06060078 (2) CITY OF LD CUPERTINO �' m&««<=,� "see• '^* sttra
.BUI ING DIVI SION PERMIT •.6 ONTRAC-TOVINFORMATION�-
BUILDING ADDRESS: MBROWN CONSTRUCTION, INC ,. PERMrr NO06060078
10873 WILKINSON AV
OWNER'S NAME: PERMIT ISSUE DATE
PANNELL DONALD R AND CHARL TTE702 S . DANIEL
E:
SANITARY NO. CONTROL NO.
(408) 260-1260
ARCHITELT/ENGINEEN: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
00 LICENSED CONTRACTOR'S DECLARATION
mF nti
1 krtby affirm Out 1 w Ikmnsed under provuiom of Chapter 9(commencing lob Deserir� tt�� (� p r�
I'r y with Section]IX1U)af Di �3afihe Butirmv arta afevriuru Code.aM myliccvcu (yt1 n I'7
inferse farce Cls anile t. Z INSTALL COMP CLASS A tt�� a/a�l'"y'1�111�6Slt 3lftlp
z to License Class Lie.a
p Dam fi . •(,I r. Conuacwr '
•1—',f` ARCHITECTS DECLARATION x�
i e I understand my plans shall be used a public rtG,cords JUL Sc 20
0
r
du u
:01� Licensed Profeaional
OWNER-BUILDER DECLARATION WON
PPt�paa p1
C O I krtso alms 11. exempt from w Canuasroh License c Law for w f{ tl��iJ �'1
.CO o folbwing mason.ffins(section t I]m Business and he Cordnm Code:Any city w county I�LfI h1f,�jp 11p1J
S29 which requires a permit to construct simr,improve,dcmolim.or mpair any suuctum G30 0
-Ziprior b its issuance.atm requires the applicant for such permit w file a signed summer,
that he is licensed pursuant to w provisions of the COmracmr's lJccmc Law(Charter 9 Sq.Ft. Floor Area Valuation
2 o (commencing with Scction]000)of Division 3 of the Business and Profeuiuns Code)or
that he is exempt therefrom atm the basis for the alleged cau mpum.Any violation of
Section 7031.5 by any appllant for a permit subjects w applicant to a civil penalty of k er Occupancy Type
mut mom than five hundred dollars(5500?
0 1,u owner of Ne property,or my employees with wages as their stole campeasadon,
will W Ne work and the structure is not intended or offered for sale(Sec.7044,Busws
and Pscfe edam cads The Canun acmrs License law doMt apply to an owner of Required Inspections
Property who builds or i m proves therton,and wk doessuch work himself or through his
own emplayoes,provided Out such improvements art not intended aroffered for We If. -
however,the building or improw mem is mid within one year of complcuon,the comer.
builder will have the burden of proving that he did not dual Or improve for purpose of
sale.).
0 1,as owner of the property.w combatively contracting with Ileen est emmossu rs an
consumer the project(Sec.7044.Business and Professions Code:)The Conomsm's U.
corse law does not apply b an owner of propeny who builds or improves thmon,ad.
who convects for such projects with a conmxmr(s)licensed pmnum m the Commences
License law.
0 1 am evempt under See .B&P C fru this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 bereby arms under penalty of perjury ore of w following declaration,
1 have and will mvntain a Cenificau of Comes In self-insum fa WorkefsCompcn-
satim.a provided for by Section 3700 of the labor Code.for On performan¢of the
work for which this posit is issued.
01 haw and will maintain Worker's Compematian Imus ..as required by Secvan
00 of the Labor Cade.for the Performance of the work for which this permit is issued.
My Warke�Cyq-mp�erts�auon Imrum�me amict roil Policy number art:
Cartier. `C' O"L f' 1'V YI14 Policy No.: J7
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mussection need not a computed ifthe Permit is fru one hundred dollars(SIM)
or less)
1 ceo ry that in the:perfomomee of the work for which this permit is isued.I dull out
employ any person in my mannerm as an become subject to the Worked Compensation
Laws of California Dam
Appliont
NOTICE TO APPLICANT:IL Offer making this Ccoimcam of Exemption,you should
become subject to the Workers Compescution provisions of the Labor Cade,you most
.J z forthwith comply with Such provisions or this permit shall a clamed reveled.
