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08110062U CITY OF CUPERTINO M > 0 z C) Lki h z -}�j' ��g,g� BUILDING DIVISION PERMIT 'MOTOR �!yTQR��,.�Ti y 2V.V,1 BUILDING ADDRESS: PERMIT NO. 227 OWNER'S NAME: PITIMIT ISSUE DACE A O. CONTROL NO. (408)295-7681 ARCHITEC (ENGINEER: BUILDING PFRMfI'INFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job DOSCiIphOn 1 hereby affirm that 1 w lianxd under Pvvisions of Chapter 9 (rommeneing with Send. Mail of Division Sof the Business and Fort ..in. Code, and my license is I. full fora am -GZIZ7 RE—RF T/0 EXTNG TORCH ON FLT RF ONLY&APPLY Lag Liaose Clan Lan, CERTAINTEED 3—PLY FLINTLASTIC 1—BSE, 1MIDPLY& 1 D.Ia,_4jc 4V Comusawr C At ARCHITECTS DECLARATION 1 uhdarsund my plan shall be used u public retards CAP CLSA 7 - Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Low for the following won. (Section 7031.5. Business and Professions Code: Any city of county which rtquims a permit m censwct, shoes. improve, dermleth, rar rapes' any muctua prior b its ane xaa. also mquirca the applicant far such permit to file a signed summer Sq. Ft. Floor Area Valuation that he is licensed personal W the pmvisionaar the Contractors L icurt.¢ Law (Chapter 9 (commencing with Section 7") of Division 3 of Ne Businrssand Professions Cade) ser Nat he u camp, thcadram and the basis fm On alleged exemption. Any violation of 57650 APN Number Occupancy Type Section 7031.5 by my applicant for. permit sobj.css Nc applicants to a civil penalty of ret mom than fin hundred dollen ($SU)). 34230004.00 ❑ L. as owner of the property, or my employes with wages as Neo vie c.....do.. Required Ins eCtlOn$ will do the work. and the awctum u Out intended! or offered fm age(Scc. 7W, Business and Pmfessions code: The conucmrs Lateran Law does ret apply m an awn= of q P property who huilds eni mprons tsr.n, and who dars.uch work himself ser through his own employees. provided Nat such improvements are not named oroEemul foreale. If. however, Ne building or improwm.t is said within one year of completion, Ne owner, builder will Nn the burden of proving that he did .t build or impeme for purpose of 1, as Owner of On property. am exclusively contracting with licensed contractors m a=tr.l dm project (Sec. 7014. Business and Professions Cade:) The Conuaeurs Li - ave Law does not apply b an owner a property who builds or 4nprows daemon, and, who contracts for such projects with a convacmRs) licensed pursuant m On Conucmrs License Law. ❑ I ore exempt under See ,B&P C for this mason Dwnu Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under pe rte ty of padmy o. of On fallowing declsnliov: hart will actin of Workers Camp am Cods.fuafor on, provided for by Section J700 of the Labor Code. fm the peAo'mana of the pro forty 37M Labor war for which this pcmhit is issuetl. r 1 New and will maintain Worker's Compensation Insurance, as acquired! by Stenon 3700 of the Labra Cade. for Nc performance of the wart for which this permit u Issued. Mymorke Ca ewfian Insurance carrier and Policy number are: Cortins Policy Na.: d 2 2 u CERTIFlCA F NIPT10N MOM WORKERS' COMPENSATION INSURANCE (Thu shim need Out he completed it Ne permit is foram hundred dollars (1100) or less) 1 ramify that in tic imli maneC of On war far which Nu permit u issued, l shall net ...ploy any person in any manrcrso ss a become subject u the Wod¢s' Canpevat ser Laws of California. Data Applicant NOTICE TO APPLICANT: If, after making Nu Certificate of Encmpton, you should become subject m the Waesm's Compensation provuio= of to Islar Code, you muss forthwith comply with such provisions m Nu Permit shall de decreed revokcd- Oat ft. ameNLF1mINGAGFNCY Nafmert usum(Seni07,Cing agency far Ne performarce ser Thor which. ter woes for which Nu permit u issad (Sec. 3097, Civ. C.) Lenders Name , Lenders Addw I terrify Nat I have read ,iia application and sum Wt the abort Informal. s correct l agree m comply with all city and county oNinances and sues laws relating m building construction. and hereby authorise represeautvns of Nis city m enter upon the &bon -mentioned property for inspection purposes (We) .gta a saw, indemnify and keep harmless dao aty of Caparison &gai=t li