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CITY OF CUPERTINO
DIVISION PERMIT
'Co IN.EORMA'I()
BUILDING
BUILDING ADDRESS:
PERMITNO.
2 RESULTS WAY
TBD - TO BE DETERMINED
OWNER'S NAME:
PERF4I ISSUE DATE
ONE:
SA CONTROL NO. -
FT,T.T
ARCHRER/FaJGINEER:
BURRING PERMIT INFO
RE -ROOF T/OFF EXISTING
BLDG ELECT PLUMB - MECH
0 C:= 0 0
LICENSED CONTRACTORS DECLARATION
9
SINGLE PLY INSTALL N E.Y!)ib Description
1 hucby afltm Thal I aro deceased under preawaru of Clupmr (mmmes,ing
with Station 7000)of Division 3 of the Business and Profession Code, and my licenxis
n full rola arta ' /3 g
'ah
Lic
Dau Contractor
ARCHRECT'S DECLARATION
I understand my plan shall be used u public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby ,firm that I an exempt fmco the CanVaanars License Law for the
fallowing o nsom (Section 70313, Business and Profusion Cale: Any city or county
which requites a permit mm crosum.L a@q improve, demolish. or .*, any swctum
Prior te its issuance. aiso m mums the appliemt for such permit to file a signal statement
Ft. Floor Area
- Valuation
that he is demoted Paean W the provision of the Contractor's Licene Law (Chapter 9
Sq.
(commencing with Section 7000) of Division 3 of de Business and Prorcuion Code) or
that be u exempt therefrom and the basis for the Jleged esenpdon Amy violation of
APN Number
Occupancy Type
P y yp
Seethon 70313 by any appllcmt for a permit subjects the applicant to a civil pwlty of
ret come than five handled dollus ISM
L u awmr of the property. a my mploYens with wages a thetrmktampemwthon,
Required Inspections
the won d the fm.k apply. 7064, B
is rotkeMsse
Lawrdo
h. Cule
nor of
ad Pr C The Conaactors lacune law las role apply lf rt owner
and
is
wwwive, ortcoPmvea�,and who doessuintwart himrelfar through his
property W lds
owneem for sale,r-
Wtsuch impmvecomu tienot ear
owacmplthe
ofdmalfered
Wiping or is sold within on year orimpro a for Ne
r, role building
nicoprovernms
pose a
salMce will have the 4ardcn of Proving that he did roc dill m improve for purpose of
Wilder
oak.).
1. u awrcr Of the'roparlY, an exclutively contracting with demand canuxlms to
coodu at the pmjca (Sec 7044, Business and Profession Code:) The Convactm's U.
ease taw deem nut appy to m owner of property who brol" or improves Norton.,ud .
.
who contracts fat snob projects with a canuactor(s) licensed pursuant to the Conuutofs
Liecome law.
❑ I ore exempt under See . B At P C for this reason
Owner Dae
WORKER'S COMPENSAnON DECLARATION
1 hereby afrmn under penny of perjury one of the following declaration:
I have nod will mmatua a Cenifiate of Cement to.114num for Wmkda Comport -
on, u provided for by Seen. 3700 of the Inbar Cade, for the perfomsma of the
wart for which this Permit is issued.
I have and will maintain Wormers Computation Issuance. as taloned by Section
37W of the labor Cod, far the performance of the wort for which this permit is lsuel
'
My Wa .compewtionn I...cerflm and policy rumber are:
Cam SS ✓.✓'`O Policy Nmolga .:2/ZYriB�
CERTIFlGTIi Op EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sxthoa reed not wcanpkmd KIM permit is forms, hunthed dollar ($100)
orkss)
1 unify this in dee performance of the wells for which this permit is ivatl. 1 and not
employ any porton in my meorcrw u e become subject mo the Wortus' Compcnathoo
Laws of Coliforms Dm
Applicant
NOTICE TO APPLICANT: IL after mating this Cenifiue of Exaception, you should
become subject ou dC Warttl', CompenLtion provlGne of use L&W COtlt, yen mast
forthwith comply with such provision or this permit shall be darned msmked.
CONSTRUCTION.is.LENDWGAGENCY
Iherbyilli^^Nemmire is� len ding agency for the performance a(
the work for which this permit is Issued (Sec. 3lri/, Civ. C.)
ed(So.. 30
ndoes
,
I<ndefs Adtlms+
Address
I 1 comfy dot 1 have mad N. application and sum this the above information Is
'
cones. l agree to comply with all city and county onnaroa and sue laws miming to
building connotation. and hereby mmbonce repmenu diva of this city to err upon the
awve-menthos,d property for inpeLoon purposes
(We) agree to ave, indolently and keep hannleat the City of Capmino aga rtu
j liabilithu Judgments. costs and expuucs which may in my way same againt said City
in conacgs,nce of the Brmdng of this permit.
I APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by:9 Date
REGULnATIONS.
