06040188 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CIINTRACTnRINFORMATION
BUILDING ADDRESS: MBROWN CONSTRUCTION, INC PERMTr"0'06040188
1153 STAFFORD DR
OWNER'S NAME: PERMIT ISSUE DATE
Alk BROWN JOSEPHINE M TRUSTEE 702 S . DANIEL WAY 04/28/2006
14 ONE: SANITARY NO, CONTROL NO.
(408) 260-1260
ARCHITECT/ENGINEER: - BUILDING PERMIT INFO
BLDG EIECT PLUMB MECH
0 0 0 0
loo LICENSED CONTRACTOR'S DECLARATION Job Description
m 1 therebyalone,Nat 1 am licee.under provisions of Cktpur 9(rommcncing
�i� with Secure 700alT, Division 3o1HC Business and Profeuium Code.mil my license is
+'c infull force and effee TEAR OFF, RADIANT BARRIER OSB, PLYWOOD, INSTALL
y23z License Clear COB �� COMP ROOF PRESIDENTIAL TL
SFO Da¢_'b^i2/—Il r.+ Con DELL ggy��aSs.
R'_f` ARCHITECTS DECLARATION fig c �t
.m i I urWe,unJ my pima small he otic as public rtcarN �+eyw d�jawl'_j
PyU
.pH Licensed Professional
OWNER-BUILDER DECLARATION ��"r
I berohy alirm Out I am exempt true,the Canuactah Licen.Law for Nc
p o fallowing lesson.(Section 700.5.Business and Professions Code:Any city memory LUY
3$ which mquirea a permit to emetruct,alter.improve,dcmoli h,or teptir any structure ,
priarm insissuance,aLwlimit.Naii,trcset ranch permittofile asigrtedsuennum
Naz he a licensed purmant to Be provisions of the Conuacuur License law(charter 9 Sq.,Ft.Floor Area ] da4�0
i (commencing with Section 7000)of Division 3 of the Business and Profucsions Cole)at
Nat he u exempt therefrom and the basis far the alleged essmption Any violation of -
Section 7031.5 by arty application for apumit subjects the applk=10AmvilPenalty Of APN Number Occupancy Type
not more One five hundred dollar(5300). 36206021 . 00
❑I,u owner of Ne propmy.m my employee with wages ss Ncv sok compensation.
will do the work and the structure is not intended makemd for side(Sec.7066.Business Required Inspections
Nd Prefessim"CadC The canbYb(s LIPJL¢law does set apply m N manal of q p
Propcny who bis ilds.i.prove Hereon,and who does such work himself or through hu
own employe°,Provided Nm such improvement art rwr inlend.maker.foe.lees'
build,,,the building or improwmcnt k salt within arc Weld of coe,Pkuf of owe
builder will have On burden of Proving W(hc did not Wild or improve for
pu PuT,...of
.k.1
❑1,as owner of the Property,am exclusively contracting with licensed centimeters to
conswm the Purim(Sec.7044.Business a.Profetlan Cod.:)The conmaaals u.
cede law don nut mPly to an awn,of property who builds or improves thmcihn and.
who contracts for such pmjeets with a Co..,(.)licensed Pueuant to On Contracmh
License law.
[]I am exempt undersec .B A P C for this reason
Owner Data
WORKERS COMPENSATION DECLARATION
41 1 hereby akin!under Pcrulty of perjury one of 0n fallowing dockatians:
[]Ihsw a.vAl mainuinaCaufinu of Consee,mselbinurtfmWmkeYsCompen-
.tion,as provided for by Section 37DO of the labor Code.far On Performance of the
work for which Nu Permit is issued
❑1 have and will maintain Workers Compensation Insurance,as required by Section
37W of the labor Cade,for the Performance of He wells for which Our permit is issued. '
My Warkcts Campea.uon hist con on ani,and Polity number.
carticr. .75�11441 Fl is IlPalicy No.: T//5O10-J
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu smin neul norbeeampknd if the permit Is forme manhood dollar(5100)
cur less.)
I cenify Nat in He Pcrformanec of the work for which Nis permit u issued.I shall not
employ any Penn in any meaner mss to become subject to On Worlieri Compensation
Laws of Califomiit.Data
Applicant
NOTICE TO APPLICANT_If,a0cr making this Cenifinle of Exemption,you should
became subject in On Worker's Campcssatian provisions of do Labe,Coda,you must
.,O forthwith comply with such provisiaru m Nu permit shall be domed rawflood.
