08120030 CITY OF CUPERTINO . :x
BUILDING DIVISI N PERMIT WINFORMAT'ION
BUILDING ADDRESS: PERMn'NO.
20063 LA RODA CT LOS GAT
OWNER'S NAME: PERMIT ISSUE DATE
5 CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
RE—RF CLS A 29S /RMV WDSHK O O o 0
pop LICENSED CONTRACTOR'SDECLARATION &INSTL ASPHLT SHNGLS Job Description
U1 facts,afire that 1 m li¢ W nsunder provisions of Chapter 9(commencing
_mawith Section 7(X0)of Division 3 ofde Business and Promssiu uasCods.and my license is
yinfunfmaandeffMC3 Ff40./ 0 9
'LjZ License Class Lac.
�=
Dam Contractor, .6J
NItELT ECLARATION
1 1. ad upuANcmcends
s 4a LicenttJ NufcTnel
OW NEmBUILDER DECLARATION
COO hmam a(Bm that 1 1. exempt from the Contractors Leense Law forft
nty
COO
O following mason.(Saito]D31.5,Business and Rofessiuv Code:My city OF count'
S m which mquiru a e.AM m eeres the slur.ntsprnn,demolish.or repair any structure
prim m its issuance,ndexquims de applicants of for mors permit m files signed aummcm
als (tom he commaliaroithSut.navethepm.ivis�tfofineBthe u,amraLanxl,weaapa9 Sq.FL Floor Area Valuation
x F$ thad be I,mom with Suction (Koad ofDivisionbasisof r dac l Busies and.Any
Code)Lir
Q�� this he u ewvpt tbcmfsvm and Use btu far the alleged exemptiau Any violation a(
seNon703IJ by my appBuntfor a pumitsubjecu the aPplicmtm acivil Penabyof APN Number Occupancy Type
not mom dun Bn hundred dollars($50a
0 1,as t=ree of the property,m my employees with wages M their sole compewdem.
will do the work and theswctum u net Intended or offered for mam(S..7044.Busimss Required Inspections
.ad de:Th
Perfmanes Coe Coc
numra Li orae Lnot apply dors apply m an e awns of q P
property who Wilds or improves Norton,and who does such work himselfor I rough his
own employ=,provided duo such improvement Me not intended mofsed for sal.ff.
however,the Wilding or improvement is mid within one you of completion,Ne owner-
insider will ban the buNen of proving that he did ret build or improve fee pure m of
sale.).
0 1.as owner m the property.w conclusively contracting with licensed contra to s b
construct the project(Sec.7044,Business and Professions Code:)The Contractors Li-
cove Law d=not apply m an owner of property who Willis or improves James.and,
who conuacu fm such pmjomm with s contractor(s)licensed pmuunt to the Contrctors
Lasmo law.
0 Issommmpsunder See ,B&Pcloodesunn
Owned Dau
WORKERS COMPENSATION DECLARATION
1 hereby afro under peoulty,of perjury one of the following dkela more: .
1 Mn and will main min a Certificate ofC...I m self-assure far Workers Compcn-
W on,ss provided for by session 7700 of the Labor Code,fm the pe ilsome eco of the
work:for which this permit is issued.
1 ban and will estimate Workers Compensation Insurance,as required by Section
3 of the Iabof Cod.for Ne performance of dte west forwhmh Nis pemht Is I..&
My Workers Comp dv.a-r-o�nln!sura�vccani ftlicynu/mbv are pry
Cartier. •5 �/Gy'�O Policy No.: 9 00041%p
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(nus cam nxd rot be completed Bede pemitu fatne hundred dollus($100)
m kms)
1 cutify duct in the perfomance a the wok fo which NIs permit u issued.l shail nm
cmployanypermninanymumrmumbaomcwbjectmthe Workcri CDmpavaOM -
Laws of California Dau
Applicant
NOTICE To APPLICANT:If.after malting this Certificate of Exemption.you ahouW
became subject m rhe Worker's Compensation provision of the taper Cod.you mutt
Oz foMwith comply with such provision minis Permit shall W doomed revoked.
iD; CONSTRUCTION LENDING AGENCY
[-+ Ithmby aiRm into mere Lia construction
coding agc=y for the perfomancc of
!Yi > Ute were for which Nis perch Is issued(Scc,3047,Civ.C.)
