06090160 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT 'CONTRACTOR INFORMATION ;
BUILDING ADDRESS: R E ROOFING & CONSTRUCTIO PEINTL`06090160
21436 RUMFORD DR
OWNER'S NAME: PERMIT ISSUE DATE
GOUDEY JOHN L AND CAROL A 15230 CLYDELLE AVENUE 09/20/2006
NE: SANITARY NO. CONTROL NO.
(408) 626-9320
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ADO LICENSED CONTRACTOR'S DECLARATION Job Description
e u 1 humby afriem Nal 1 am licensed under provisions of Chapter 9(commencing P
.Z" wish Section 70W)of Division Sof Om Bturess and Professions Cods,aM my lic..is
+« is full �3 -7 -7
REROOF- TEAR OFF 1 LAYER CEMWOOD, ADD 1/2" CDX,
;�� Littnsc class Le.g 30# ASTM FELT, CLASS A ASPHALT COMP 36 SQUARES
a TSConDECL , 1[
'Et9 ARCHITECTS DECLARATION
I w U I uMmmanJ my plans shall ix used a public records
a
,Qt Licensed Prorcssi...I
i 3 OWNER-BUILDER DECLARATION
2<m 1 hereby affirm Out I am czcmpt rem the Convacmrs License Law for the
00 following mann.(Section TIU 1.5,Business and Pmfasions Code:Any city or county
<m which mquims a Permit to consumer,aper,improve,demolish,or repair any structure
Prior n its issuance.also tequircs the applicant rot such permit m rile a signed statement
E . Nat he is licensed pursuantto the provisions of dm Contractors License faw(Chapters Sq.Ft. Floor Area Valu4i15
,~n (commencing with Scction]000)of Division 3 or the Business and Pmressions Code)or
0 Nat M is commit theefmm and the basis for the alleged exempdom Any vi.i.uno of
Section 7031.5 by Ary applicant for a permit subjects the applicant to a civil penalty of 3 e pTQ 7Q�sst Is
has more than five hundred dollars;(S5(K). f2`OY4] A1` •b 1 0 0 Occupancy Type
I,as owner of and
property,err my wmencled es with wagr a m,(Sem.cnmpruimuss
will dothework,and the swctue canoes License
fawdo offcond for nut apply
Bney of Required Inspection
and a rty who ns Coot:The Conuazert nd who Law does set apply lf an owns is q P
property who bisipro car i d Our such i m roand who dessac intend,
cooffrcarlhmugh his
awn employes,provided mot such impromments arc not initr ofo makers,the rnmforsah,K.
builder Nebuil the carimpmvemensg coldwithinoneYw Of mprove for theowrren
builder will have the burden of proving Nat he did not build m improve far purpose of
weJ. Z�? /�
❑1.as at,of the progeny,am e.,Iainly convecting with licensed rontraetun to !/
corlwm the project(Sec.70aBusiness and Professions oThe Convectors Li- O
cense an Law coca not apply m owner of property who buildsds orr improves thereon,and
whofor such projects; m�
with a comorts)licensed Ne
nsed pursuant Convah
cm
License
La u❑lose ere czcmpt underSm ,Bk PCfor Nis moan
Owns, Dau
WORKERS COMPENSATION DECLARATION
I hereby a/fum abler penalty of perjury oro of Ne following dmlatauons:
1 ham and will maintain a Cerfiriae of Consent a mlf.insum far WorkersCOmpcn-
woric f a pmviocd foe ai Smuon 3'1000(de Labor Code,for dm performarrm of me
work for which Nis permit is issued.
❑1 have and will mainum Wmiccr's Compensation Insurance,as required by Scction
37W of me Ube,Code,for In,performance of Ne work for which this permit is issued. '
My Worker's Colmproamion-IM carrier carrier and Policy number Oce:
Cartier:S ICA-e IVC, Polley Na.: 5 7 I—I O DSA
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu suction nccd not be completed if the permit is far..hundred dollars(SIM)
or less.)
1 ternary Nat in me Wrobromme of the work for which this permit a issued.1 shall not
employ any person in any manner an as to become abject to Ne Workeri Compensation
Laws or California.Dau
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject a me Workers Compensation provisions or Ne UMr Cock.you moa
.J Q foMwim comply with such provisions or Nu Permit shall M decreed revoked.
z� CONSTRUCTION LENDING AGENCY
[+ I hereby alarm Out then is a Construction lending agency for the perrorman¢uf
Cli the work for which Nis permit is issued(Sec.3092.Civ.C.)