'Z "" CONSTRUCTION LENDING AGENCY
1 Mmb affirm NU them is a construction k.in a
(—� Y g gene}for Nc perfmmarrce of
Liathe work for which Nu permit is issued(Sn.3097,Civ.C)
1 A larder's Name
D z Lendues Address
O Q 1 cella(}that 1 have(cud this applica Ian and mule Nu On shove iNormauon Is
U, P correct I agree to comply with all city amot county ordinances and seen laws relating to
0r, Wilding construction.and hereby aothorten rePoosenuttws of Nis city m enter upon the
LQ above-mentioned pmperty for iupecuon puq,oxL
(We)lgra to same,indemnifyand keep harmless Ne City.(Ca,en.!Saint
vFn fA Iimilitienjudgmen¢casts and expcmca which may in any wry accrue against mid City
UZ
in of this perink.
APPLICANT eUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
�SOUR EREGU ONS
� '/ Re-roofs
Signemrt oTApplicanVContractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will He applicant or finery building occupant stom or handle hasallow material
u delmod by the CuMnino Municipal Code.Chapnr 9.12..4 de Health and Safety
Code.semen 255320)? ,E
❑Ya � All roofs shall be inspected prior to any roofing material being installed.
Will Ne applicam or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove '
I
marardnw air conuminnts u defined by the Bay Aooa Air Quality Managemem all new materials for inspection.
District?
❑Y, �w
I haw reel the ha.rthws manrialsrequirtmenu undo Chapnr6.95 of the Califor-
nia H ML cum t)yhaW a=Uma at iE iS MY MSW 533liLY 10 understood thCcum bolding P� /Q — �� O/
doe wtu A,Sof ly haw•unana that itis 55 respansihilir I un muco He occupam cur., to
Iquimmen chmutexmet 'or se of accmfreanofoccupancy. Signature of Applicant Date
Ceti(
Dan All roof coverings to be Class "B"Or better
CITY OF CUPERTINO
06m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 36206021 . 00
DATE ISSUED. . . . . . . : 04/28/2006
RECEIPT # . . . . . . . . . : 34190
REFERENCE ID # . . . : 06040188
SITE ADDRESS . . . . . : 1153 STAFFORD DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BROWN JOSEPHINE M TRUSTEE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4968
RECEIVED FROM . . . . : CHRIS BROWN
CONTRACTOR . . . . . . . : CHRIS BROWN LIC # 25108
COMPANY . . . . . . . . . . : MBROWN CONSTRUCTION, INC
ADDRESS . . . . . . . . . . : 702 S . DANIEL WAY
CITY/STATE/ZIP . . . : SAN JOSE, CA 95128
TELEPHONE . . . . . . . . : (408) 260-1260
*FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 12, 000 . 00 191 . 16 0 . 00 191 . 16 0 . 00
BSEISMICRE VALUATION 12, 000 . 00 1 . 20 0 . 00 1 . 20 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 192 . 36 0 . 00 192 . 36 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 192 . 36 AMEX
TOTAL RECEIPT 192 . 36
•
y Community Development
10300 nCTorreAvenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
WUPERTINO
Building Department
JOB ADDRESS: PERMIT #
060YO((Yor—
O R'S NAME: PHONE #
GENERAL CONTRACTOR �,�,wti FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and 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
Septic Tank
Sheet Metal
Sheet Rock
Tile
•
Owner/Contractor Signature Date
{
Community Development Department
i Building Division
�+- City of Cupertino
10300 Torre Avenue
• CITY OF Telephone: (408) 777-3228
Fax: (408)777-3333
C U P E IST I N O
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.
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: .1/5-2 51�Y2G 14 -_
Roofing Company Name:
Aplicant's Signature: Date: '/�- ' 6
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
S REROOF
C111 OF
• CUPERTINO PERMIT APPLICATION FORM
Building Address:
Owner's Name: Phone#:
Contract r: Phone#: License#:
Z4 12 6 0 1E_/0�3 a
Contact: Phone#: Cupertino Business License#:
S
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#
Ur To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: ,c,^l r-;&I- O
Residential Commercial
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are anrestrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
/L i O d roo-F • ct w �.
Qty. if
A licable 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
•