Wee Q L<ndds Nun.
M z Lenders Address
U 0 1 certify that I ban mad this application ad sum,thx the above impartation u
CL E' comes I at=m cmnply with all city and corny ordinances and sum len muting to
0 V Wilding convection,and hereby mabonne miemplana of Nis city to enter upon the
W Movemendond Property for inspection purposes.
(We)agree to save,indemnify and kap bsrmleu the City of Cupertino again,
Co) liabilities,judgments.cote and expenses which may in any way seems,against said City
U Z in covequuse of the granting of this Permit.
^ APPLICANT UNMSTANDS_AVD WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU 'nok
/Zo Re-roofs
Signs=of Applica lContrcmr Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicator fuuue Wilding occupant more ahandle husNov material
as defined by the Cupertino Municipal Code.Chapter 9.13.and the,Health and Safety
Co .section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
Dyes
W01 me.,he.,or future Wilding occupant use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
it huamnus air conuminanu a defined by the Bay Area Air Quality Management all new materials for inspection.
.tistrier? {�
0Yes .QN.
1 ban read the harm ws materials m W vemrnu under Chapter 6.95 of the Cali mo-
out Hcalth&SafctyCodc,Satiate nM5.25533 and M534.1 mucas dthus if the Wilding
dines and currently Nn a testes that It is my mapovibiliry as notify dcc
e occupant of de
roquhremenuwhmhoomaM I 'ormissuaacofaCemiOcancftJccu�wr.y. Signature of Applicant Date
Ownemn� 2754 / All roof coverings to be Class'%W'or better
CITY OF CUPERTINO
� 2 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . . 36934028 . 00
DATE ISSUED. . . . . . . : 12/03/2008
RECEIPT # . . . . . . . . . : BS000006739
REFERENCE ID # . . . : 08120030
SITE ADDRESS . . . . . : 20063 LA RODA CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SANDMAN LEONARDO AND MONIKA C
ADDRESS . . . . . . . . . . : 20063 LA RODA CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4410
RECEIVED FROM . . . . : LOS GATOS ROOFING
CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481
COMPANY . . . . . . . . . . : LOS GATOS ROOFING
ADDRESS . . . . . . . . . . : P 0 BOX 1726
CITY/STATE/ZIP . . . : LOS GATOS, CA 95031
TELEPHONE . . . . . . . . : (408) 298-9399
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--------- ------------- ---------- - --- ---------- ---------- ----------
1BSEISMICR VALUATION 8, 964 . 00 0 . 90 0 . 00 0 . 90 0 . 00
1REROOFRES SQ FEET 29 . 00 377 . 00 0 . 00 377 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL, PERMIT 377 . 90 0 . 00 377 . 90 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 684 . 00 #2727
---------------
TOTAL RECEIPT 684 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
------- ---------------------------- -------- ------------- ---------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
CITY OF CUPERTINO
REROOF
CRY F
CUPEfIiTINO PERMIT APPLICATION
APN# �� y' � Date:
Building Address: 0�vU4 2 ZQ hD ,� ,
Owner's Name: ✓ Phone#:
l elW a l-alo SCvv)e4n d o y49 M- 7� 2.
Contractor: S C j iJ Phone #: Z16) 2 9
rit. c S 0 e 1✓7 Ll
Fax #: 13 7/
Cupertino Business License#: Contractor License #:
It?0() 170 '7
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt ShinglesAsphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
. ❑ Other (Specify) ❑ Other (Specify) 7)I(, GSB
Number of existing coverings I ❑ Provide I.C.B.O. Report#
To be Removed ❑ Provide Mfg. Installation Specs.
=_ I— Aae Gloss
JA Descziption:
Residential Commercial ❑
Fire Zone: Yes ❑ NoConfirmed with Planning Dept. if
there are any restrictions: ❑
Valuation:
I Have Read, Understand and.Will Comply with Cupertino's Tear-Off Policy:
Signa re