07090007 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ` S
— PERMIT NO.
BUILD G DDRESS:
PHIL CT RESPONSIBLE ROOFING INC 07090007
PERMIT ISSUE DATE
OWNER'S NAME:
SALEME JOSE A AND MYRTHA J 2882 SPRING ST 09/04/2007
SANITARY NO. CONTROL NO.
.INE:
(650) 96-11-6151
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
p a LICENSED CONTRACTOR'S DECLARATION - Job Description
m 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
!Uz with Section 70M)ofDivision3oftheBusinessandPr�Professions ylicenscis WASH DOWN EXSTNG ROOF; INSTALL 30 MIL ACRYLIC
-<o in full forte and effegt `
D? License L� Lic.# COATING IN TWO PART SYS(GRAY BASE COAT WHITE TOP
Date Contractor Do
ARCHITECTS DECLARATION COAT)
i C< 1 understand my plans shall be used as public records
�aU
oy Licensed Professional
y OWNER-BUILDER DECLARATION
1 hereby atTrrn that I am exempt from the Contractor's License Law for the
p Oa following reason.(Section 7031.5,Business and Professions Calc:Any city or county
li -which requires a permit to construct,alter,improve,demolish,or repair any structure
Z y prior to its issuance,also requires the applicant for such permit to rile a signed statement Ft.FIOOr Area Valuation
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ��] $8460
t=– (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
? that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of Number Occupancy Type
nut tre than five hundred dollars(s500). 3754201'7
.
I,a owner of the property,or my employees with wages as their sole compensation,
will do the work.and the structure is not intended oroffered for sale(Sec.7044.Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale-If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li-
ccnse Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
[]I am ez t under Sec B&P C for this reason
Owner Dare q l G
W6KKERIS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
have and will maintain a Certificate of Consent to self-insure for WorkeesCompen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker' CompensadiN Insurance carrier and Policy number arc:
Carrier. Policy No.:
CWnFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I cenif-v that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of Calif ia.Da
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Corte,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
z O CONSTRUCTION LENDING AGENCY
E.r I hereby affirm that there is a construction lending agency for the performance of
!Y, > the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
gLender's Address
U O 1 certify that I have read this application and state that the above information is
LL correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes-
✓� a (We)agree to save,indemnify and keep harmless the City of Cupertino against
V] liabilities,judgments,costs and expenses which may in anyway accrue against said City
U Z in consequence of the granting of this permit. Date
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: /A _ __i
wit
SO CE R GUL,JONS.
- /F(/�/rr=6.,� Cf/Gf� �i 7Re-roofs
Signature Applicant/Comractor Dam Type of I:oof
HAZARDOUS MATERIALS DISCLOSURE yP
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes M No
Will the applicant or future building occupant use equipment or devices which
If a roof s installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
Cl Yes 4No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand thatif the building
does not currently have a tenant,that it is my responsibility to notify the occupant of the
requirewhich rust be met rine to issuance of a Certificate of Occupancy. Signatur(.of Applicant Date
Gy. All roof coverings to be Class"B"or better
Owner or authorize gent Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMI`I RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk : Lot:
APN 37E42017 .00
DATE ISSUED. . . . . . . : 09/04/2007
RECEIPT #. . . . . . . . . : BSC00002542
REFERENCE ID # . . . : 07C90007
SITE ADDRESS . . . . . : 60`_ PHIL CT
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SALEME JOSE A AND MYRTHA J
ADDRESS . . . . . . . . . . : 60_` PHIL CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4654
RECEIVED FROM . . . . : RESPONSIBLE ROOF
CONTRACTOR . . . . . . . : ELMORE, PAUL M. LIC # 105
COMPANY . . . . . . . . . . : RESPONSIBLE ROOFING INC
ADDRESS . . . . . . . . . . : 28f;2 SPRING ST
CITY/STATE/ZIP REDWOOD CITY, CA 94063
TELEPHONE . . . . . . . . : (6`,0) 969-6151