ilidesjudgmenu.coeumdc.perues whichmryln any w.yamue agafnstsaid Cry i onsequ<nee rar the gnntrng of Nin per mit PLICA 1'T UNDERSfANOS AN WILL COMPLY WITH ALL NON -POINT n Issued by: Date I Oji-- URCEG Reproofs Type Of Roof �NS Signa. of ApphamyCon cur Dere HAZARDOUS MATERIALS DISCLOSURE til to applicant serfuture Wilding ^.Chant Yom m MMk hvasdo=mauriaf ss fi d by is CCupertinoMMunicipal Cadc. Chahar 9.12. and the H=IN and Safety C t. 25532(a)? ❑YenNNO 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 a, future building .,.at use wuip., or devim which ba'rsrdous air contaminants a defirmd by the Bay Area Air Quality MMag=mens all new materials for inspection. ire? C] Y. I hon read the haurdaum undals mqultemen s under Chapmrb.95 of to Califor- six Ka ltb& Safety Cade, Seam rs25505.25533 and25534.1 undersand thuifNe balding dens t torten lap law • anent Nat it y maponsibility a notify On occupant of the requi mens richmm la met 'or a arce nr.eenifaateafOccup.ray. Signature of Applicant Date All roof coverings to be Class'/W' or better Owner rte Namcda cal Dam' I CITY OF CUPERTINO • 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 34230004.00 DATE ISSUED.......: 11/18/2008 RECEIPT #.........: BS000006637 REFERENCE ID # ...: 08110062 SITE ADDRESS .....: 22731 MEDINA LN SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 91.80 --------------- 91.80 VOICE ID DESCRIPTION -------- ------------ 601 ROOF TEAR OFF 604 ROOF IN -PROGRESS • REFERENCE NUMBER -------------------- MC VOICE ID DESCRIPTION -------- ---------------------------- 602 - ----------- 602 ROOF PLYWOOD NAIL 605 FINAL REROOF OWNER ............: CHAD & TAMARA MIENDERS ADDRESS ..........: 3171 ST FLORIAN WAY CITY/STATE/ZIP ...:. SAN JOSE, CA 95136 RECEIVED FROM ....: LINDA ASH CONTRACTOR .......: ASH, BOB LIC # 18553 COMPANY ..........: ASH ROOFING INC ADDRESS ..........: 620 ORVIS AVE CITY/STATE/ZIP ...: SAN JOSE, CA 95112-2322 TELEPHONE ........: (408)295-7681 • FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- 1BSEISMICR ----------------------- VALUATION 7,650.00 -------------------- --- 0.80 0.00 0.80 --------- 0.00 1REROOFRES SQ FEET 7.00 91.00 0.00 91.00 0.00 TOTAL PERMIT ------------- ----- 91.80 0.00 91.80 ------- 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 91.80 --------------- 91.80 VOICE ID DESCRIPTION -------- ------------ 601 ROOF TEAR OFF 604 ROOF IN -PROGRESS • REFERENCE NUMBER -------------------- MC VOICE ID DESCRIPTION -------- ---------------------------- 602 - ----------- 602 ROOF PLYWOOD NAIL 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 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 V4 " 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: a 1m(it `t - -Ta myCf M ) finkrs Job Site Address: '4�'51 rlkd yt(1 I.. ( Roofing Company Name: Applicant's Signature: Greg Casteel Building Official Revised 07/30/08 Date: il -I -O r L t Z10F CUPERTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION DSII O°�a APN # 2 q ooDq, C) Date: 11- 19-00 _.q Building Address: n n t; , Y1 La �v Wu Owner's Name: -3i-71 st . Pini tj-N l y - SAR .10 Sb Phone #: O C c1 � T��1 M I el �s Contractor: �vk ,� �L _ Phone #: Zy15 _ 11 6 v I Fax #: -7 Cupertino Business License #: Contractor License #: 07-1 Z Type of Roof Covering: Existing: Proposed: �K Built -Up Roof k- Built -Up roof ❑ 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 Pro imide Mfgr. Installation Specs. ft C -133 Job Description: -Tefte- Opt- TUY-Gt+ ON F"T 900F ONLY AV PL\( Ci�T/lrn1T81W 3 41 0 +%uN i LAST(( 1- dAS� 1 - �ti1t D Dt_y �- . ► —Gth� , Residential Rr�L Commercial Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the applicatio or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation I Haye Riad, Understand and Will Comply with Cupertino's Tear -Off Policy: p Revised 6/16/08 A'i ,aw CI O CUPEI,TINO CITY OF CUPERTINO REROOF FEE SCHEDULE Number of Squares Fee ID Fee Description Fee Group Permit Type 1RER00FC0M Re -roof Commercial B 1COMMLROOF IBSEISMICO Seismic Commercial B 1REROOFRES Re -roof Residential B 1SFDWLR00F IBSEISMICRE Seismic Residential B 1RERO0FMRES Re -roof Multi -Family B 1MFDWLROOF 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B Revised 6/16/08