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VFaORMATIOK -
- -
BUILDING DIVISION PERMIT
�'CONTRACT6*,I
BUIIDNpp pgOsgFSS:
PERMIT NO.
�Vlilb ALDERBROOK LN
MAXIMUM ROOF CARE CORP
08100069
OWNER'S NAME:
PERFBT ISSUE DATE
LUCEY CATHERINE M TRUSTEE
423 QUEENS LN
10/13/2008
NE:
SANITARY NO. CONTROL NO.
(408)441 -0933
ARCHrIELTENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
M
lob Description
1 hereby affirm tha 1 w P.wn under provisions of Clspicr 9 (ore.i s
with Section 7")o'Divlsion 3 ofte Butinev and profcisiom code, dmyliccnmu
RE RF T/0 SHK &WDSHNGL INSTL 1 /2 "OSB 30LB FLT&
u«�I><n. =t. Lk.• J ,
GAF -ELK TMBRLIN 40YR SHNGLS ULD3462 CLS A 22SQ
Dam Contractor
A HITECTS DECLAI Tl
1 undenund my paw shall W aced as public records
Licensed Pm(estiana
OWNER-BUILDER DECLARATION
1 hereby status that I am exempt from tW Contractor's License Law for 0m
following rtuon. (Scetim 7U31.5. Business and Profectianc Cade: Any city or county
which requires a Permit to canaWCL slim. Improve. dermAlsh, or relc r any smactum
Prior to is issuance. also roquires the applicant for such permit to file a signml vamminnt
Contacmes License Law rehapW 9
Sq. Ft. Floor Area
Valuation
dust W U lkmued pursuant mJe pmvidomaf the
(commencing with Section 7000) of Division 3 of the Businesa and Prohmnows Codc) or
$9963
Nn W Is exempt du mrmm and the bass for the alleged c terepJon. Any vlolalon of
..161 Number
-
Occupancy Type
Sermon 7031.5 by any applimant fora Permit subjects the applkat to a dvil penaty, of
wo more than five hundred dollars (SSW).
3 692003 9
I, u owner of the papmty, m my anployces with wage a their so4 cmmpenation,
Required Inspections
will dItrnssemrenarotintendedoroRc forsak(Sec. 1061. Bu
of
macmrs Law duo tort apply 1f at owner or
m Cade: This d
and P.I.W.
property who buildaorimproves theroan. and who does suchwork himwlfmthrough his
property who ves and who
'
awn employees,provided Norsuchim6=IdM are nosamended ors fortau B.
o year or m.
. Jre building or love overmans u wallas for du owrcr-
t improve
builder will have the Wrden of proving that W did not Wild or improve for purpose of
Wilder did
akJ.
❑ 1. as owner of the pmpemy, am exclusively contracting with RrxmN contactors to
construct the project (Sec. 7044, Bnsimas and P,ohmm m Code:) TW Conmamme- V-
,
come raw does not apply to an owner of Property who Wilds or improves demon, and,
who contracts for such pmfecb with a CcMamm(s) IittM1Yd pimsam to the GonmLLlara
Licence law.
❑ IamexempturaerSea .B&PCrmuisremon
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby aRurre under penalty of perjury one of Je following deelaermanc
have and will maintain a Cmfil mms of Garment m self -ImYrt for WorkersGamper-
Jon. m provided for by Section 3700 of the labor Code. for the performance of the
wok for which this pmmit is wood.
❑ 1 have and will maintain Workers Compensation Insurance, m required by Scetiom
3700.f the labor Code. far the peefammee of the work for wbuth this Pennants Issued
'
My WerkrlaCmnpem.due blsura carrier and Policy number am:
Carrier. JYr f_Tiw�- PoIIryNo.: 3ro�- Z
IERT OF E7(FMMUN FROM WORKERS'
COMPENSATION INSURANCE
(ITIs section reed nothc completed if the permit isforene hundred dollars (SI W)
or 4u)
1 enmity that in the performance of the work for which this permit Is issued, l shall net
employ any person in any manner so as to became subject a the Warken' Cmnpcmation
Laws of Califomm, Data
Applicant
NOTICE TO APPLICANT: IL aAct making this Certifiesm of Exemption, you should
become subject to the Worker's Compensation provisions of the tabus Code, you muss
forthwith comply with such provisions or this permit shall W cleaned rooked.
CON ON LENDING AGENCY
rl . is. c
the Jere4sued( NM.CNg ageny for the perfwmame of
for which
the wank for which this permit V issued (See 3001. Civ. C)
Landers Name
,
Undoes Address
1 I certify that 1 have read this application and sum tha the above information is
' correct. I agree to comply with all city ad county ordinances and sum laws relating m
Wilding comwction. and hereby wtharia reprraeetatives of this city to enmsupnn the
aWve- mentioned property for inspection purposes.
(We) agree to save, indemnify ad keep harmless the City of Cupertino against
i ImbiliJm, judgmcas, costa ad exp,. which ma, In any way ameagamt mid City
in cor eat. of the 1.6.9 of this per nit.
' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCEI✓]= G,LATIO
AA
Re -roofs
Type of Roof
Sigmtu a pp t Dom
HAZARDOUS MATERIALS DISCLOSURE
Will ft appliamor future building occupant arc or halve banNous material
as de0oed by the Cupertino Municipal Cade. Chapter 9.11, and the Health and Safety
caJC. section
riY. sss3z(a)7
❑tam No
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
0011 the applicat or f turt Willing occupant taw cyvipment or devices which
I ha>ardmes air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
cl?
