06050246 (2) CITY OF CUPERTINO �
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION;
u l..X,/••o-. a'>£' �y$°.�BuLi#h-".. a G,h,lf. ...--Y?3>�`�£C®s8
BUILDING ADDRESS: PERMff NO.
EL CAMINO ROOFING CO INC 06050246
O NBLOSSOM DRPERMIT ISSUE DATE
NE: 1. SANITARY OL N0.
ARCH=/ENGINEER: (488) 292-7644
BUILDING PERMIT INFO
BLDG ELERPLUMB MECH
0 0 0 0
J p LICENSED CONTRACTOR'S DECLARATION Job Description
C I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
with Section 7")ofDivison 3 of the Business and Professions Code.Wmy license is
c. in fun force and`f4el- yZ y37 L
3? License Class ff�a''!! Lk Is REROOF-REMOVE (E) WOOD SHAKE/INSTALL 1/2
Dau: C- ) —4 L Conuacmr Ao• ADR-
ARCNrMCTSDECLARATION PLYWOOD & 50 YR COMP SHINGLES .
c< I understand my plans shall he used as public mcnrds
U
y Licensed Professional
OWNER-BUILDER DECLARATION
f I erchy afri m that 1 am exempt fruits the Contnmors License Law for this
o O following reason.(Section 7031.5.Business and Prefections Code:Any city or county
3 which requires a permit to consuuct alter.hnprow,demolish,in spar any suudo.
prior m itaissuance,also mquireaNc applicam for such permit to file a signed sukment
i that he is licensed pursuant m Ne pmvisiotu of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valu113350
[IO
(commencing with section 7000)of Division 3 of the Business and ProOessime Code)m 13 3 5 0
i$ thin M is exempt therefrom and the basis for the alleged eximplim.Any violation of
Section 7031.5 by any&poll=,for a permit subjects the applicant m a civil perulty of APN Number Occupancy Type
om N
not man five hundred dolWs(55o0). P y yP
Q I,as owner of the property,or my employees with wages as their ale compenuoh n, IS901042 00
will do the work,and the structure is not intended or offered for ask(Sec.7014.Business
and Prefealmu Code:The Ccomactors License Law does net apply to an owner of Required Inspections
property,w he bui Ids or improve thrsmn,and who does such work himself or duough his
owo employees,provided tNt.vch improvements see not inteMed in offered for ale If,
however.due Wilding or improvement is sold within one year of a mpktion,the owner-
builder will have the Writes of preving that a did non build or improve for purpose of
ale.).
❑I,as owner of the property.am exclusively contracting with licensed rontracton he
wmI=she projem(sec 70x.Business and Profuwoes Crede:)Th.Cootnetors U.
as Law does not apply to an owner of property sidle Wilds or improves demon,and,
who connotes,for such pmkm with a contracions)licensed Pursuant in the Convenors
License law.
❑lamexemptunder See .B&PCfonthlsmason
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 lumby ase under family of perjury oro of the following declinations:
40o
hew and will maintain a Certificate of Common to self-insure for WorknrsCompen-
n,ns provided fon by Section 3700 of Ne Labor Code,for the pe formatce of the
wort for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,an required by section
3700 a the labor Cade,for the performance of the wort forwhich mica permit is issued.
My Workers Compensation Inxun.earls and Policy tier am:
Cartier.�;A Poliry No.: b OS'
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sit on nerd not W completed time Permit is forone hundred donars(5100)
or ks.)
1 certify that in she Performance a the work for which this permit is is sed,1 shall not
employ anypcrson in any manner so as 0 become subject to she Workers'Compensation
Lam of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Cerdficam of Exemption.you should
become subject m the Workei s Compensation provisions W the Lahor Code You most
0 forthwith comply with such provisions or Nu permit shall a deemed invoked.
;V) CONSTRUCTION LENDING AGENCY
?
Ihereby air.that Nem mm
is•crucdnn lendingagony for do performance of
tho work for which this Permit r banned(Sec.3097,Civ,C.)
10 Lender's Name
Z Lenders Address
p 1 certify that 1 haw read this application and state thin the above infomudw u
F' reran.I agree to comply with all city and county ordinances and sum laws mlating to
V building convection.and hereby authorim mpreemadws of this city to enter upon the
shove-mentioned property for inspection Purposes
(We)agree m saw,indemnify and keep harmless to City of Cuperino slowed
i,, liabilities,judgments,coats and cxpcenea which may In My way. .last aid Clry
i Z in consequence of the granting of this permit
APPLICANT UNDERSTANDS VD WILL COMPLY WITH ALL NON-POINT Issued by:S44T�ko Date ,- L 0I-
SOURCE REGULATIONS.
Ilel— '�� Re-roofs
Signna la nuacton Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant in future Wilding pecupms sore in handle haardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yex G}Jgo
Win the apprcant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
rev cot nos air contaminunu as&f.rmd by the Bay Arra Air Quality Mansome., all new materials for inspection.
❑Yes No
1 have mal Ne MmMous materials mquiremenu undcrChapmr6.95 of the Califor-
nialkslthRSdclyCedc.S.-d.2505.255334 25534.1utlMnu dt iftheWilding S y/'0 6
dors rot eurrsn0y haw. t than II r in mspomibilisy m nmufy the occupant of the
nommme hick met prior'issuance rsCwfcam fOccu
5p— %ry ob ig re of Applicant Date
owner emd.pem Dam All roof coverings to be Class "B"or better
c:1Community Development
�!. 10300 Torre Avenue
e J Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
WUPEkTINO
Building De artment
JOB ADDRESS: PERMIT #/' c—
�7iG/
OWNER'S NAME: D Y '!J PHONE # 1 *2,-y76 4 c—I
GENERAL CONTRACTOR:-G' d. RyeK . FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractor d 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 /o Fie.
Septic Tank '
Sheet Metal
Sheet Rock
Tile
• 57--3
Owner/Contractor Signature Date
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35903042 . 00
DATE ISSUED. . . . . . . : 05/31/2006
RECEIPT # . . . . . . . . . : 34623
REFERENCE ID # . . . : 06050246
SITE ADDRESS . . . . . : 829 ROSE BLOSSOM DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : MARION BOROWIECKI
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : EL CAMINO ROOFING
CONTRACTOR . . . . . . . : CASTILLO, MARK LIC # 21455
COMPANY EL CAMINO ROOFING CO INC
ADDRESS . . . . . . . . . . : 1650 S 7TH ST
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 292-7644
�EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 14 , 000 . 00 212 . 76 0 . 00 212 . 76 0 . 00
BSEISMICRE VALUATION 14 , 000 . 00 1 . 40 0 . 00 1 .40 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 214 . 16 0 . 00 214 . 16 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 214 . 16 010627
TOTAL RECEIPT 214 . 16
•
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 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: _ Cr.'ai1 /� 0r�c•,�Z�.,
Job Site Address: 1?�ZC1 Rb 5f-
Roofing Company Name: 2511 e, r� /L� Co• l
Applicant's Signatu Date:
• Greg Casteel
Building Official
Revised 11/2/04
I
CITY OF CUPERTINO
/ REROOF
��OSoa
CUPEkTINO PERMIT APPLICATION FORM
APN# 5-61 03 D / 4� Das'3/- 06
Building Address:
$Zq V45C oloySa,_t Df
Owner's Name: P one#'
Contractor/ / ^ License#:
C�fe"7;vv yZY.?1 Z-
Contact: Cupertino Business License #:
•S O
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles * Asphalt Shingles
p 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: ,// '" � '
Residential [ Commercial ❑ �llrSf
Fire Zone: Yes ❑ No Z Confirmed with Planning Dept. if
there are any restrictions: LJ
Co t 3f PPrrCo�ject: Type o��nstruction: Occupancy group:
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