08100170 CITY OF CUPERTINO :• � ,+« x .�» �'
BUILDING DTVILION PERMIT 0NTBACTQR,IN,[0iW'1 ION h-
BUILDING ADDRESS: PERMIT NO.
11652 VINEYARD e"? QIIV U- T PRINCIPLE ROOFING F, OR100170
OWNER'S NAME: FERMrr ISSUE DATE
OfNE: A O. CONTROL NO.
(408) 898-7298
ARCHITECf1ENGINEF3t: BUILDING PERMR INFO
-� BLDG ELECT PLUMB MECH
0 0 0 0
up C LICENSED CONTRACTOR'S DECLARATION Ib Description
1 bombm N
y starts l Am licensed Unum,provision of CMPmf 9(commOe.SCflA
cnciny
with Section 70W)of Division 3 of0m Business Aad Pmfesdon Code,wad my license is
n � inlullforeaandRE-RF RMV EXT WDSHK INSTL STONECTD METAL
;yj? License Class tic.• 916991—
Via- Dam ConnoisseurRF(LITEWEIGHT)CLS A 26SQ
ARCHyIECTS DECLARAnON
1 undermumd my Plans shall be used u public mcanls
JaV
t u in LuenseJ Pmfcssionel
5 h 3 that I A•exempt fr m Ce Contr ON
1 hereby affirm
Nn 1 em exempt Team the COnlramors License law for use
C O o following reason.(Season 7031.5,Business and Prefeatiom Cade:Any city or county
5$ which tequims A permit no canssmcl after.Improve,demolish.or repair wry stmcture .
iy prior bin,issuance.Alan,requima dm applicant for such permit to Om aligned aumment
g�0 that he is licensed pursuant to Ne provisional of the Contractor's Liecase Law(Chap=9 Sq.Ft.Floor Area Valuation
r�yg mornmeoing with Section 700M of Division 3 of the Business And Profession Code)or
`t Nat he is esernpl thesafmrn and the basis for the Alleged exemption.Any violation of $15000
Semon 7031.5 by arty applium for A permit mbjccu the aPPlianl N a civil pommy of APN Number Occupancy Type
eat nam than five hundred dales.(yspo) 36654012 . 00
❑1,u owner of the property.Or my employees with wagea As Neo sole wmPenusan,
will do six work and the,smmmumi4 Mt smneed of-flared far Oak(Sec.1044,BLW—
and Profew ous Cade:The Containers License law dors net apply Nora Owner of Required Inspections
pmpeny who bast W a car ire proses Narcan.And rho dna such weak himself or Nmuth but
own employee,pmWded dutsuch impmvemema Am Out iomnded Mallow for Sam.IL
however.the building or improvement lasold within an year of comptesan.the owner-
builder wiB recta Um Wrdra of proving Mai M did not Wld o impose far purpom of
tile.).
❑1.u Owner of ibo pgxny.um caclo ivcy,cw uring with BmnuA mnuutm m
coasmmci the project(Sec.1014,Businev and Profession Cade:)The COMMO S Li-
cane Law does not apply man owner of pmpeny who builds or improves thereon.and.
soba cmanCts formeir pmj,=w1N A eonVYtor(a)licensed pursuant m the Ca11VaLtaYi
L'cene Raw.
I.MPlmldef SCC ,BkPCforthsmasom
Owner Data
WORKER'S COMPENSATION DECLARATION
I bomby Affair under penalty of perjury one of the following declaration:
I leve arld will for by
n•Ce n 3700 of Consent r Code.f n fm War4Y ace of Ina f r Provided for mi Scesan 3]00 of me Labor Code,far tbo performance a(the
were for wbkb this Permit Is iasneC.
❑I have and will maintain Worker's Ca ommadon Imuran¢,As required by Section
37M.f the labor Cade,fu the performance of the wart for which Nu permit Is liked.
My Workers Compemation lnmranea carrier and Policy number am:
Cameo Cfid��t�+��Policy No.:
CFRTI CATE�PfION PROM WORKERS
COMPENSATION INSURANCE
(rids nim nmd teat W Completed If Ne permit Is rar.hundred dollar($100)
Or mea) -
1 comfy thea in the performance of tM work far which this permit is laws,l shall eat
employ any person in my mannerm as b become subject to the Workcn Comperiason
Laws of California Dam
Applicant
NOTICE TO APPLICANT:If. net making his Cenircam of Exemption,you Mould
hos ark subject N the Warkels Compensison pmviaimu of Ne Lima Code,you muss
O forthwith comply wit such provision o Nis permit shall be dcemcd mamknd.
Z ti CONMUCTION LENDING AGENCY
[-•i Ihart&Mm that Nem s a construction lending agency for the performance of
[�
the were fm which this permit s usucd(Sec.M.Civ.C.)