? O CONSTRUCTION LENDING AGENCY
(-+� I her by which
that vert u sued s sc.3W7,Cit. agency far w perfesarmc of
D:v� LO work for which Nu petit u issued(Sec.J09],Civ.CJ
GLanders Name
.7 z Landers Addm.v
U Q 1 certify that 1 have mad this applicsoi nt and sum Nat the above information is
I, f coseL I agree to comply with sit city and county amina eons and sum laws relating to
OO building construction,and hereby amkme representatives of this city to enter upon the
[27
above-mcntiuned propcny for mspccuon purposes,
t„r gy (We)agree to save,indemnify and kap harmless w City of Cupertino gaim,
N Iiabiliueapdgmentaxestsmd expenses which may in any wayacerueagainet said City
or the goaming of
U Z APPLLICANT UNDERSTANDS Ars Permit.WILL COMPLY WITH ALL NON.KdNTdi -C�
souacE LATfO � yD Issued by: Date
i Re-roofs
Sr um of ApplicanUConmac Dam
HAZAR OUS MATERIALS DISCLOSURE Type of Roof
Will w applicant ar tee.building occupant start ar handle harallous material
asdcfirmd by 0e Cupertino M Pal Code,Chapter 9.12,and the Health and Safety
de,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
OYes Na
Will the applicant or future building Occupant on,equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
OCmit
hevardam air contaminants w dcOncd by the Bay Area Air Quality Management all new materials for inspection.
District? /
0 Yes �gNu
1 have mad w h M msusmamnata mquiremcnts under C1t&Pmr6.95 ofw Califon
nia Hcalth&Safety Cods,Scctiam 25505,25533 and25534.I undersand thmif the building
dos om currently have a mean,Nm it is my sespondbilitY m rm ily use occupant of the
mquimmcn hmuukmet of aCenirmateorarop*�cru Signature of Applicant Date
Ocr or
6'9•u6 All roof coverings to be Class"B"or better
authamad agcm Dam'
CITY OF CUPERTINO
2 of 2 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 35613024.00
DATE ISSUED. . . . . . . : 06/09/2006
RECEIPT #. . . . . . . . . : 34786
REFERENCE ID # . . . 06060078
SITE ADDRESS . . . . . : 10873 WILKINSON AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : PANNELL DONALD R AND CHARLOTTE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4733
RECEIVED FROM . . . . : MBROWN CONSTRUCTION
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
OE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
______ _____________ __________ __________ __________ __________ __________
BPERMFEE VALUATION 9, 000.00 158.76 0.00 158.76 0.00
BSEISMICRE VALUATION 9, 000.00 0.90 0.00 0.90 0.00
__________ ----------
TOTAL PERMIT 159.66 0.00 159.66 0.00
METHOD OF PAYMENT AMOUNT NUMBER
__________________
OTHER 297.52 AMEX
TOTAL RECEIPT 297.52
Community Development
e 10300 Torre Avenue
! 't Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
4JUPEkTINO
Building Department
JOB ADDES PERMIT #
laysI hSon A\/(, D 6 C)
OWNER'S NAME: d PHONE -
GENERAL CONTRACTOR:M FAX #
I am not using any subcontractors:
Signature baie
Please check applicable subcontractors and complete the following information:
RI 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
0 ile
Owner/ ontractor Signature Date
CITY OF CUPERTINO
SUK- REROOF
• CUPERTINO PERMIT APPLICATION FORM VOLNOco g
APN #
i65:1s ^/3 ,0, _ ��.
Date:
60
ZI - v
BuildMTS wv1 , Vlsm_,
Owner's Name. vie Ph # �
2106
Contract or: � License#: I Q n
Contact: Cupertino Business License #:
CAfi %.,,J V-% 25
Type of Roof Covering:
Existing: Proposed:
Built-Up Roof ❑ Built-Up roof
@' Asphalt Shingles if' Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles - ❑ Wood Shingles
--P(--R ` ❑ Other(Specify)
Nrber of existing coverings 1 ❑ 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:
o v 9 )` i C(a�
Residential Commercial ❑
Fire Zone: Yes ❑ NoZ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type�o/f Construction: 0 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
•
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: �/\ l �j �- '? N yic I
job Site Address: 10 5 —I 3 (,J I 1 S c2 )n Ave.
Roofing Company Name: ltiJ C / C T t V-\/ �Vt C ,
Applicant's Signature: r Date: 6 ' 1-06
. Greg Casteel
Building Official
Revised 11/2/04