06120040 (2) CITY OF CUPERTINO &+rte-gra. v +' ' '" ' asz-x3'�
' BUILDING DIVISIONPERMIT C0NTRAC.TR?Nk'OT2MATI
BUILDINGADDRESS: M & S ROOFING CO. PERMrrNo.06120040
10 2
OWNER'S NAME: PERMIT ISSUE DATE
KEITH LEE 208 COPCO LN 12 /11 /2nnr
14 ONE: SANITARY NO, CONTROL NO.
(408) 314-0870
ARCHITECTiENGINEER: BUIfDING PERMIT INFO
BLDG ELECT PLUMB MECH
i8 LICENSED CONTRACTOR'S DECLARATION Job Description
i u F I hm Ib
hereby anhal 1 am m licensed under provisions of Chapter 9(comoe1ing p
:z�w wit Section90f10)of0ivision Sof Ne Businecand ProfessionsCade.andmyliecuse is
�,- in hall tome and effem., REROOF-REMOVE SHAKE . ROOF, INSTALL NEW 40 YR COM
,ern x License Class Lic.N
;o Dam ConteactorEXISTING PLYWOOD TO REMAIN
ARCHffELTS DEC, A
i�� I undcrsunJ my plans shall k tens]u public mcnNs ,
yU
G Licensed Professional
OWNER-BUILDER DECLARATION
if 1 kmhy a(frm Nm I senexempt from ense the Contractors Loot.Law for to
o O following mann.(Section 7031.5,Businca and Psofections Code:Any city or county
I m which requires a permit on consent,all improve,demoli h,or repair any structure
primus its luuance.altu requires Ne applicant forsuch permilmfile asigoedtutement
tat W is licensed pun antro to provisions of On Comment',License,law(Chapter 9 Sq.Ft.Floor Area Valuz$iID10 6 0 0
(commencing wit Section 7000)of Division 3 of On Business it Proressinns Code)or
Nat W is comp,thmcfrom and On,bas for Ne alleged ammptiort Any violation of
Section 7013 by any applicant fm a permit subjects One applicant to a civil penalty of APN Number Occupancy Type
not mom One five hundred dollars(S300). 35709006 . 00 p y yp
❑1,as owner of tK property,or my employca with wages as their into compenamm.
will do the work,and tic Nucnre is not intended or offered for sate(Sec.71)44,Business
and Professions Cade:The Centimes License Law does act apply in so owner of - Required Inspections
property who Wilds or improves duccon,and who does such waft himself or through his
own employees.provided tat such improvements are not intended reoffered for ale.If,
however.the Wilding or improvement is sold within one year of completion,lie owner.
builder will haw the Wrecks of proving Nat he did hot Wild or improve for purpose of
sole.).
Q I,u owner of the property,am uelusively contracting wit licensed conmuors m
construct to projcm(Sec.7044.Busincn, ssi
and Profeons Code:)The Commenr's U.
cera Taw does out apply he an owner of property who Wilds or improves dcrton,and
who contracts for such projects wit a contractors)licensed pursuant in the Comma is
License Law.
El I ren uempt under See ,B B P C for this mines
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby afBrm under penalty of perjury ane of Ne following deci oro:
1have and will for by Section
37M of Cie Las Cow.for
far Woftchce of the
alias,r provided for by Schon 3700 of the labor Code,far Ne performance of de
w0(k reef which this Permit I,la]aed.
❑1 haw and will maintain Workers Compensation Insurance,an required by Section
3700 of to labor Code,for Ne poff aftance of the work far which this permit is issued.
My Weiser,Compeaauon Insurance artier and Policy numberare.
Cartier. Policy Q �CCnIN FROM
yE
S_'
COMPENSATIONINSURANCE
LL�
'
(This section reed not W completed drive permit is fosse hundred dollars(5100)
or less.)
I comfy tat in the performance of the work for which Nis Permit is issued,I most am
employ any person in any manner an as to become subject to Ne Work eri Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making Nu Ccn flem,of Eutptian,you should
kcome subject to to Worker's Compensation provisions of Ne labor Code.you must
.J Q fa twit comply wit such provi mal ser Ni permit ded dull be electreveled.
'z "" CONSTRUCTION LENDING AGENCY
(-+ 1 hereby afrum last dere is a construction lending agency for the performance of
7 the work fur which Nu Permit is Issued(Sec.3091,Civ.C.)