It7 A Under's Name
.7 z tenders Address
V Q 1 emify Nat 1 have mad this application and sure
m the about information is
D, F toren.I agree so comply with all city and county ordinances and sou laws relating m
0 V building convection,and hereby authorize represenuiivcsof this city to eme,upon the
afrove•mcmiuned property rat inspccuon purposes.
F0. (We)agree a save,indemnify and keep haemleas the City of Cupenino against
fn liebiliuu.ludgments.costs and espensa which may in any way accrue against said City
U Z in consequence of dm granting of this permit.
^ APPLICANT UNDERSTANDS .WILL—C PLY WITH ALL NON-POINT Issued by: Date
SOURCER —'
Re-roofs
si mor pecan onuactor Dau —
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding Occupant store or handle hvardous manorial
as defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code,Section 25532(.)? ���fff
❑r a Tad Ne All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or forum building Occupant use equipment or dcvicm which If a roof is installed without first obtaining an inspection,I agree to remove ,
suis hOvakna air contaminants a defined by the Bay Area Air Quality Management all new materials for inspection.
Dicoria?
QYs ,
1 have mad the Wommor materials requimmenuubulk,Chapter 6.95 of dm Califon
nu Heal"SafctyCods.Sections 25505,M533 and 25534.1 undersand mat ifde Wilding
does not eummuly hart a tern.that it is my responsibility m nodry the occupant of me
m�gta�remp wh_ytixmctp,-N6, er,ctrRamnrc<mpl�oj Signature of Applicant Date
I t t �/In, I a l
Owner or munrutocd age, Date. All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408)777-3333
4UPERTINO
Building De artment
JOB ADDRESS: 2 '` QU o tCS pr PERMIT# X,Q
�D d
OWNEXS NAME: PHONE # W-q-7(o I7(g
GENERAL CONTRACTOR FAX #
c` o Iq
I am not using any subcontractor
Signature Date
Please check applicable subcontractors and complete the followin information:
60 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
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: C`L NkYO) GOUd"
lob Site Address: -2 Dr-
Roofing
rRoofing Company Name: (Z (2-00'2\ YlC>\
Applicant's Signature: Date: 0( t2ol o u
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
om 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 32641008 . 00
DATE ISSUED. . . . . . . : 09/20/2006
RECEIPT # . . . . . . . . . : 36130
REFERENCE ID # . . . : 06090160
SITE ADDRESS . . . . . : 21436' RUMFORD DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : GOUDEY JOHN L AND CAROL A
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : RE ROOFING
CONTRACTOR . . . . . . . : PROCTOR, PAUL LIC # 20615
COMPANY . . . . . . . . . . : R E ROOFING & CONSTRUCTION INC
ADDRESS . . . . . . . . . . : 15230 CLYDELLE AVENUE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95124
TELEPHONE . . . . . . . . : (408) 626-9320
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------ -- - - --- ---------- --- - - -- - -- ------ - -- - --- ------- ------ ----
BPERMFEE VALUATION 15, 000 . 00 223 . 56 0 . 00 223 . 56 0 . 00
BSEISMICRE VALUATION 15 , 000 . 00 1 . 50 0 . 00 1 . 50 0 . 00
---------- ---------- - ----- ---- -------- --
TOTAL PERMIT 225 . 06 0 . 00 225 . 06 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----- -- - - - - - ----- ------------ ------------------
CHECK 225 . 06 10320
TOTAL RECEIPT 225 . 06
•
CITY OF CUPERTINO
REROOF
• CUPERTINO PERMIT APPLICATION FORM
APN# —3�Z_CP _ 41
_ Dig Date: a 1201 U(V
Building Address: 2U.tnccrc( �Y
Owner's Name: � Phone#:k 4 CaYo1 C,t�t e'
Contractor: License#: .12-159
Contact: Cupertino Business License #:
� le lY6c�c r ��-�}21 - 1�l13 ZD 15
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles �, Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles /�,, 1 E3Wood Shingles
�t Other(Specify) (2P_M\rQC00 ` ❑ Other(Specify)
Number of existing coverings t ❑ 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: %,,-,2 � \"er CemWCOC I o'd 6 ,I?_" CD)( , AJC) OSTM
IE�l �t ` ,A' AJ lT CoYy\P
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are an restrictions: U
Cost of Project: Type of Construction: Occupancy roup:
115 CxX)
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
•