08100063 CITY OF CUPERTINO �s�,�� i4iaY-- w,vs +eaa'uta.wfno'"` '�+' C.�rk '�*T'
BUILDING DIVISION PERMIT �cONTRACTOR IIYk�O.T.ti�'IATI,QQN� *
PERMIT NO.
Buu.41F�3gDtI FOOTHILL BLVD KEITH ROOFING CO INC 08100063
OWNER'S NAME: PERMIT ISSUE DATE
JOAN THOMPSON 920 LINCOLN AVE 10/13/2008
NE:
(408) 295-8616 SANITARY NO. CONTROL NO.
ARCHMICTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
goo LICENSED CONTRACTOR'S DECLARATION ,IOU Description
mF 1 hereby affirm thy 1 am llmnxd under provixio o of Chapter 9(cnmmmem, DSCiIp
with Somt..7000)m'Division Sof the Bond.and Professioncode,and my'kerne is RE—RF RMV SHR& INSTL 7/16 OSB RDNT BARRIER
in full Toru area
>'y? Lice.Clan Lie.9 30LBFLT& PRES T/L CMPSHNGLS CLS A 32SQ
con
—
e3p=� Date ARCHrIECCI'S DDEECtaLARAn NOTE: KEITH ROOFINGRENWD BSL
?W U 1 undersand my plvu shall be used u public records
Ld
In Licerucd Pmfeadonai
3 OWNER-81JIMER DECLARATION
E 1 hereby air..that I em exempt from the Conumeors Licenm Law for We
p O following reason.(Sexton 7031.5,Business and Profession Cade:Any city or county
S$E! which requires a permit to construct.alter.imp.,demWiN,or repair any muctum
_Z'n prim a its issuance.also require,the applicant forsuch permit to Me a signed statement
ss
thart W is licenced Forebear,to the provialons of the Contractor's Uccorc Law(Chap=9 Sq.Ft. Floor Area Valuation
xh-g (commencing with Section 7000)WDivision3orthe Businessand Pref.m.Code)to $12940
— that he is exempt themfmm and to bels for the alleged eaempdon.Any violmfun of
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil Penalty ofNumber Occupancy Type
tont mom than five hundred dollasIS500). 35701091 .W '
0 1,u owma orthe property,or any employees with wages u thehsok carepenuton.
willde the work.and the a,ruaoe is not mounted or offered for ule(Sec.70th,Business
and Proressions Cade:The Com amexes Liave Law dams not apply to an owrut of Required Inspections
property who buildsorimproves the con,and whodoessuch work Wareelfor through his
awn employ¢;provided that ancla imppratenenta are not intended oroRe cul for sale B,
however.the building or improvement is sold within ore year of completion.the owner.
builder will have the burden of proving that lex did ret build ar improve for Purim.of
❑1.as name,of the proRnY•am exclusively contracting with licensed comnue.to
comment the pmjec(Sec.7044,Boximea and Prefeadon Code:)The Cmuxmrs U-
ceese Law does not apply an an owner of property who builds or improwa themon,and,
who concocts for such projects with a convactur(s)licensed pursuant to to Contractor's
Lice.law.
Cl 1 am exempt under Sec .B&P C for this mason
Owner Dau
WORKERS COMPENSATION DECLARATION
1 hereby afr.under pevy on
lty or perjure of to following declarui ne,
I have and will maintain a Certificate of Consent to self-insum for WorkehCompen-
amon,u provided for by Section 3700 of to labor Code,for one Performance of the
wok for which this permit a issued.
❑I have and will maintain Workc's Compensation Wurana,as required by Section
3700 ofthe Labor Code,for the pedormanrx ofthe auk for which this Permit u Lsswd '
My Workees Compen ad aurarue amaand Poliryn/um^beram:
Carie H PW'xy Nw.!5 f; /
CERTIFICATE OF (EMPIION FROM WORKERS'
COMPENSATION INSURANCE
(rbisseetm need not be cernpleud if We permit is furore hundred doll.(SIM)
m less)
I mrufv that is the peaom axe N the work for which this permit Is issued.l shell not
employ any person in any munnerw as m become subject to to Workeri Compensation'
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:IL after making this Ccnificau of Exemption,you should
become subject to the Workers Compensation provision of to labor Code,you mute
.,z forthwith comply with such provision or this Permit snail In domed n:veknd.
zOECONSTRUCTION LENDING AGENCY
5: 1 hereby affirm that there is a convection lending agency for the performance of -
the work for which this Permit is issued(Sec,3097,Civ,C.)
