me,prior In fia
issuance ar a ceniic of Oce u 5lgnatUre A I ant 7 Date
Owncr gen'- g
All roof coverings to be Class"B"or better
am daDam
CITY OF CUPERTINO
!m 2 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36654048 . 00
DATE ISSUED. . . . . . . : 09/21/2006
RECEIPT # . . . . . . . . . : 36140
REFERENCE ID # . . . : 06090206
SITE ADDRESS . . . . . : 11558 RAINTREE SPRING CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : VERKROOST ROBERT
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : BONITA JENKINS
CONTRACTOR . . . . . . . : FOLK, DIETER LIC # 20389
COMPANY . . . . . . . . . . : OLD COUNTRY ROOFING
ADDRESS . . . . . . . . . . : 125-B GROBRIC CT
CITY/STATE/ZIP . . . : SUISUN, CA 94585
TELEPHONE . . . . . . . . : (707) 864-5557
•FEE 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
----- ----- ---------- ---------- ----- -----
TOTAL PERMIT 148 . 76 0 . 00 148 . 76 0 . 00
•
Community Development Department
Building Division
S' Mn'�• City of Cupertino 10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
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: Q�—
Job Site Address: II S 5 fj �a�-vijt.�_ _ C_14—
�q
Roofing Company Name: d�� 11z: X^. - r�
Z
,.
Applicant's Signature: :F• / p Date: ! u 04
• Greg Casteel
Building Official
Revised 11/2/04
Community Development
; 10300 Torre Avenue
.W� Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: PERMIT#
U 5 Is 4F
OWNER'S NAME: PHONE # z 6 -14 -7 0
GENERAL CONTRACTOR Q( FAX#
I am not using any subcontractors:(W t_. VII- t.. W 9 ai o 6
Signature Date
Please check applicable subcontractors and complete 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
Owner/ tractor Signature Date
s
CITY OF CUPERTINO owogm �0 REROOF
PEkT
• CUINO PERMIT APPLICATION FORM
APN # 2r L t
5O Date:
Building Address:•,SIISJ�Bs� � ' t 7 /
Owner's N_ � Phone 6 —6 G 7
z b
Contractor ( Phone#: License#:.� ZZ 7 3 J
cin Z_ O U
-2 (�
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles >(- 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 ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: T/ �� a000V �SOX4 n' /� cop A-
Residential ) !" Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: oe Type of Construction: Occupancy group:
o00 / 7 v <(L13
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
•