08100083 CITY OF CUPERTINO
BUILDIi1G DIVISION PERMIT CONTRACT(1R INFORMATION«
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BUILDING ADDRESS: PERMIT NO.
2003'1 SOMERSET DR RONNING ROOFING CONST 08100083
OWNER'S NAME: PERMIT ISSUE DATE
KLOSS DOLORES T TRUSTEE 10/15/2008
NE: (408) 397-8453 SANITARY NO. CONTROL NO.
ARCH=/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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up C LICENSED CONTRACTOR'S DECLARATION Job Description
hereby M.that 1 w licensed under previsions of Chapter 9(commencing
wive Section lIXlU)ofOivision3of th[e,,Busneamd Pro(emum Code.aM mylianm i. RE—RF RMV SHK INSTL 1/2" PLY 40YR CMP 30# FLT
j n Z ilicfan'.scnd e(h /Jen I Lie.»
_ CLSA
jHDam CHTIE(.TS DECLARATION 24SQ
W Wu I undewnd my plans shall be usod u public records
g G Licensed Pmfersional -
OWNER-BUILDER DECLARATION
y I berehy alarm Not 1 am exempt from the Contractors License Law for the
OC following mason(Sectio^Ifq i.5,Business and Rofcrna iuCade:Any city of county
e which requmn;a Permit to construct.alter,improve,demolish.Or repair any smucmre
prior m its issuance.alto requires Neapplicant rermch permit m folearigned sulrmcnt
EiC that he is Reamed interaction in the previsions of the Conuacmr'r License Law(Chapmr 9 Sq,Ft.Floor Area Valuation
y1— (commencing with Section 7000)of Division3ofdicBusiness and Professions Chose)Or r 10000
259 that be is exempt theafem and the basis for ted alleged association.Any violation of
Section 7031.5 by any appliaun for a Permit subjects the applicant to a civil penalty OfNumber Occupancy Type
rot mom wan five hundred dollar,(M). 3 693202 0?61
I.as owner of the property.or my employees with wages in their sok compenrtion,
will do the work and the s amara Is out mended aonead for rale(S..7(sM.Buunasa
and Nofrssiom Code The Cremators License Taw doe rot apply to an owner of Required Inspections
lumbar,who buildsorimpow Ih rich.andwho datesuch work himselfenthrough his
chum employee,pmNded dual such improvements art not intended or^Rered fors+lcif.
however,the building in improvement is mid within one year ofcompledo^.the owner-
builder wi0 have the burden of proving that be did Out Wild or improve for surprise of
sale.). .
❑1.U rwrcr a we property.an exclusively contracting with Bcenud anmacan to
combat the Mica(Sce.10".Burines,and Professions Code:)The Co m maws U. '
come law does not apply m m owns of property who Wilds or imp.thea^^,and,
who am netrfar such pupw wive a eonmeades)licensed pursuant on rhe Committers
Lice.Law.
❑lamnaemprunder See .BBpCfathumsson
owner Data
WORKERS COMPENSATION DECLARATION
I hereby air=under perWty of perjury none of the following decleatiom:
I haw and will maintain a Cenifieaa of Comem on self-insure for Warker.Compe^-
sauan.as provided for by Section 3700 of the Labor Code.for the Performance of we
work for which this pamil is issued.
(]1 have and will maintain Workers Compemati0n Inmrana,as required by Section
3700 ofthe labor Code,for NC Performance of tin work for which this Pemba;Wood.
My Workeh Compe hutsr`an1¢cenla and Policy number art:
Carie;� a iMJ� Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu sealar need rotbecempiead Iliac permit u fin e=hundred dollars($I00)
or We)
I artily that in due performs ce of the work fee which this penin is issued.)shad ma
employ any person in my marearan e to berme subject m the Worker'Compensad^n
Lew of California.Data,
Applicant
N(MCE TO APPLICANT.If,alar making this Certificate of Exemption,you should
become subject On the Work Ya Cemp:mnion pmvisiona of the Labor Cade,you most
.JO forNwiwcomply with such pnevisio=a it
this permshaW lldeemed revoked.
Z" CONSTRUCTION LENDING AGENCY
Ihcreb,aRnn tiuc thea u a anametion lending alone,farted aform.of
!Yi IW work for which this Permit is brad(Sec.3(y97,Civ.C.)