CIL F; Ixnder's Name
.: z L<niefs Address
U Q I certify that I haw mad tits application tee suss this the above information is
I,t" corm 1 agree to amply with all city and county ordinances and suss laws miming to
0U building construction,and hereby authonne reprslmIaLI s or this city to enter upon the -
Ir] aluvc-mentioned property for inspection purposes.
f"LL (We)agree to save,indemnify and kap ham less the City of Cupertino against
res liabilities,judgmcnu,ease and cxperues which may in sty way accroc against aid City .
U Z APPLI yuhT aNDFRS`TANDS AND
WILL COMPLY Wlnl ALL NON-POINT Issued by: Date
s GULATIONS.
d - Re-roofs
Si .roof Applinm/Canuanor Dafte
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appliom or future building ocupaotnore or fundic hanrdoos material
as defined by the Cupertino Municipal Code.Chapter 9.13.and the Health and Safety
Cade.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes Noo
Will the epplicam rure building occupant use equipnunt of devices which If a roof is installed without first obtaining an inspection,I agree to remove
handon au,conumimem s sa defhmd by the Be,Area Al,Quality Managcmom all new m Is for inspection.
uWeR
0y.
I have mad the hvalloua mahcriab requimmcnu underChapurfi.93ofNe Califon
orb Health&sac ,Sexton 25505,25533 and25534.1 undersand thdlftu Wikin
toes mol w e tmun Uw it i my rec ohhdhilru ic ratify the occupant of
m men nichmustbemetprioroiuuanceafaCcrtficeteofOccu at of Applicant Date
OW
onuthorind agent au'
All roof coverings to be Class'%{"or better
CITY OF CUPERTINO
S 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35701091 . 00
DATE ISSUED: . . . . . . : 10/13/2008
RECEIPT # . . . . . . . . . : BS000006324
REFERENCE ID # . . . : 08100063
SITE ADDRESS . . . . . : 10164 S FOOTHILL BLVD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : JOAN THOMPSON
ADDRESS . . . . . . . . . . : 10164 S FOOTHILL BLVD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : ROGER BRIGHT
CONTRACTOR . . . . . . . : BRIGHT, ROGER LIC # 21477
COMPANY . . . . . . . . . . : KEITH ROOFING CO INC
ADDRESS . . . . . . . . . . : 920 LINCOLN AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95126
TELEPHONE . . . . . . . . : (408) 295-8616
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--------- ------------- ---------- ---------- -- -- ----------
1BSEISMICR VALUATION 12, 940 . 00 1 . 30 0 . 00 1 .30 0 . 00
1BUSLIC FLAT RATE 1 . 00 110 . 00 0 . 00 110 . 00 0 . 00
1REROOFRES SQ FEET 32 . 00 416 . 00 0 . 00 416 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 527 . 30 0 . 00 527 . 30 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
--------------- - ------------
CREDIT CARD 527 . 30 VISA
---------------
TOTAL RECEIPT 527 . 30
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---- ----- --- ------ -------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 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: I€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 " 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: 1/')G�J� l 116{y1rK6/�
Job Site Address:
Roofing Company Name:
Applicant's Signa Date: L</6/6
• Greg Casteel
Building Official
Revised 07/30/08
521DOO �3
CITY OF CUPERTINO
REROOF
COF
OcUPERTINO PERMIT APPLICATION
APN # 8570 i o l 1 , co Date:
Building Address: V
al
Owner's Name: / Phone #:
Contractor: fin! Phone #: 7,9 y
v'Irl G'dl�c
Fax#:
Cupertino Business License #: Contractor License #:
c;,?/ -7S�< v
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
�dood Shakes ❑ Wood Shakes
41 ❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report #
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description /Sll J �� l� 6's3
�6 tFYI tivl "} res. -TIL Cod sl�t"5
Residentia Commercial
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:
I Have Read, Ue nd and Will Comply with Cupertino's Tear-Off Policy:
Signatu
Revised 6/16/08
CITY OF CUPERTINO
REROOF
a o
CUPERTINO FEE SCHEDULE •
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FC0M Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
�2 1REROOFRES Re-roof Residential B 1SFDWLROOF
1BSEISMICRE Seismic Residential B
IREROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08
•