08120081 CITY OF CUPERTINO a a u.'i ugs.,w,t a ' IsxY .' i "'rA
BUILDING DIVISION PERMITCQNL`I�CQ;R II`'ORM41TI0N:,z_
BUILDING ADDRESS: PERMR N0.
19421 PHIL LN ALLA JERDES 08120081 '
OWNER'S NAME: ' PERMIT 15SUE DATE
NE: A CONTROL NO.
ARCHnECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Lipp LICENSED CONTRACTOR'S DECLARATION Job Description
iir u� 1 hereby al0m But 1 m Ifxtsaed under Pierian"of Chapter 9(commencing P
U with Section 1")of Division 3 of the Business And Prafuaem Cock,said MY Recruits is
^P<„ k full forte and effect RE—RF UP TO PLYWD, WILL LV EXSTNG PLYWD 30# FLT
:ttat,_ Lice.a. Lk.Itt PAPER, 1 LYR RPLCE W/40 YR COMP, CLS A 34SQ
[ ARCHrIEC17S DECLARATION
; U I uokostand my plans Nall M used u public rtc«ds
9 G� Licensed Professional
chs OWNER-BUILDER DECLARATION .
F 1 hereby affirm that 1 am comp,from the Conuaneh Licensa law for the
D o following reason.(Sncdon 10313,Business and Professions Code:Any city or county
m which na irm a permit in construct,alar improve.demolish,Or repair any structure
_Z< prion to its issuutee.also nequima tM applicamt for such permit to III...i'cd sciences,
i that he is licensed pumun,to the provisions of the eentmn«s Licence taw(chapter 9 Sq.Ft. Floor Area Valuation
yF� (commencing with Sncdm 700M of Division 3 of to Business and Pmfcasiam Cottle).1 5000
y^3$ that he u exempt dust d.and this basis far the all cul exemption Any violation of
Section 7031.5 by arty applicant,for a Permit subjects the applicant to a civil penalty of APN Number . Occupancy Type
not more than five hundred dollen ISM 37505034 . 00
❑I,a owner of Ne ptvpmy.«my employers wW wage u Nc'v role campenssdon,
winoatfesimenCdce-The Contractors Law
Out
apply an
Required Inspections
and Pmfeaons Cede The inn icamri.License law sem cot apply f m owm of 9
own
property who Wild,«impove ch improvements
ve ets arenaucmended imUlf dl for ugh his
ownemployms,provided ineve impmmmcnciin not earofdaroRered themaer-
bull&,however.the building u Mp Of p-Ani,mid within ane)ens of completion,Ne ase of
builder vaW have tin burden of proving Net he did not build or Improve far purpose of
;i!,.
ok . '
I,ss mwaa of the Property am midusively contracting with licensed conuactan in
construct the projecl(Sec.7044,Business and Professions Cade:)The Cunwcmr',Li-
ccee Law does not apply Is so owner of property who builds sir improves Nana,,and,
Me Law.far auto pmjecu wiNaco vsumrts)flcenmd punnsntmthe ConvUmr's
L e Law.
❑ oro tempt under-ha .B at this moon
0 se Dae
WO K• 5 Oh SATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declaradons:
have and will maintain a CeNOe,m of Consent m Ulf-Insure for Workers Compcn-
on,Is provided for by Section 3700 of the Labor Code,far the p rf amen of the
work for which Ni,permit is issued.
❑I have and will maintain Warners Compensation Insurance,as mquima by Section
37M of Be labor Code.for the performance of the work,f«which this permit is issued.
My Workers Compensation Insunme carrier and Policy number am:
Cartier. Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(this section need not W completed If Be permit I,(wont hundred dollen($100)
or leu)
T cattily that in the pcormen.of the work for which this Permit k issued,l shall am
employ I"Pp95non in TY ma«t«.0 "I" in
m M
the Work='Compensan
laal C
ws alJem' Dam 1IiiQQ.� f„�Y��JvY �JYY
NOTiwu
NOT //
ICE 1"n ft Wo T:1 a tem¢ mg Nu Ccnificete of Under os you should
bucome subject y it Worh pir Compensation Prod ons of de meed Cada you must
.J O fanhwith comply with such provisions or Nu permit,nall be deemed tevoks4
z ` CONSTRUCTION LENDING AGENCY
[—n I hembY affirm Nat Nen iraconataatetion lending agency for the Nf...f
D:7 Be wart for which this permit Is issued(Sec.3097,Civ.C.)