W� Q Lenders Name ,
z lender .•
s Md
U 0 I Out dual 1 haw read this application and sum that the above information is
IL E' caeca I.gra to amply with LI city and county ordinances and start laws minting in
DU Wilding concoction,and hereby anwoda repreamtstiw of this city in ala upon the
r above-mentioned pmpcny for inspection purposes
ply (We)agree to saw,indemnify and kap harmless the City of Cupertino against
liabilities,Judgments,coats and expanses which may in any toy scaue Mrsim,said City
U Z in consequence of the granting of this permit ll^
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date A�� ?_„l0
SOURCE GULATIONS.
D Re-roofs
Si tea of Apple Da -
xA or ria s M TSC erhima Type of Roof
-edby Cupertino
fu pantruma handle Heardommamrial
r deli=d by 0c Cupeniro Municipal Code.Chapter 9.11.and due Health and Safety
Coda,Section 25532(x? All roofs shall be inspected nor to an roofing material being installed.❑ye. pya'
sun lire applicant or roma Wilding eaupanr one component a devices which If a roof.is installed without first obtaining an inspection,I agree to remove
.mitharardnm air cucurinants adeorud by tin Bay Area Air Quality Management all new materials for inspection.
D u ct7 r�r�
❑Ya �
Ihavemvl Codc,SNaum 5%5, mquiamcnuuoder undershoot
h.95ofd¢Cilding
.is Healthave mail the housecoat
rturis25533md1Ss34.l Chita nd.95 fled Wilding
dost not currently hart a anent that it u my numenhility a notify do occupant of tin
aqui, nrwhichin armiraa^aof.catBem,ofaaPme, 2&plicanI Date
6 All ro overings to be Class'%¢,'or better
=r orauthome agent as
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
. APN . . . . . . . . : 36932020 . 00
DATE ISSUED. . . . . . . : 10/15/2008
RECEIPT #. . . . . . . . . : BS000006358
REFERENCE ID # . . . : 08100083
SITE ADDRESS . . . . . : 20031 SOMERSET DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KLOSS DOLORES T TRUSTEE
ADDRESS . . . . . . . . . . : 20031 SOMERSET DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-3115
RECEIVED FROM . . . . : RONNING ROOFING
CONTRACTOR THOMAS RONNING LIC # 22255
COMPANY . . . . . . . . . . : RONNING ROOFING CONST
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (408) 397-8453
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------------- ---------- ------ ---------- ----------
1BSEISMICR VALUATION 10, 000 . 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 24 . 00 312 . 00 0 . 00 312 . 00 0 .00
---------- ---------- ----------
TOTAL PERMIT 423 . 00 0 . 00 423 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --- ---------
CHECK 423 . 00 #10157
---------------
TOTAL RECEIPT 423 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
Community Development
10300 Torre Avenue
✓ Cupertino CA 95014
"^ Telephone(408) 777-3228
CITY of Fax(408)777-3333
*UPEI�TINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: O 2 PHONE #C/,65?- O _p
GENERAL CONTRACTOR FAX #
I am not using any subcontractors:
Si Date
Please check applicable subcontractors and complete the followinginformation
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
Tile
•
Owner/Contractor Signature Date
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/ "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: �6f�r� r Lai:/
Job Site Address: Q� 1 _S�J_Mt? le_yzet (2
Roofing Company Name:
\ d(3�0
Applicant's Signature: Date:46/<90—
• Greg Casteel
Building Official
Revised 07/30/08
A(, CITY OF CUPERTINO
REROOF
CITY OF
•CUPERTINO PERMIT APPLICATION
APN # n 3 0-0
.v, \ Date:
Building Address: aw�>f r �
Owner's Name: Phone #:
55
Contractor: k6 Phone #• V,,, go_ �gy
�/�✓� V Fax e:�eJ �;2Q t, 7s�
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ,d'—Wood Shakes
❑ 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: t c
PeVVLdK
(-,o q LA e �� oz y
Residential , Commercial 11
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: O Qom_
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
•
Si ature
Revised 6/16/08
CITY OF CUPERTINO
REROOF
CI O
CUPERTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
2 1RER00FRES Re-roof Residential B 1SFDWLR00F
/ IBSEISMICRE Seismic Residential B
1RER00FMRES Re-roofMulti-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08
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