QLe de'a Name
D z lenders Addfus
U O 1 certify Nat I have mad this application and sum Nu the above information is
Ip, comma 1 agree to comply with all city And county or'linances and sum laws relating in
.C) Wilding construction,and herby mdumm mpmmnutives of Nu city W=let upon Nc
W above-mentioned PMPeny fm isupecsan Puryusea
G (We)ASme to ave.indemnify And keep Anomalies the City of Cupertino Against
fn limilitin,judgments.cons and expenses which may in any way acerm sgaini saidCity
U z in consequence of the tooting of this permit.
�••� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date Z`7 -eJl—
SOUR EGC6.�ULAl10Ni.
1`
Silt �` Data Re-roofs
HAZARDOUS mum of ApplicaHAZARDO m
US MATERIALS LsaCLOSURE Type of Roof
Willy use Cup
fusum beat oocupantporemhendm hmallonmamriai
As 4fincd by the Cupertine Mun opal ode.Chapmr 9.11,and sea Hcalth and Saiety ,
Cam.Section 15531(,)] All roofs shall be inspected prior to any roofing material being installed.
❑Yu
Will the Applicant or future building occupant am equipment m devices Mich If a roof is installed without first obtaining an inspection,I agree to remove
it hvuMn Air commmitunu asby the Bay Area Nr Quality Management all new materials for inspection.
Wcsi
❑Yca No
I have mad he hvudsua mamriasmquiremcnu under Chepmr G95 of dm Cask,
CIA HeaiN k SalnyCode.Secdom 255(15.25533,sul MIA.IuMerssarW thmifNc Wilding
don,Mt.Macro ly have A mnanc Nat itis my responsibility us of,the occupant of Ne O
require Signature of Applicant Date
I-('/ /--b All roof coverings to be Class'W'or better
Owner M mmof s!Agent Dam
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36654012 .•@@ 01
DATE ISSUED. . . . . . . : 10/27/2008
RECEIPT # . . . . . . . . . : BS000006470
REFERENCE ID # . . . : 08100170
SITE ADDRESS . . . . . : 11652 VINEYARD -cT-5e4NCr C:
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WOLFGANG ADERXOLD
ADDRESS . . . . . . . . . . : 11652 VINEYARD SPRING CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5135
RECEIVED FROM . . . . : DERECK LOI
CONTRACTOR . . . . . . . : DERECK LOI LIC # 27564
COMPANY . . . . . . . . . . : PRINCIPLE ROOFING &
ADDRESS . . . . . . . . . . : 10160 STERN AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
TELEPHONE . . . . . . . . : (408) 898-7298
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-- ------------- ---------- ---------- ---------- ------ -----
1BSEISMICR VALUATION 15, 000 . 00 1. 50 0 . 00 1 . 50 0 . 00
1REROOFRES SQ FEET 26 . 00 338 . 00 0 . 00 338. 00 0 . 00
TOTAL PERMIT 339 . 50 0 . 00 339 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 339. 50 MC
---------------
TOTAL RECEIPT 339. 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -- -------------------------
601 ROOF 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
4kUPERTINO
Building Department
JOB ADDRESS: _ PERMIT #
1 16 SL Ar;WL 6-7
OWNER'S NAME: e PHONE #r4W
GENERAL CONTRACTOR: '� d FAX #
I am not using any subcontractors: L� G
Signature Date
Please check applicable 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
--T?,- I oZ 2
Owner/Contractor Signature / Date
Community Development Department
Building Division
City of Cupertino
10300 Tone 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$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 "per foot slope and demonstrate
that there is no ponding.
2. . An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name:
job Site Address:
Roofing Company Name:
Applicant's Signature: V Date:
• Greg Casteel
Building Official
Revised 07/30/08
CITY OF CUPERTINO D kl o U 17 v
aNAuREROOF
COF
•CUPERTINO PERMIT APPLICATION
APN # � O /� . � � Date: lo�La-�vX
Building Address: ,
I /6SZ I/i �.1za cS'- u
Owner's Name: Phone #:
y✓a siz il�-Ce(� 6,.fc4)
Contractor: Phone #:
�l,G✓r�iGj� ��o`y�iiq �i Confr`2tt-G`C�� �`ff�� �'�J8 — �t��7$
✓j Fax #:
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ phalt Shingles ❑ Asphalt Shingles
Wood Shakes ❑ Wood Shakes
41 ❑ Wood Shingles ❑ good Shingles
❑ Other (Specify) V Other (Specify)S /tQ �� t�L'�+ CL
Number of existing coverings ❑ Provide I.C.B.O. Report #
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: ,eesna✓e, 6,ra67-4;i�//J dXaA4, *r' Sy �wf�dL
Residential 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, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 6/16/08
CITY OF CUPERTINO
fit REROOF
1 OF
CUPEI�TINO 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 1SFDWLR00F
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08