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08110054 CITY OF CUPERTINO BUILDING DIVISION PERMIT �IO�,y.�TRA�T' .I,t y'r Q%•1A �I BUILDING ADDRESS: PERMIT NO. 924 ROSE BLOSSOM DR WILLIAMS ROOFING nslinne;4 OWNER'S NAME: PERMIT ISSUE DATE NE: A N CONTROL NO. 411 (408) 252-5120 ARCHI]EC(ENGINEER: - BUILDING PERMIT INFO BLDG ELECT PLUMB MEC" era o LICENSED CON7RACIOWS DECLARATION Job Description ZC 1 hereby affirm that 1 am licensed under pmvisimu of Chapter 9(cammcncing <L+ wiNSecuon 70W)of Division 3af NC Bulinus and Prafcsvuns Cade andmyliematis n a. in full rows and � � RE—RF T/0 SHK INSTL 7/16" OSB, INSTL CLS A COMP uahaa : �• Contractor - SHNGLE 30 YR 23SQ ARCHITECT'S DECLNkAnON Fq< 1 undersand my plans still be emd as Public records J6V sG� Licensed Professional u,w5 OWNER-BUILDER DECLARATION i% I hereby affi rm that 1 am exempt front the Contnnots License Law for the a pe DO following rtamn.(Section 7031.5,Business and Profession Code:Any city at county which requires a permit to construct,tithe,iopmw.demolish,ter mpalr any suumom prior b its issuance.aim requires the applicant for such permit m rile a signed summer < Nu he islicehedpunumttotheprovisionsOfNeContrsemr'aLccomLaw(Chapter9 Sq.Ft. Floor Area Valuation Y� (commencing with Section 70d0)of Division 3 of Ne B usimas and Professions Code)or ERR R that be is eumpi tbemfmm and IW basis for the alleged exemption Any violation of 6200 Section 7031.5 by arty applicant for a Permit subjects the applicant m a civil penalty of APN Number Occupancy Type sot seam than five hundod doll.n(swim 35906029 . 00 ❑1,u vwar of tbe property,a mY wployw with wage u Ibev role compensafion, will"the work,and has awaum Is not intended or offeree for silo(Sm.7W.Business area pmfessions Code:The Contravenes Liar Law acre set apply 0 an owner of Required Inspections property who builds err im provestremae,and who does such work himalf or through his own employers,provided that such impmvemenu art notimmnded ooRcred furmle.If. however.We Wilding or improvement Is mid within as year of completion,IW owner- builder will have Ne burem of proving that he did Out WiW or Improve for purpose of sale.). ❑1.as awns or the property.ma esclurively contracting wide Iiarued Contrmtma m eonsom the project(Sec.Toa,Bunn and Professions Cade:)The Con es U- come Law does WE apply m an owner a property who Wil"or improsn thereon.and. who contracts fm such pmjeeu wits a ces raaor(s)licensed pasuam m Ne Cmdoetots License Law. lamesemptunder See ,B&PCfoethisruamn Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby air=under penalty,of pmjory one,of the following desmrations I h:w,am will ma mad.•CertiRamaf Consent m self-Whom fu WorkefsCompen- ext,as provided for by Section 31M of Ne Labor Cads.for the perfame.of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation InsWana,as outlasted by Section 3700 of Nc lather Code.for the perfurmaae of the work for which this pchrok is issued My Wor�kefys Ca�omT�pensation y1 �Ina amu andPolicy/number tic: Caoler.lin w-a rfpZ Policy No.:6177_ici�3 uNh CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thtssection need rot be Completed Bthe permit lsfor Cn t hunNed"Ban(5100) or less) 1 certify Nat lo the perfmmasm a the work for which this Permit u issued.I shall not employ any person in my manrcrm as in become subject to the Workers Compensation Laws of Califomis Dan Applicant NOTICE TO APPLICANT:IL after making this Cenificate of Exemption,you should become subject in Ne Worker's Compensation pmvie(ons or Ne Labor Code.you muss 0 O EN forNwiN Comply with such proHsions or Nu permit shall be doomed o vokcd. ?y CONSTRUCTION LENDING AGCY I-.