❑ Yu o
-
thawroa dhe mamrialamq immcnuundcrChipw6.95ofJmCalifw-
n uHe althkSafmyCade,SSti.n-%s.25533a 253M.lundcrsaN ifft Wlding
does not c ndy haw • tenan, tha it is my mpancibilk, m whit, the occupant of Je
requlremer hi h."Ite e��ony(Ifaa earacmtifc,maraapancy.
Signature of App leant Date
All roof coverings to be Class '%?." or better
ownmma D,m'
hart;ma.pem�
• 3 ITEMS OF 3
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 36920039.00
DATE ISSUED.......: 10/13/2008
RECEIPT #.........: BS000006330
REFERENCE ID #....: 08100069
SITE ADDRESS .....: 10816 ALDERBROOK LN
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # 1
METHOD OF PAYMENT
--------------- --
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
397.00
397.00
VOICE ID DESCRIPTION
-- - - - - -- ---------------- --- --- - - - - --
601 ROOF TEAR OFF
604 ROOF IN- PROGRESS
•
REFERENCE NUMBER
--------------------
MC
VOICE ID DESCRIPTION
-- - - - - -- ---------------- ------ - - - - --
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
OWNER ............:
LUCEY CATHERINE M TRUSTEE
ADDRESS ..........:
10816 ALDERBROOK
LN
CITY /.STATE /ZIP ...:
CUPERTINO CA,
95014 -4606
RECEIVED FROM ....:
STEVE HUNTER
CONTRACTOR .......:
STEVE HUNTER
LIC # 22369
COMPANY ..........:
MAXIMUM ROOF
CARE CORP
ADDRESS ..........:
423 QUEENS LN
CITY /STATE /ZIP ...:
SAN JOSE, CA
95112
TELEPHONE ........:
(408)441 -0933
FEE ID
UNIT QUANTITY
AMOUNT
PD -TO -DT THIS REC
NEW BAL
---- - - - - --
1BSEISMICR
-- ----- - - - - -- --- -- - - - --
VALUATION 9,963.00
---- - - - --- ---
1.00
--- - - --
0.00 1.00
0.00
1BUSLIC
FLAT RATE 1.00
110.00
0.00 110.00
0.00
1REROOFRES
SQ FEET 22.00
286.00
0.00 286.00
0.00
TOTAL PERMIT
---- - - - - -- ----
397.00
- - - - -- ---- - - - - --
0.00 397.00
---- - - - - --
0.00
METHOD OF PAYMENT
--------------- --
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
397.00
397.00
VOICE ID DESCRIPTION
-- - - - - -- ---------------- --- --- - - - - --
601 ROOF TEAR OFF
604 ROOF IN- PROGRESS
•
REFERENCE NUMBER
--------------------
MC
VOICE ID DESCRIPTION
-- - - - - -- ---------------- ------ - - - - --
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
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 2007 IBC Standards
and manufacturers specifications on re- roofing. All roofs are Class "A" per Cupertino
municipal code 16.04.080.
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 $176.18. The re- inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply pwith the above stated policy on re- roofing.
Homeowner's Name: Q..(i�k pk_, — RI�SZM
Job Site Address: tvby —/Uo t�
Roofing Company Name: o iYN a -1 iyy w P_0c 0,nv
Applicant's Signature: 07� -� Date:,L- -O$
• Greg Casteel
Building Official
Revised 07/30/08
CITY OF CUPERTINO
e�� REROOF
OCUPEkTiNO PERMIT APPLICATION
E
0Fm0c�(9
APN #�2 I a oU O Q)
Date: /'D _ 1
Building Address: 0 1
Owner's Name:
Phone #:
Contractor:
m�kJ lm �
Phone
Phone #: c10S_ (,clo 3
7
Fax #: Woe — r - $
Cupertino Business License M �y3 6�
Contractor License #:
Zos
Type of Roof Covering:
Existing: Proposed:
• Built -Up Roof ❑ Built -Up roof
• Asphalt Shingles 4/Asphalt Shingles
Q/Wood Shakes a Wood Shakes
d Wood Shingles ❑ Wood Shingles
❑ Other (Specify) a Other (Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report # UL_
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: �Gui- o 5 (`� 1�- ;r Waze� 5 r��, tr ( F r C3 5 fj 22
3O(1
Gf csJ— U 1- A3 tf 6
Residential Commercial El
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation: // P J
I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy:
0 D nr i!
Revised 6/16/08
Rik
0 0
CUPEI,TINO
CITY OF CUPERTINO
REROOF
FEE SCHEDULE
0
Number of
Squares
Fee ID
Fee Description
Fee
Group
Permit Type
1RER00FC0M
Re -roof Commercial
B
1COMMLROOF
1BSEISMICO
Seismic Commercial
B
.�_2
1REROOFRES
Re -roof Residential
B
1SFDWLR00F
1BSEISMICRE
Seismic Residential
B
1RER00FMRES
Re -roof Multi- Family
B
1MFDWLROOF
1BSEISMICRE
Seismic Residential
B
1BUSLIC
Business License
B
Revised 6/16/08
L
•