07080012 IQR 'TIO�
PERMIT NO-
CTTy OF cls RTTl`t0 PERMIT 4i 0708 0 012
BUILDING DIVISION TBD _ TO BE DETERMINED PERMIT L55UEDATE
3UlLD1 A RESS:
LOCKWOOD DR SA R CONTROL No.
A '
OWNER'S NAMF,: ------ �
KENSI ARITA Bull DING PERMIT INFO M
ELECT PLUMB
E: ECH
BLDG L—]
ARCHITECT/ENGINEER: JOU D-SCrIptlOn
RATION PLYWOOD AND FELT 30 SQ FT
ACTOR'S DECLARATION r g(commencing OF WOOD SHEAR
LICENSED C- ns rovisions of Chade license REMOVAL 3 2 SQ FT
I hereby affirm that I am licensed undcrandprofessionsCodc,andmy COMP
5 witb Section 70011)of Division 3 0(thc Btsu" rI Z Z y PLUS 5 OYEZ'R
i in full force and efC L Lic.A `
A License Class Contractor !O
p
Date pRC1IITEC."f-S DECLA
tans shall be used as public records
I understand my C'
U
Licensed Professional pW NER-BUILDER DECLARATION Valuation
a t from the contractor's e-AnyeCi`aor for
-u 1 hereby alrirm that 1 am exemp air any strvdurc $17 9 0 0
demolish.or rep signed statement $q. Ft.Floor Area
o following reason.(Snit to7cnnstruuualtcrStmprmvcand fcssiciC°o Cil Aa sig
which requires a P requires the applicant for such p Law(Chapter 9 Occupancy Type
'y
prior to its issuance.also req provisions of the Contractor's License TN Number
a hat he is licensed pursuant to the p tion.Any violation of
tlS1{v�,
p with Section 7000)of Division 3 0 the Bed exemp Professions Code or
(commencing therefrom and the basis for due allege Iicant to a civil penalty of 3 4 2 2 9 0 4 0
_ that he is exempttitan for a Perrtit subjects the app ecti0llS
Section 7031.5 by any aPP compensation,
Required Insp
not more than five hundred dollars(S500)1oyc es with wages as their sole compB�tion,
iness
0 I,as owner of the property,or my P
Law docs not apply to an owner of
will do the work and the struamre us not intended- offered for sal° u h his
and Professions Code:The Contractors License for sale,ft,
property who builds or improves thereon,and who does such work himself or g
rovements are not intended or offered
Yea,
of wmpletion.the owner-
own employees.provided that such imp c for pure—of
however,the building or improvement istwad a a no mild or imp
builder. have the burden of proving
Grs to
sale.). n with licenseConiraetmconu=trs l f
n am sine i and Profcssioms Code:)The ves thereon,and.
1,as owner or the prop,7044.Business property who builds or imp
construct the project(Sec. ntractors
to an owner o(prmPe ursuant to the Co
cense Law docs not applyto
with a contnctor(s)licensed P
who contracts for such projects B g P C for this reason
License Law. t under Sec
i am exemp Date-------
owner WORKER'S COMPENSATION DECLARAnONlarauons
I hereby affirm
under penalty of perjury one or the following Worker's Compo"
for the performance of the
have and will maintain$e uon 3700 of the Labor code
l-insurc for
sadon.as provided for by
Compensation Insurance•as required by Section
work for which this permit is issu noir is issued.
I have and will maintain Workers Compo
rforntanc.eof the work Cnumber are
3700 of the labor C mod�uor which this Pr
tln prance carrier and Policy r, l —
MY Worker's Comp v �rKy No.:
Carrier. CERTIFICATE OF XEMPffON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.) Permit is issued.I shall not
come subject L0 the WO1kMCompensation
I certify that in the.
of the work for which thus
employ any peon m any manner so as to be
Laws of Calirornia.Date tion,You should
Applicant 1f,after making this Certificate of Ex on must
NOTICE lcE Tp APPLICANT: nsation provisions of the Labor Codc,Y
1 with such provisions or this permit shall be deemed revoked.
become subject to the Workers Compo
'Z forthwith comply
b CONSTRUCTION LENDING AGENCf
envy for the 11Crf°finance Of
' [hcrchY'a[firm that there is a construction lending 6
i> the work for which this fic
unit is issued(Sec.3097,Civ C.)
Lender's Name
Q Lenders Address
Z at i have read this application and start that the above information is
[certify to and county ordinances and state taws r%)Pon to
he
correct.I agree to comply with all city representatives of this city to cora o a
U building construction,and hereby auituon P r� nino against Date
u xs. ainst
ahovc-mcnuuncd property(or inapt ha the City of C°pc_
agree,to save,indemnify and keep may in any way accrue against said City
y GsW. eWecosand expenses w Issue6 by:
liabilities,judgments, it- WITH ALL NON-POINT ! !i
consequence of the grartung of A P WILL COMPLY
A PLIC UNDERSTANDS A
� rZ-t APPLICANT &In e-rc ofs
SOURCEREGULA pate -Type of Roof
°n Ctor installed.