Uj
Q Lendeder's Name
�z Undies Address
O Q 1 sonify Nat 1 haw rad this application and sum Nat the above infotmatin its
IL (•-' corms.1 agree,o comply with all city and county ordinances and sute laws telaling in
0 U Wilding construction.and hereby authmirz mpreseneaives of this city to enter upon the
shave-mentioned property for inpeetian purposes.
C. (We)agree to ave,indemnify and keep harmless Ne City of Cupertino against
N liabilities,judgmcnu,costs and circuses which may in any way eccme against aid City
V z incamaegmnce of Ne gaming of thi Mrmit-
^ APPLICANT UNDERS'�4NDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 2���—p�
SOURCE R ULATIONS�.
gnmum rA nmcaaa —/ ..D Re-roofs
an RDOUSMATERIALS DISCLOSURE Dam Type of Roof
Will Ne a C- t of rectum Wilding eaupataort2. it c Husks an material
u defined io the Cupertino Municipal Code.Chapter 9.13.and On HcaIN and Safety
cmlC.Section us3z(a)a
❑Ya X11No All roofs shall be inspected prior to any roofing material being installed.
Will tic applicant or ff`um�rt Wiltling aaupam enc cyvipment m Jcvim which If a roof is installed without first obtaining an inspection,I agree to remove
emit WAMOM air conuminants ae defined by On Bay Area Air Quality Management all new materials for inspection.
Diaries?
❑Ya No
I have mad On havallons materials rtquitements under Chapmr6.95.r&Calif. /
rias mithgncild,Cade,,SV7ta5505, my anJ25534.I tto notify
Wthmicup Willing
Joss not &Sdcy how a u nl that it i 55 responsibility u notify the occupant of Ne
requirements wmoat k reel prior to issuance of a Certificate of Occupancy. SignatureorA0
licant Date
owner main mitred age - Date - All roof coverings to be Class"B"or better
Community Development
a e 10300 Torre Avenue
' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
OCUPEkTINO
Building Department
JOB ADDRESS: �0��2,f— pCE`WI Ne XZVT,,�- PERMIT #
06(-2-60 '--(6
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: P2 . \� 12//-0 66
�gnature Date
Please check applicable subcontractors and complete the followinginformation:
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
CITY OF CUPERTINO
•m 1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35709006.00
DATE ISSUED. . . . . . . : 12/11/2006
RECEIPT #. . . . . . . . . : 37002
REFERENCE ID # . . . : 06120040
SITE ADDRESS . . . . . : 10125 SCENIC BLVD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KEITH LEE
ADDRESS . . . . . . . . . . : -
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2724
RECEIVED FROM . . . . : M & S ROOFING CO
CONTRACTOR . . . . . . . : MIRSAD KRAJWIC' LIC # 28360
COMPANY . . . . . . . . . . : M & S ROOFING CO.
ADDRESS . . . . . . . . . . : 208 COPCO LN
CITY/STATE/ZIP . . . : SAN JOSE, CA 95123
TELEPHONE . . . . . . . . : (408)314-0870 .
&E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
___ --------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 11, 000.00 180.36 ' 0.00 180.36 .. .. 0.00
BSEISMICRE VALUATION 11, 000.00 1.10 0. 00 1.10 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 181.46 0.00 181.46 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ __---_-__---___--_
CHECK 181.46 1870
TOTAL RECEIPT 181.46
•
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$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply
-with the above stated policy on re-roofing.
Homeowner's Name:
Job Site Address: ID lczf .�I n Ct�__OU l C zz
Roofing Company Name: C
Applicant's Signature: Date: 1
• Greg Casteel
Building Official
Revised 11/2/04
i �
CITY OF CUPERTINO
'- REROOF
• CUPEkTINO PERMIT APPLICATION FORINT
APN# S U DD/l Date:%
Building Address:fO tfJ
S C
Owner's Name: Phone #:
Contractor: , _ License#: O oI�I
Contact: ! ) s/ _ / Cupertino�$/ugs iFnense #:
I t r Z(vO
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 0 Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings_� ❑ Provide I.C.B.O. Report#
,i� To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ Crte(
Job Description: re/✓AOvl' ) a/q o 10'J'0' Ale>� 7 ycoMP
Residential Commercial64
❑ .S �
n1 �— / QQ
L 7� \
Fire Zone: Yes ❑ No Confirmed with arming Det. if
there are any restrictions: LJ
Cost of Proj t: D Type of Construction: Occup ncy up:
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
•