08100153 CITY OF CUPERTINO
BUILDING orv)s)oN PERMIT CONTRACTOR INFIORMATION �_
1• .,w;ersx<a3M '�A-H.3` .ix +7+�.xw £," "'¢
BUILDING ADDRESS:, PERMIT NO..
10863 LEAVESLEY PL R A CON
OWNER'S NAME: PERMIT MU DATE
OrN R. A 0. CONTROL NO,
408) 559-1877
ARCHITECLIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
woo LICENSED CONIRACTOR'SDECLARATION IObDeSCrDescription
U 1 homey affirm Nn I son I licensed under provisions of Chapter 9(commencing P
NNSmtion]OIfO)of Division JofNe Budncv ad Professiam Code.an yficenseis
n�d in fun fora adeffea 3 RE—RF T/0 WDSHK INSTL NEW SHTNG INSTL A LFTM
i&J— Lkcmc Clam i'L—Lt.♦
� Dam /n—p _contrwar ASPHLT SHNGL PRES TL 25SQ CLS A FIRE RATED
ARCHITECT'S DECLARATION
W< 1 uderetand my plans shall be used as public rtcnrds
n
L O Licensed Promosnasaal
OWNER-BUILDER DECLARATION
I hereby affirm that I exempt from Ne CamtractoLicense law for Ne
0 0 following mason.(Smut.7031 L 3,Business sea Pnofectiuns Cao de:My city or ceunty
which rtquirea a permit m cmuuthe alter.immow,demolish,fi repair any Mroctum
priorto isisauediprodMuse re1.the the of for such Permit to Tilo..Lawaautemem
<
does
ommanocgwith SeMunt tm the 3 of conuinessliomclaw(Chapter9 Sq.Ft. Floor Area Valuation
(commes exami N Scetiare 70W)of Division 3 of Ne Bm)nnseand
pt Professions Code)or
$ Na be,V earmpt Nuefrom and the baso(m the alleged!eumpsiam Any violation of 59975
Section 7011.5 by any applicant for a permit aubiccu the epPlicut m a civil penalty of APN Number Occupancy Type
can mac Nan Ince hundred dalWs(55001 P Y YP
01,uatvnerafthe ryaspmty,mmY nmplaycu with wageaude'v sole campensatiav, 35615024 . 00
will dofmaam ands: iceCoreisrotintendedo Lawdid fmul apply
an Buncrof
pro ertywh obu Cade:The.disco vers Lacenseand who
law duet nets apply m u Owner of Required Inspections
man
property proviimgat such
himpr seawho dosesuchwork himselforlMough his
awne ,then.provided Natsuch imps sold within
ttare not intendedmpleded for Ole If.
bcwcuitilm,Ne builaw Me,m improvanat is that
wi i in arc year Mcrprow f r Oc POP=r.
Of
boilder eats love the buNen of proving Nat bo did not builo m improv for purpose of
sae.).
❑I.sa owner or the property.am eouctua ely cormeming with Handed ceneacmn in
cans axtn the project(Sec.7014,Business ad Pmreasima Code:)The Conmacmri Li.
cense law does rot apply to Me owner of property who builds or improves thereon,and.
who conuacu for such pmjeeu wits a conwctoKs)Ilanxd Panama m the Conwmars
Lmeme Law.
❑lameacm)nundm STs ,BhPcfm Nismawn
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby aQirre oder penalty of pedury one of the fallowing dolautimer -
1 hart and"I m datim a Cmi fiam ofcoment to self-inure fm Waiters Compo
On,as provided for by Section 3700 of the labor Code,fm the Performance of use,
wmk far which this Permit is board
❑1 have and will mumbo Worleers Compenutian Wurana,u required by Section '
3700 of Ne Labor Code,fm the pofarm ax of Ne wash far which NU Permit is issued. '
My Workers Campauadon War•m^carom sed Policy number me:9 D
Carrier. 57�
ierW/La/ Policy No.:
CERTIFICATE OFEKEMPTION MOM RK
COMPENSATION INSURANCE
(17dt xNon reed mtbecompkied if de permit Isformnc hundred dollars(2100)
nr lea)
I certify,that in the performance of the wait for which this permit is tsucd,1 sMll not
employ any pesaon in say mannerm to in become subject in Ne Woke s'Compensation
Laws of California.Dam
Appilc+nt
NOTICE TO APPLICANT:IL net making this Ccrtifiate of Exemption,you should
became subject m the Workers Compensation provisions of de Labe Cade,you muse
.J z forthwith comply with such provisions or Nu permit shall be domed mvokcd.