Signature DOUSMATERIAISDISCLOSUndrior to any roofing material being
„ant store 2.and the He ltth anmaterial inspected p inspection,
I agree to remove
Will the applicant or future building occupant
9.12.and clic All roofs shall be Insp an Insp
as defined by the Cupertino Municipal Code,Ch p 0O f 1S Installed Without first obtaining
code,Section 25532(a)7 �° If a ection.
DYes or devices which aterials for Insp
applicant or future building occ°pant use equipment alit Manzgcmcmt all r ew m
will the app the Bay Area Air Qu Y
emit hazardous air eontaminan�eGncd by
District?
CYes tf°r- Date
under Chapter 6.95 of Ca"
for-
dtbatifthe building
Ihavcrcadthehard 25534.1°"der nftnc licant Class,•B,i or better
niaHcaI h have
rce yC°de•Sections25505,25533 risibility to notify the occupantSignature of APP s to be
does not currenrly C va a tcnan that it is my Ce uC a Ccrtiricale of Occupancy All roof cOVering
rcyuirem_"Iswhichmustbe n i
Community Development
10300 Torre Avenue
Cupertino CA 95014
408
'<. Telephone( )777-3228
Fax(408)777-3333
CITY OF
UPEkTINO � De artment
Buil In #
PERMIT `? � cf o'✓1 '`-.
JOB ADDRESS:
S: Low'
PHONE # ��o - 7 2 �
L �nGv FAX#
OWNER'S NAME: 1�o�i�b
GENERAL CONTRACTOR: .-
subcontractors: Date
I am not using any Signuture
a licable subcontractors and com lete the followin LO_USINESS LICENSE #
Please check BB
SUBCONTRACTOR USINESS NAME
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
Date
Owner/Contractor Signature
CITY OF CUPERTINO
CUPER�TINO PERMIT APPLICATION FORM
APN# Date:
Bl�x}g,fres : D ✓Z
Owner's Name: ►,� Phone 7,72
mp'. ris A)s 2�
Contractor: �TI�6 License#:
73 24 24
Contact: � n I � „ / Cupertino Business License #:
lJ Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles '5( Asphalt Shingles SO y/Q
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings I ❑ Provide I.C.B.O. Report#
To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cupertino's Tear Off Policy: PT
Job Descn' tion: .11
R6 Mo✓AL- OF Wouf> 5/y. Pty P0'9 1 ;49 Sa r
Residential 5( Commercial ❑ C A 370
Fire Zone: Yes ❑ No [ Confirmed with Planning Dept. if
there are any restrictions: ❑
Cost of Pro' t: Type of Cons cti:)n: Occupancy groin
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Brig Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC B asiness 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
i Prior tc> permit issuance' yu(InAust L,gue to coluply with X19' ChC Stant ands
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied without first obtaining all u-ispection
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 appro-,ral.
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 mate:•ial down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail impection and the job is not ready,
you will be charged a re-inspection fee o:-$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" Fer 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: 10 I y. o� ypo 0 2
Roofing Company Name:
Applicant's Signature: __49E�: Date: G
Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
3 ITEMS OF 3 PERMI" RECEIPT OPERATOR: CathyS
COPY # 1
Sec: Twp: Rng: Sub: B11c: Lot:
APN . . . . . . . . : 34229040.00
DATE ISSUED. . . . . . . : 08,'02/2007
RECEIPT #. . . . . . . . . : BSi)00002236
REFERENCE ID # . . . : 07080012
SITE ADDRESS . . . . . : 10,114 LOCKWOOD DR
SUBDIVISION . . . . . . :
CITY CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : KE14SI ARITA
ADDRESS 10,114 LOCKWOOD DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2616
RECEIVED FROM . . . . : FA]ZIBORZ GHORBAN
CONTRACTOR . . . . . . . : TBI) - TO BE DETERMINED LIC # 00096
COMPANY . . . . . . . . . . : TB]) - TO BE DETERMINED
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----------
BPERMFEE VALUATION 17, 900. 00 255 .96 0. 00 255 .96 0. 00
BSEISMICRE VALUATION 17, 900. 00 1 .80 0. 00 1.80 0. 00
BUSLIC FLAT RATE 1. 00 107 .00 0. 00 107 . 00 0. 00
--------- ---------- ---------- ----------
TOTAL -PERMIT 364 .76 0. 00 364 .76 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 364 .76 MC
---------------
TOTAL- RECEIPT 364 .76
A-1 Roofing &Rain gutters Inc.
23000 Connecticut St. #1 � -
Hayward. CA. 94545
Lic. 732424
(510) 782-5197
Fax: (510) 785.6655
'+'•Y..-;l��r�r'�V'yrs;w�r '��•'.?k':r•"�a'1':�' `ths
August 07,2007
City up Of Cupertino
Attention Inspector. Bob ,
RE: 10414 Lockwood Dir.
I spoke with you on the phone thi.3 morning and I went a head and got
the MFG regw-rernent and you were correct, (Not that I questioned it)
But I had to check as part of my job and The owner said for me write
this note to you informing you that the roof will be dome according to
the MFG requirement and ready at time of final.
Thank you for taking you r time to speak to me over the phone this
morning.
Thank You
Raq el Pardo