GQ Lemices Name
',z Limbers Address
U O 1 certify that 1 have sem this application anb rum Nu the sham information is
u, F catttcl.I agree m comply with all city and county oNinatens and sou laws retailing to
.0 U Wilding construction.and hereby suNanx mpmaencitimr of this city m enter upon use
r W aMve-mentioued property far Inspection purposes.
gy (We)agree to save,indemnify and"harmless Be City of Cupertino against
Iiacolitics,Judgments.costs ad Islamics m4u
which may in any way aus ,ir ,aid City
U z
n nsequvme of the panting of Nia not
'--' APPLICANT UNDERSTANDS A WILL COMPLY WITH ALL NON-POINT Issued by: Date — 7— Gt;P
OURc�REGULA c
/ L Re-roofs
Si unof Appli UC n r Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicam or future Wilding occupantamre or handle harardous material
ns defined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safely
C
Section 25532(id? All roofs shall be inspected prior to any roofing material being installed.
❑Yu �J10
Wall the applicant or future Wilding occupant use equipment sir device which If a roof is installed without first obtaining an inspection,I agree to remove
t hurardous air contaminants u defined by the Bay Area Air Quality Management al new materials for inspe Ion.
let?
❑Yea
C
Ihrve cowl Ne huaanu mate,,, qu'M5 untkr ChaptedtWi tW Wilding
n' oh"Safety COae.sMmru355,,5, 533 and 25534.1 undenund NatiftM Wilding
not cumnlI have r this it' my mapomihilitY m mfil'y Be occupant of Bm
quite cots niehmu er el etrmceor.cemfiepyFQe Nry� Signature ofApplieant Date
ser Or aidsoired agent 11/ L DateAll roof coverings to be Class'%q."or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 37505034 . 00
DATE ISSUED. . . . . . . : 12/09/2008
RECEIPT # . . . . . . . . . : BS000006790
REFERENCE ID # . . . : 08120081
SITE ADDRESS . . . . . : 19421 PHIL IN
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ALLA JERDES
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : ALLA JERDES
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : ALLA JERDES
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ------ -----
1BSEISMICR VALUATION 5, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
1REROOFRES SQ FEET 34 . 00 442 . 00 0 . 00 442 . 00 0 . 00
TOTAL PERMIT 442 . 50 0 . 00 442 . 50 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- ----------- -------
CHECK 442 . 50 #0147
---------------
TOTAL RECEIPT 442 . 50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
----------------- -------- --- ----
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
Community Development
e 10300 Torre Avenue
' -/ Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
#UPEI�TINO
Building Department
JOB RESS: \ PERMIT #
C O O l
OWNER'S NAME: PHONE #C(02,,-2 ,z
GENERAL CONTRACTOR: FAX#
I am not using any subcontractors:
ignature Date
Please check applicable subcontractors and complete the following information:
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
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature 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.
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 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 withIfok,9-S
bove stated policy on re-roofing.
ft
Homeowner's Name: �1��
Job Site Address: � I 24 O,%,A �ay�,k
Roofing Company Name:
Z -q
Applicant's Signature: L'�-� Date: c>>� I'
• Greg Casteel
Building Official
Revised 07/30/08
l 0
CITY OF CUPERTINO
" ` s REROOF
OF
UPERTINO PERMIT APPLICATION
APN # 3-75 O Date: i 2^G r U
Building Address: / O
Owner's Name: Phone #:
(A �C, 403
Contractor: Phone #:
Fax#:
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
o Asphalt Shingles )6 Asphalt Shingles
K Wood Shakes ❑ Wood Shakes
41 ❑ 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:
f .gyp oo�', ,
Residential L c4- _ jrJ4 0 Commercial ❑
1�LV cY -d- i!\tuv c_t
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: 5
I ave Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 6/16/08
CITY OF CUPERTINO
f j REROOF
CUPERTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
• / 1RER00FRES ' Re-roof Residential B 1SFDWLR00F
1BSEISMICRE Seismic Residential B
1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08