OCONSTRUCTION IFNDING AGENCY
t r 1 hereby Milan Na Nem Ice a construction lending agency for the performance of
Use wah for which this permit u issued(Sue.3097,cis.C.)
0. Q Lenders Name
ZD z lenders Address
U 0 1 terrify that I bare read Nis application and sum Nat Nc abate information is
Ll.t" corms 1 agme in comply wit all city and aunty on .and ewe laws relating in
.0 building conswcnion,and hereby sometime mprosecounfis of On;city to Omer upon the
Wabout-mentioned progeny for inspection purposes
G (We)agree to save,indemnify sed keep hamksl the City of Cupertino against
fn liabilities.juagmens.cases and expenses which may In say way acme against said City
(.)z in consequence of the granting of this permit.
^n APPLICANT UNDERSTANDS D WILL COMPLY TH-ALL NON-POINT Issued by: 60 Date /e�_29�
SOURCEREGULA}101
� Re-roofs
Signature ofAg c ontrxtor Dam
/�AZARDOUS MATERIALS DISCLOSURE Type of Roof
Will t pPlicul or future building accupul Mom or handle huallous material
as derined by the,Cupertino Municipal Code,Chapter 9.11.and the Health and Safety
Code.Section25532(a)?0
y. inspected All roofs shall be prior to any roofing material being installed.
won Ne app cant ass mem building ncapent a q iPmeet ass m a whim If a roof is installed without first obtaining an inspection,I agree to remove
't haraMnus air casnuminult u dcfiru d by Ute Bay Area Air Quality Management all new materials for inspection.
ctr Al".
❑Yea
I have mal Ne hnaNnw macrisis mq.immew under Chapter 6.95 Ofthe Castor,
nu Health"Safety Code,Sections 155115.25533 and 25534.Iundersund and.if the building
does not currently haw a tenam,that it u my responsibility m notify the,occupant of the
mqulmrncnu which muse be as ora C.15eam of oeapancy. Signature of Applicant Date
Ownem auNari a cm Dow
Z �9 All roof coverings to be Class'%¢"or better
r . .
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . .. 35615024 . 00
DATE ISSUED. . . . . . . : 10/23/2008
RECEIPT #. . . . . . . . . : BS000006449
REFERENCE ID # . . . : 08100153
SITE ADDRESS . . . . . : 10863 LEAVESLEY PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WILSON ERIC K AND SUSAN C
ADDRESS . . . . . . . . . . : 10863 LEAVESLEY PL
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4747
RECEIVED FROM . . . . : R A CONSTRUCTION
CONTRACTOR . . . . . . . : ANDREWS, RON LIC # 21382
COMPANY . . . . . . . . . . : R A CONSTRUCTION
ADDRESS . . . . . . . . . . : 3851 R. CHARTER PARK DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95136
TELEPHONE . . . . . . . . : (408) 559-1877
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ----------- - ---------- ----- ---- ----------
1BSEISMICR VALUATION 9, 975 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1REROOFRES SQ FEET 25 . 00 325 . 00 0 . 00 325 . 00 0 . 00
------ ------- -------- ------
TOTAL PERMIT 326 . 00 0 . 00 326 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- - --------------- --------------------
CHECK 326. 00 #16031
---------------
TOTAL .RECEIPT 326. 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
--- --------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
S
Community Development
10300 Torre Avenue
O Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
�UPERTINO
Building De artment
JOB ADDRESS: //- PERMIT #
OWNER'S NAME: 6cJcG5'6rt/ IPHONE #
GENERAL CONTRACTOR - . Coils/� FAX.#
I am not using any subcontractors:
Signature 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
umbing
17 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 1/4 " 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: /� �f
Roofing Company Name: / \- /T . (!�O✓)5
Applicant's Signature: Date:
• Greg Casteel
Building Official
Revised 07/30/08
0, / 6 015 �
ZONE-
CITY OF CUPERTINO
REROOF
:CUPERT`INO PERMIT APPLICATION
`33-61 a�2_Ll, v 0
APN # Date: i� z
Building Address-
. j0F63
Owner's Name: G j� b , / c I o ` Phone #:
Contractor: Phone #:
Fax #:
Cupertino Business License #: 67�? 13 G Contractor License t
6 ep� 63 3Y3
Type of Roof Covering:
Existing: Proposed:
❑• Built-Up Roof ❑ Built-Up roof
a Asphalt Shingles '< Asphalt Shingles
,�r-- Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
o Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:
Residential Commercial Li
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: q c 75�
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 6/16/08
CITY OF CUPERTINO
t�p REROOF
CUPER,TINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FC0M Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
2s 1REROOFRES Re-roof Residential B 1SFDWLR00F
/ 1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08
•