05100104 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTUR`INFURiVIATIU1�i �$
Bu1LDINcnppRFss: CUPERTINO ROOF, INC PERMITN005100104
OWNER'S NAME: PERMITISUEDATE
PROCTOR, MONICA 1052 KELLY nR in /lig /9,nos
NE: SANITARY NO. CONTROL NO.
(408) 973-9427
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
O ELECT PLO O
_0z LICENSED CONTRACTORSDECLwRAT1OH , Job 1 hereby affirm that 1 am licensed under Provisions;of chapter 9(commencing P
with Section 700D)of Division 3 ofthe Business and Professions Cma,md my limeamis
in full force and enael. &'yq3 TEAR OFF SHAKES INSTALL Cf/ INSTALL 50 Y
zqq License Class L Z �l Uc g SEQUOIA /
t: Date �i— Cunmracmr
IICHITin uaa DECL icacc
I understood my Plate MVI W wed u publle records ` Hey RATICIN 46b
� u
G Licrnscti Pmfcsainnel
+� 5 OWNER-BUILDER m the CwhION c
0 i 1 nurebr affirm that 11. ,usin from the Conon C s License Law(or tis leoOrJ
p o (allowing remove.(Section AD LS,Busies,and vex,de Profession Code:My city or county
$� which requites s permit m cnnslmeL alter,Improve,Jemnlish,at repair any structure '
a/hAt Pass.
prim to its issuance,also requires the applicant for such permit to me a signed statement
< that bo is licensed pursuant ratite provisions of the Contractee,Liwusc Law(Chapter 9 Sq.Ft.Floor Area I 4000
$ (eammencingwith Smtion7000)nf Divuion3of Ne Rusin mdPmfessiom Cnde)w py
Nat w is eumpt Moorman and ft basis for the alleged eaemptiou.Any violation of O ,..-,
Section 7031.3 by arty applicant fes s permit subjects the applicant to a civil penalty of APN Number Occupari Stype
not more Nen fin hundred dollars IS300).
❑l.uawner of the propeny,mmy employes with weguutW'v mletompensstirn. 316240017 . 00
will do the work,and the structure is not Intendedorartered fmnte(Sm.7044,Busik•• Required Inspections
and Profession,Code:The Comrcmes License law does not apply re an awemr of q p
property who Wilda Or Improve thereon.and who them,such work himutfor through his
own employee.provided that such improvemenss art not Intended or offered for sale.If, v
however,the building or improvement is mid within am year of completion,the wvner-
Wilder will ban the burden of proving that he did not Wild or Improve for purpose of
ssle.).
❑1,as owner of the property.am exclusively contracting with licensed contractors 10
construct On project(Sec.7044,Business and Professions Code:)The Conoecmri Li•
cense law does not apply to an owner of propeny.whe Wild,or improve derma.and,
who convects for such projects with a tonrmetmOd licensed pursuant on On Cowarnmes
License law.
❑I am exempt under Sea ,B d:P C far this mason
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby&Man under penalty of perjury ane of the following declaration,:
❑1 Inwood will maintain a CeniOcateof Comets to self-imam for Worker's Compen.
Milan.u provided for by Section 3700 of the 4Wr Cade,for the performance of the
wart far which this Permit is Issued.
❑I haw and will maintain Workers Compensation Insurance,u required by Session
3700 of the labor Cade,fm the Performance of the work for which this permit is issued.
My Worker',Compensation insurance carrier and Policy number arc:
Carrier: `3� �,4 e C(--Cj PolicyNo.: I 2
CERTIFICATE OFEXEMPTION FROM WORK S'
COMPENSATION INSURANCE
(This mmon wed not W completed if the Permit Is Forane hundred dellen($100)
carless.)
1 certify Our in the Perimmance of the work for which this permit is issued,I shall not
employ any Perron in my meamrm m to becomembject to the Workma Compensation
Laws of L'alifoml0.Data
Applicros
NOTICE TO APPLICANT:If.after making this Certificate of Faemption.you should
become subject to the Worker's Compensation provisions of the labor Code,you muss
O forthwith comply with such provisions w this permit W comment t rented.
CONSTRUCTION LENDING AGENCY
[� IIsmby affirm that Nem is a construction lending agency for the performance of
a Ne work for which this Permit u issued(Sec.309.Civ,C.)
WM 0 Lattices Name -
z Lender's Address
U Q I unify des 1 have mW this pplicuian and sum that the am.informadun i, .
tL r" coneca 1 agree to comply with all city and county ordinances and sum laws relating in
0 tS.'J: building eonmuction,and hereby auNodm mpmttnutlws of this city to enter upon Ne
N7 above-mentioned Property for Inspection purposes
fi (W0)agree m mw,indemnify and keep harmless the City of Cupertino against p
nyti
liabilities judgmena,casts and expresses which may in my Way acme against Mid City /Ir—s4e
O in mmran
wegms car Ne gting of this permit.
$ PLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date G Q
w
SOU /A{y✓]U�/L`ATITII—ONNSS�J��'
nareof ApplkanVConI u Data
2 ^u Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant w future Wilding aaupant Fare or handle h sam ous material
m dented by the Cofounder,Municipal Code,Chapter 9.12.and the Health and Safety
Cade,Section W32(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yu„ —-------QNo
Will she applicant or future Wilding occupant uA cquipmant m devices which If a roof is installed without first obtaining an inspection,I agree to remove
It haaardous air contaminants at defined by the Bay Area Air Quality Management all new materials for inspection.
Disnim7
❑Yes
Ihow arctyC meretm ,2550materiaurcquimmenu 4.lu dcnmdMiftWCatdinI (� ( � `—
n' d<S mlyyhawa tecsim,25Sis ism rmearmi.I ra awry
tti naeua Wilding `/'�r/4`L..+Ir/✓^y
oma not ntiy hew a tenant that h is reapomibility m ratify cu accvpmt of the
mylimmcn ch mu met poor mmnMeeanCerdnumeafacupr. Signature of Applicant Date
1
Wror authomnd agent All roof coverings to be Class"B" or better
Opass
CITY OF CUPERTINO
1 0£ 1 PERMIT RECEIPT OPERATOR: kiereaw
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 316240017.00
DATE ISSUED. . . . . . . : 10/18/2005
RECEIPT #. . . . . . . . . : 31642
REFERENCE ID # . . . : 05100104
SITE ADDRESS . . . . . : 10226/30 VISTA DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PROCTOR, MONICA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : CUPERTINO ROOFING IN
CONTRACTOR . . . . . . . : DAVE SMITH LIC # 25701
COMPANY . . . . . . . . . . : CUPERTINO ROOF, INC
ADDRESS . . . . . . . . . . : 1052 KELLY DR. .
CITY/STATE/ZIP . . . : SAN JOSE, CA. 95129
TELEPHONE . . . . . . . . : (408) 973-9427
•
FEE 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 1565
TOTAL RECEIPT 214.16
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
CITY OF CUPERTINO
REROOF
UPEIZTINO PERMIT APPLICATION FORM
APN# 1 Date: I O - I
Building Address:
Owner's Name: Phone#:
l-
- /
0✓1 1 c 0. �C-1-0 2. Z Ste- S`
Contractor: v P�2 Phone#: q-� i-,l License#:
-r, U J
Contact: %, Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
_"e Wood Shakes ❑ Wood Shakes
❑ Wood Shingles O Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
,AkI Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
"Fjob Description:-tcr,2 0� S�,SL't"-s Yi M-I S �-J-
I I e Ck e-
4iC Q o
Residential--B Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are anrestrictions: IJ
Cost f P oject: Type of Construction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE 7-B—ldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
?UPEkTINO
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 V4" 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: ` i ' OV ,,e A `-1-°2 n
Job Site Address: ' Z 2 C' 1 Oa,_-Sd
Roofing Company NameU �� +) U O
Applicant's Signature: I Date:
• Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper