08120028 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR.�I I`�,RMATIO,.N� ;
Cz
BUILDINGDDRESS: - PERMTI NO.
11563AMORNING SPRING CT YORKSHIRE R
OWNER'S NAME: NORTHERN PERhOT 14UEDATE
NE: A O. CONTROL 10.
(925) 606-6700
ARCHITECT/ENGINEER: BUILDING PERMU INFO
BLDG EI-ER PLUMB - MECH
LICENSED CONIRACIOWS DECLARATION lob Description
W� P
O 1 ion 70 affirm dui 1 tie licensed under and
Pactans o!;Code. 9(commencing
with Section 70110)of Dividon 3af dm Business and Profrssians Code,and my license u
n N inrulltameaM 1: �44k . RE—RF T/0 1LYR SHK W/COMP LIFTIME WARRNTY CLS A
z ucnnso CI a t+' Lie.
Dam Can maryo.rh^ 18SQ STONEWOOD COLOR
a ARCHITECTS DECLk ATION
o! I underrated my plans shall Im used as public records
Dwu
g G t; Licensed Pmfessianal '
OWNER-BUILDER DECLARATION
3 1 Washy Afton Nal 1 am concept from the Convectors License Law for am
O O following revon.(S.60"70 1.5.But.and Pmfcusimu Cole:A.,city or county
,t$(v which requires a permit to corummL ohm.ImPmw,demulish.or repair any urucmu
prior in its issuance.she requires the applicant for such permit to file a signed moment
Nu W u licensed pursuan.to cpruvisiM of the CanmabrS bras Law(Chagm9 Sq.Ft.Floor Area Valuation
XG (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
$ dux he is moment thandimm W the basis for the alleged s mmpuaa.my violation Of $9300
Semon 7031.5 by any appllcant for a pumlt subject the aPPOcant e•evil penalty of APN Number Occupancy Type
Oat come dem fsw hundred collas 450 36652033 . 00
0 1,u aims of the pmprny.Or my cmPloytra w'uh wages u Nab rule cmnpe^vdon.
win an the wart.and da swnom is an,muted or altered far sale(See.lou.Business Required Inspections
end Proresdans Code:The commutes I,smnm Law arcs rot aroma t apply b an aromof q P
property,who hands orimprawa thereon,and who doo"mchwart himselfur Waugh his
own employace,prwlded that such impr Panne ll art WiLinunded moRertl forsale IL
however.the huilding ere improvement d sold within aro year otwmpladon.the awner-
Wilder ang haw dm Wastes of pmsvtg dist Im did nm ddb or imlmom far puNase of
sele.).
❑1,as owner of the pmPmtY.am exclusively contracting with licensed convactars to
conswet the project(Sec.7044.Business am Profresimu Code:)M Commodes V-
cense Law dams,not apply in an omman of property who hands or insinuates Nemo.and.
who coouta for such pm)ecu with a contractor(s)licemed pursuant Or due O urmscbrs
Lieenm Law.
I w exempt ands See .B B P C fm this reason
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 bertbY Nim under penalty of pmjmy n.of the folbwing decluatiorc[
41 I haw am will maintain acarti(mor Consentto self-ince for Woteescompcm
.due,u provided far by Section 3700 of the Labor Code,fm dm pe formarcc are the
weak for which this penmft is issued.
ve
mall will maintain Worker's Compensation Insurance,u required by Seatian
700af Ne Labor Code.for use performance of the wodr for which this permit is Issoed.
My Warkrfs compensmicat bawrran¢cartio and Policy number use: '
Carrier: SIk10 ce,n Policy No.: "7L3e0/97L7,
CEFMRCATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(this soca.mea of be complete Ifthe permit is foro.hmbeddanm($100)
or leu)
I cerufy,that in um pafoonaren,of the work fm which Nis Permit is issued.l"I nm
employ any person in any manrcr an u b become subjen to the Worked'Compensation
Laws of Califomia Dam
Applicant
NanCE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subjm Or the Worka's Cnmpensadon pmvislons of the Labor Code.you muss
.J O foMwidt comply with such provisions or this Permit shall he deemed rtsmked.
zC'ONsmucnON LENDING AGENCY
y
[—r 1kmby affm mat dart is a construction lending agency far the pufa mance of
DS> W work fm which this permit is issued(Sec.3097.Civ.C.)
landeen Name
z Landers Add=
U O 1 codify that 1 haw read this application and stain than the¢bow informati.is
E•' comesm I agree W comply with ail city and county aminamcesd ansum laws uimml;to
.0 U Wilding connotation,and hereby auNoria mpms cOhmaaf this city b enterupnn the
W show-mamomed property for inmcmin.pmpnma
(We)agree to taw,indemnify and keep hanmlrat the City of Cupertino against
y liabilities.Judgments,cow and expense which may,in any way amuse against said Cry
U 7 in conuquenee of the grating of Nis permit.
r7 APPLICAN'r UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO CE REGULATIONS
t✓ d3 Re-roofs
AA
reef Applican✓Canmcbr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Win the applicant or future Wilding m.P.L..or lusbk haurdaus manmiAl
u de0md by use Cupertino Municipal Cade.Chapter 9.13,and tie Health and Safety
Code.Sect.25532(,)7All roofs shall be inspected prior to any roofing material being installed.
❑Yes Na
Will the applimaL or future Wilding.cupam um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
nit huallous air cotamWnu a dented by the Bay Arta Air Quality Management all new materials for inspection.
o cIT
Y. Jaffa
I have read Ne hu rd.smuerials mquircmenu under Chapmr6.95afthe Califor-
niaHnslth&Safety CAM.Sccmns255D5.25533ab 35 .lm =dthuirthe building
does ret camenay hew a mount.this it is my responsibility to scary the aaupent of the
my menu which mea W met prior to issuance oft C.ilc&7;r IPfy Signature Of Applicant Date
aYf L[sJkA'1 /t• 43,0X All roof coverings to be Class'RW'or better
Ow or authonmd agent Dam'
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 36652033 . 00
DATE ISSUED. . . . . . . : 12/03/2008
RECEIPT # . . . . . . . . . : BS000006738
REFERENCE ID # . . . : .08120028
SITE ADDRESS . . . . . :11563 MORNING SPRING CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER .. . . . . . . . . . . . : PATRICIA NG
ADDRESS . . . . . . . . . . : 11563 MORNING SPRING CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5121
RECEIVED FROM . . . . : YORKSHIRE ROOFING
CONTRACTOR . . . . . . . : KENNETH E FALCONS LIC # 28212
COMPANY . . . . . . . . . . : YORKSHIRE ROOFING OF NORTHERN
ADDRESS . . . . . . . . . . : 7275 NATIONAL DR
CITY/STATE/ZIP . . . : LIVERMORE, CA 94550
TELEPHONE . . . . . . . . : (925) 606-6700
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--------- -------- --- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 9, 300 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1REROOFRES SQ FEET 18 . 00 234 . 00 0 . 00 234 . 00 0 . 00
------ -------- ---------- ----
TOTAL PERMIT 235 . 00 0 . 00 235 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
--------------- --------------------
CHECK 235 . 00 #23630
---------------
TOTAL RECEIPT 235 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
---- -------------------- -------- ----------------------------
601
- ---- ---------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
Community Development Department
. Building Division
City of Cupertino
rna wr 10300 Torre Avenue
? CITY OF Telephone: (408) 777-3228
UPEKTINO 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 1997 UBC Standards
and manufacturers specifications on re-roofing.
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.
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.
Homeowners Name: Nc(Y1 r y
Job Site Address: 5 MoaliVADU Y lel,
Roofing Company Name:V0( 1 tm�N tc T
A plicant's Signature: l/�6�/ �lYywJCYtI Date:
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
0,4-
CITY OF CUPERTINO
REROOF
cuPERT NO PERMIT APPLICATION FORM
APN# �v s� 03 -3 , Dat /o
Building Address:
1152 othi Yl '}1 D q504
Ow 's Name Phone#:
'70:4M., U08- - 077
ontractor: U Phone#: License#:
Contact: Phone #: Cupertino Business License #:
—lo
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
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.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job escription:
Residential Commercial. ❑ J Cojor'-,S4on"oocl 4&Wj sr 19
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are anv restrictions: LJ
Cost f Project- Type of Construction: Occupancy group:
Qty. if
A licable Fee ID Fee Description Fee Group
BPERMFEE Bld.-Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING