08100120 CITY OF CUPERTINO
BUILDING DIVISiCdN PERMIT -CONTRACTOR INFORMATIOkY
BUILDING ADDRESS: PERMITN0.
11528 ROCK SPRING CT LOS GATOS ROOFING 08100120
OWNERS NAME: PERMIT ISSUE DATE
gb, BISELY JEFFREY AND AMY P 0 BOX 1726 10/20/2008
NE: SANITARY NO. CONTROL NO.
ARCHTIECTIENGINEER: BUILDING PERMIT INFO
RE—RF RMV 1LYR EXT RF & BIDO ELECT PLUMB MECH
ataai LICENSED CONTRACTOR'S DECLARATION O O O O
I hcmby aRrm that 1 am nxnsed under pmri or Chapto 9(commercial --_— _ .,_ _.._ .. .._. ,. Clb eSCriptlon
with Sedan 70M)ofDivinan 3 of We Bushrcg and Proressis Cade.and my license is
H in fell torte and ef�ect
j�Z Lieenso Cl a I3e.g
�Fp Dam yrrr . Conlracwr
q 7W ARCHITECTS D
CC 2 I understand my plane shall be used as public recoNs
Dyu
g iso t, Licensed Professional
OW NER-BUILDER DECLARATION ,
r� 1 hemhy oRsun that I am exempt from the Contactors License Law for the
i O O following mason.(Second 7031.5,Business and Professions Code:Any city or county
S$ which requirm a permit to complain.alter.impmw.demolish.or opals any attention
ormr bits issuance.elm tryuims theappimada for such permit on file a signed stavmcot
E G that he u licensed parstam o We previsimnnf the Cantaztors Lt..lsw(Chapter 9 Sq.Ft. Floor Area Valuation
(commencing with Section 7000)of Division 3 of the Business and Pmessions Code)or
D3$ that he u exempt therefrom and de basis for the alleged exemption,Any violation of
Section 7031.5 by any applicant fee a permit subjects the applicant W a civil penalty of APN Number Occupancy e
not mom dun five Wedged dollars($-'M P Y ZYP
❑Lasowner arms pmpeny.W my wployw with wag'saNcirsole cmnpensadon,
and do thework,ands:The Cuetanoanmmdede awdesnota(Sec.7064.owner
and property
who
Professions Chide:The C s theraters License ties ds ma apply lf rt awn'is Required Inspections
.a eny who builds or ins pmvea thereon,and who dace etch cork himself or through his
ownemployees.ping ar thatsrchimpmvemmtaartnotlanded npleti .far mIa If.
however.Webuildingmimprovementusold withinn, yensofmproefartheowner-
Wilder will have the WNev of proving Wal k did net Wild o improve(o purpose of
sale.}
❑1,as owner of the property,w exclusively contracting with licensed contactors in
construct the project(Sec.70x1,Business and Profostiom Code)The Conhace's U.
come law do'not apply in an owner of property who Wilds or improves theeon.and.
who cmuacV for such i a)ema with aemuanar(s)licensed pun'nl to We CoovanMs
llmtsa law.
❑lam'eroptundarSee .BdkPCfmthis.
Owner Dam
WORKER'S COMPENSATION DECLARATION
P1I hereby.Rum tMer penalty or perjury arc of de following declarations .
have aM WI maintain aCmofcam ofcmumm a el(--invert fee WorkersCanpcn-
salon,as provided for by Sectio 3700 of the Leber Code.For,the performance of the
work for which this permit is issued.
�1 have and will maintain Workers Compensation Ivunnce,a inquired by Soden
1700 ofdm labor Code,for du:performance:ofdee work forwbich that permit is issued. '
My Woka Compemadoo Inaanttet, and Policy number ase:
Cartier. (/hLRLQ��' Poliq No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rrms inion teed nothecomplced Utie permh Is foream hundred donate(3100)
or lint)
1 coofv Nva in the performarcr of ton work Re which this permit is issued.I shall not
employ any person in any merger so as te become subject in tie Workmi Compensadaa
Laws of Califomia Dam
Applicant
NOTICE TO APPLICANT:IL after making this Cer ificam of Exemption,you should
become subject in the Wosscrs Compensation provifione of den Labor Code.you mut
.,O forthwith comply wide such Psovisiom o see permit shall W deemed mated.