Re -roofs %
Type of Roof
I't%.L r ---) 10-3/-0 8
M=
Sign ureorAppliaMConmrator Dae
HAZARDOUS +ATERIALS DISCLOSURE
Wilt the applicant or future Wilding acupmtsome or handle hautdaus material
'
as delned by f Cupertino Municipal CO. Chapter 9.13, and the Health and Safety
CO. 0year n532(.)7�o
❑Ys,
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or mere wilding occupant use equipment ar devices which
it havudau aif com minmu as dafncd by the Bay Area Ail Quality Managccoenm
all new materials for inspection. '
Wicl7
❑ Yu
Ihave mid the haxudamalsmquimmew uakrppm695 ofe Wil
ria yCude,Sathorce255129334.1 understand Wilding
��[/(�, 'itl.0-14• �D ^� / a
dao outcumendy have • erarn dust it 4 myresponsibility Woutify e meopsimt of the
V�p/lp�tx� �/lJYc
m rte which no he met m uU me of a Canifeato of Occupancy.
Signature ofApplica Date
-off
'
All roof coverings to be Class '%W' or better
Owner or arch unle ages, Dae
e2 ITEMS OF 2
•
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ...I....: 35720042.2
DATE ISSUED.......: 10/31/2008
RECEIPT #.........: BS000006523
REFERENCE ID # ...: 08100210
SITE ADDRESS .....: 2 RESULTS WAY
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: SylviaM
COPY # : 1
OWNER ............: ECI TWO RESULTS, LLC&CB RICH'D
ADDRESS ..........: 2025 GATEWAY PL, STE 100
CITY/STATE/ZIP ...: SAN JOSE, CA 95110
RECEIVED FROM ....: EDWARD GREGORY
CONTRACTOR .......: TBD - TO BE DETERMINED LIC # 00096
COMPANY ..........: TBD - TO BE DETERMINED
ADDRESS ..........:
CITY/STATE/ZIP .... ,
TELEPHONE ........:
FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
------------------------------------------ ----- --------------------
1BSEISMICO VALUATION 104,507.00 22.05 0.00 22.05 0.00
1REROOFCOM SQUARES 20.00 337.00 0.00 337.00 0.00
TOTAL PERMIT : 359.05 0.00 .359.05 0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT :
AMOUNT
---------------
359.05
---------------
359.05
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
REFERENCE NUMBER
--------------------
MASTER CARD
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
an
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
CITY OF Fax (408) 777-3333
WUPEkTINO
Building De artment
0
JOB ADDRESS:PERMIT
2�-/ X 115 t,-) �,
#
OWNER'SNANIE: 4,5CI 7wD r{,eBu4-s LtC,
PHONE # yo -y6,7 -7s 3 a`
GENERAL CONTRACTOR: g,4Gey. s q)
FAX # S C� - 8 6 - Y3
I am not using any subcontractorsdu MJ C %"_Qk7) _ 10,3.1— O P
Signa Date
Please check applicable subcontractors and complete the following information:
/o —v'/- a P
Date
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
a Y i O /
Septic Tank
Sheet Metal
Sheet Rock
Tile
/o —v'/- a P
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.
• 5.
a) Spark arrester installation.
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: wo a «r L L L
Job Site Address: 2 e sJ
Roofing Company
Applicant's Signat
• Greg Casteel
Building Official
Revised 07/30/08
CITY OF CUPERTINO
REROOF
.CUPEf1;TINO PERMIT APPLICATION
APN #
-7 W
Date:
Building A ress:� /
JEe -SUitr �4
Owner's Name:
Phone #:
/�9) of— 546 7— 7S—Z,5---
S—3�Contractor:
Contractor:
/ %�
�id lnc w. �gf[CI r'�JJ� `^'/'�P
Phone #:P,?6-. 019 7
Fax #: S/ -o - ?e?6 -- r'S
Cupertino Business License #:c� �5 �/
d
Contractor License #:
Type of Roof Covering:
Existing:
Proposed:
-Up Roof
y�!'Built-Up roof
❑wilt
Asphalt Shingles
/❑_ Asphalt Shingles
❑ Wood Shakes
❑ 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: �a ��(ny in� ��°,�Cr
�lyt r r 9G[if/e� -Z,7j-" zS0 .-31,-As,44,,.,.
-:' V De
Q(O
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:
/0 `/ SD
I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy:
Revised 6/16/08
a,,
CUPEI,TINO
CITY OF CUPERTINO
REROOF
FEE SCHEDULE
Number of
Squares
Fee ID
Fee Description
Fee
Group
Permit Type
Cep
1RER00FC0M
Re -roof Commercial
B
1COMMLROOF
(
1BSEISMICO
Seismic Commercial
B
1RER00FRES
Re -roof Residential
B
1SFDWLROOF
1BSEISMICRE
Seismic Residential
B
1REROOFMRES
Re -roof Multi -Family
B
1MFDWLROOF
1BSEISMICRE
Seismic Residential
B
1BUSLIC
Business License
B
Revised 6/16/08
-1
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