^ lbereby alarm Nat them Is a Construction lending agency,ror the Earforman¢err a Ne work for which fids permit is issued(Set 3D97,Civ.C) fy Q Landes Name z IaMets Adducts U p 1 certify that 1 haw mad this application and stale Nn the show information u IL E comm I agree ut comply with all City and county oNlnancts and eche laws relating b 0 building construction,and ureby audience representatives of this city m cme"pnn tic r W ahow-mentioned property for inspection purposes (We)agree to saw.indemnify and kap huCupertino mless the City of against , ti Iiabilities,juagmema.cats area expenses which may in any way a arvo aguasl said City U,Z, in eonsee unme of the granting of this pvmil /Z—//, �/ �Gv ^ APPLICANT UNDERSTAND ND WILL COMPLY WITH AIS.NON-POINT Issued by: Date SO REGULATIONS. yy//G , eA Signature of AppficmUCuotramor Dam Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Ibe applicant or future Wilding occupanumm or handle hamNous material as defined by has Cupertino Municipal Code.Chapter 9.13,and the Ralph and Safety Code,Semion35533(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes QAo will fit applicant or future Wilding Occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove it hvarahas air conumihnu as defiued by the Bay Area Air Quality Management all new materials for inspection. LFm7 / CYa a6 I have read the hvardosmaunialsrequi¢nems underChaperfi.95 oftle Califor- Iia Health&safmycede,Sections 25505. 3 25534.I understand thasirdm Wilding does no c our Maw.terrane that It risibility m noury,Ne aceupant or the reyuim he met -ort i Oracwficateoiroecuanay. Signature of Applicant Date � /6l©B OwneraauNmvad agent Date All roof coverings to be Class'%3."or better 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. Sa) 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 Raid 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:p Job Site Address: _ 1ZC-// �A/ gem '1Z�A_Ur6k��u-L D� Roofing Company Name: Applicant's Signature — Date: Greg Casteel Building Official Revised 07/30/08 - CITY OF CUPERTINO • 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35906029 . 00 DATE ISSUED. . . . . . . : 11/17/2008 RECEIPT #. . . . . . . . . : BS000006622 REFERENCE ID # . . . : 08110054 SITE ADDRESS . . . . . : 924 ROSE BLOSSOM DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : CHARLIE VMA ADDRESS . . . . . . . . . . : 924 ROSE BLOSSOM DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : STEVE G WILLIAMS CONTRACTOR . . . . . . . : WILLIAMS, THOMAS LIC # 6341 COMPANY . . . . . . . . . . : WILLIAMS ROOFING ADDRESS . . . . . . . . . . : 1826 CHERRY HILLS DR CITY/STATE/ZIP . . . : DISCOVERY BAY, CA 95014 TELEPHONE . . . . . . . . : (408) 252-5120 • FEE ID - UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL --- ------------- ------- ------ --- ---------- ---------- 1BSEISMICR VALUATION 6, 200 . 00 0 . 70 0 . 00 0 . 70 0 . 00 1BUSLIC FLAT RATE 1 . 00 110 . 00 0 . 00 110 . 00 0 . 00 1REROOFRES SQ FEET 23 . 00 299 . 00 0 . 00 299 . 00 0 . 00 TOTAL PERMIT 409 .70 0 . 00 409 . 70 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER --------------- ------------ - CREDIT CARD 409 . 70 VISA --------------- TOTAL RECEIPT 409 . 70 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- --- ---------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF • CITY OF CUPERTINO ok// 005Y REROOF ICUPaEkT4yol INO PERMIT APPLICATION APN # ��n O � Date: Building Address: / L Owner's Name: Phone #: Contractor: Phone #:Sj D Fax #: Cupertino Business License #: Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles X Asphalt Shingles 'Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles a Other (Specify) ❑ Other(Specify) Number of existing coverings / ❑ Provide I.C.B.O. Report# 1 To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: �U ^7//6 Residential Co mercial ❑ 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: 1 Have Read, Understand an Will Comply with Cupertino's Tear-Off Policy: • Signature Revised 6/16/08 CITY OF CUPERTINO 4 REROOF CUPEkTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BSEISMICO Seismic Commercial B IREROOFRES Re-roof Residential B 1SFDWLROOF 23 1BSEISMICRE Seismic Residential B 1RER0OFMRES Re-roof Multi-Family B 1MFDWLROOF 1BSEISMICRE Seismic Residential B IBUSLIC Business License B Revised 6/16/08