Z " CONSTRUCTION LENDING AGENCY
[—i 4 1 herobY aRnm shut Nem is a comtrudrm lending agency far the perforou.or
Qi tie work for which this permit B issued(Sec.3(19'1,Cie.Q
lenders Name
2 benders Address
U O 1 certify that I have toad this application and state that dee shove information u
I3. comma 1 agree m comply with all city and county oNingems and sum laws relating to
C) building convection,and hereby suthnrien representatives of this city he enter upon tie
F 1 aW e-mendoned property for Inspection purposes
(we)agree in save,indcmdty and soup harmless the City or Cupertino against
(n liabilities.judgments.costs and'peru'which may in any my acome against said City _
U Z in consequence of We granting of this permit.
`-' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS,
Re-roofs
Sigwme ofApplicartuCtmonemor u
Da
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the a Cupem or forum balding e.Chapter
atom orand t e hacadam maoriat
m defined io de Cupertino Municipal Code.Chaper 9.13,and the HedW and Safety
Cade,Seniors 23532(3)?
❑Y' ❑Ne All roofs shall be inspected prior to any roofing material being installed.
40 Will ft pplicant or future Wilding occupant to equipment or dcvisxs which If a roof is installed without first obtaining an inspection,I agree to remove
I hand.'air comeminadts as defied by rte Bay Arta Air Quality Mamgemcnt all new materials for inspection.
DisdicO
❑Yin ❑Nu
I have mal the bvadmu maerials mquinmcots underehaper A95 of the caller.
.is Health kSateayCadeSoce.25505,25533 ad 25531.I understand!Wel ifthe building
does ran currently have a seem,that it is my responsteility in notify me meupent of the
requirements which mug be met prior a issuance or a Certificae ort3capmq. Signature of Applicant Date
All roof coverings to be Class'ns'or better
Owner on authom7d agent Doe'
CITY OF CUPERTINO
• 2 ITEMS OF 10 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36651030 . 00
DATE ISSUED. . . . . . . : 10/20/2008
RECEIPT # . . . . . . . . . : BS000006404
REFERENCE ID # . . . : 08100120
" SITE ADDRESS . . . . . : 11528 ROCK SPRING CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER BISELY JEFFREY AND AMY
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5124
RECEIVED FROM . . . . : LOS GATOS ROOFING
CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481
COMPANY . . . . . . . . . . : LOS GATOS ROOFING
ADDRESS . . . . . . . . . . : P 0 BOX 1726
CITY/STATE/ZIP . . . : LOS GATOS, CA 95031
TELEPHONE . . . . . . . . : (408) 298-9399
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- -- ------- --------- ----- ------- --------
1BSEISMICR VALUATION 5, 496 . 00 0 . 60 0 . 00 0 . 60 0 . 00
1REROOFRES SQ FEET 20 . 00 260 . 00 0 . 00 260 . 00 0 . 00
TOTAL PERMIT 260 . 60 0 . 00 260 . 60 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- ----------
CHECK 1, 615 .70 #2699
---------------
TOTAL RECEIPT 1, 615 .70
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---- ------------ -------- ----------------------------
601
-- ---------- -
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 1997 UBC Standards
and manufacturers specifications on re-ioofing.
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 with the above stated policy on re-roofing.
Homeowner's Name:
Job Site Address: Art
Roofing Company Name: L [)S 1Tajj oL c /1 d //7 U
Applicant's Signature: �1�I z�''y'}Z-C./ ,6 Date:
• Greg Casteel
Building Official
Revised 11/2/04
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
OUPCITY OF
EkTINO Fax(408) 777-3333
r IV Building Department
JOB ADDRESS: PERMIT n
OWNER'S NPHONE ,
GENERAL CONTRA&61Z S FAX
I am not using any subcontractors: S Q O
Signature d Date=
Please check a licable subcontractors and complete the following information:
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
O er ontra toi Signature at
Dpi C)
CITY OF CUPERTINO
REROOF
OF
CUPERJINO PERMIT APPLICATION
APN# S/ Date:�� �S O5f
Building Address:
14570 ? /t�oG K rim
Owner's Name: Phone #:
Contracto . J_os z rr' Phone#:
�J Fax#: 3
Cupertino Business License #: Contractor License #:
23'l q / 30w? 07
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles >�( Asphalt Shingles
* Wood Shakes ❑ Wood Shakes
o Wood Shingles ❑ Wood Shingles
❑ Other(Specify) Other (Specify) AS>r>> 3d
Number of existing coverings / ❑ Provide I.C.B.O. Report#
To be Removed Provide Mfg. Specs.
J C.
a i
Sao elFt ss
JoE Description:
26
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: ❑
Valuation: q/ /
I Have Read, Understand and-Will Comply with Cupertino's Tear-Off Policy:
• / 1'� l GC.fi��'�2.C/'l,
Signature