FEE ID UNIT QUANTITY liMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ----------- ---------- ---------- ----------
BENERGY PERMIT FEE 158.76 76 .20 0. 00 76 .20 0. 00
BPERMFEE VALUATION 8, 460. 00 158.76 0. 00 158.76 0. 00
BSEISMICRE VALUATION 8, 460. 00 0.90 0. 00 0.90 0. 00
----------- ---------- ---------- ----------
TOTAL PERMIT 235 .86 0. 00 235 .86 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 235 . 86 #11826
---------------
TOTAL RECEIPT 235 .86
0.7091 ooc�) 7
CITY OF CUPERTINO
REROOF
CUPEkTiNO PERMIT APPLICATION FORM
APN# Date:
� 1 0o V2:
o'
Building Address: (00s— , et
Owner's Name: n P ne#•
Contractor, f License#:
rL�S D Sj b l e_ 2-;2_eq0
Contact:Ed 5 P' Cupertino Business License#:
E' GZi
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
lYbther(Specify) Q K4 kr'--Other(Specify) A—C o4t
Number of existing coverings ❑ Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read,Understand and Will Comply With Cu ertino's TjE Off Poli :
Job Description: � U,1 Yt PSC 1 i it MOT. i'IS 3 Q} Mil C�Gr' %
C 8w1KWWO PaiT7SqfTent h2Se_ C0C97WLe
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type o Construi.tion: Occupancy group:
4� ff-P C 0
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE 13ldg 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 buildin,;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 Df$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:
r
Job Site Address: (0 0151
Roofing Company Name: CS OKS/ a C7 G
Applicant's Signature: Date- "/Q�
Greg Casteel
Building Official
Revisec 11/2/04
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
Fax: (408)777-3333
Building Department
REROOF TEAR OFF POLICY
1. You must schedule an inspection for the tear off the day before
you wish the inspection to be made. The procedure is to call the
Building Division (408) 777-3228 between the hours of 7:30 a.m. and
3:30 p.m. to request a next-day inspection.
2. When the roof is torn off, the nails have been removed or driven in,
and all of the dry-rotted wood has been replaced, you must call the
City Building Division. An inspector will be there within one hour.
There are special hours for this service: from 7:30 a.m. to 10:30 a.m.
and 1:00p.m. to 3:30 p.m., Monday through Thursday and from
7:30 a.m. to 10:30 a.m. and 1:00 :p.m. to 2:30 p.m. on Friday. (Note:
Building inspectors are on lunch break from 11:30 a.m. to 12:30 p.m.
and will not be called during that time. City Hall is closed between
12:00 and 1:00 p.m. daily.)
3. If you call for a tear-off inspectic)n 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.
Greg Casteel
Building Official
Revised 1/13/04
POLICYHOLDER COPY NC
STATE P.O. BOX 420807, SAN FFANCISCO,CA 94142-0807
COMPENSATION
INSURANCE
FUND CERTIFICATE OF WORKERS COMPENSATION INSURANCE
ISSUE DATE: 10-01-2006 GROUP: 000713
POLICY NUMBER: 0007568-2006
CERTIFICATE ID: 11
CERTIFICATE EXPIRES: 10-01-2007
10-01-2006/10-01-2007
CITY OF CUPERTINO NC
10300 TORRE AVENUE
CUPERTINO CA 95014
This is to certify that we have issued a valid Workers' Con pensation insurance policy in a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer.
We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and foes not amend, extend or alter the coverage afforded
by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document
with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance
afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy.
THORIZED REPRESENTATI PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE CO!tTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT #1600 - PAUL ELMORE, PRESIDENT SECRETARY - EXCLUDED.
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2003 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
RESPONSIBLE ROOFING INC DBA:RESPONSIBLE NC
ROOFING INC
2882 SPRING ST
REDWOOD CITY CA 94063
M0410
(REV.2-05) PRINTED : 09-17-2006
State Of California
,.CONTRACTOR3 STATE LICENSE BOARD '
AC-FIVE LICENSE
Cenwmcr
Affairs
.-....., 328490 Enldy CORP
a�s;�e=s�me RESPONSIBLE ROOFING INC
C39 C43
02/29/2008 WR
Any change of business addrass/name must be reported to the Registrar within 90 days.
This license is not transferrable,and shall be returned to the Registrar
upon demand when s ispended,revoked,or invalidated for any reason.
This pocket cai d is valid through the expiration date only.
If found,drop in any mailbox.
Postage guaranteed by:
Contractors State License Board
P.O.Box 26000
Sacramento,CA 95826
Licensee Signatire
ee
M