07060061 CITY OF CUPERTINO
BUILDING DIVISION PERMIT T.J.
MAN
PERMIT NO.
BUILQI)VGA��ESS:LtA PALOMA DR BRIDGEMAN ROOFING CO 07060061
l l 11 PERMIT ISSUE DATE
OWNER'S NAME:
LATSHAW GARY AND SUSAN 13621 FERNCREST CT 06/08/2007
SANITARY NO. CONTROL NO.
.qE: 4088668170
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
_ BLDG ELECT PLUMB MECH
0 0 a a
cd
0 0 LICENSED CONTRACTOR'S DECLARATION Job Description
i v t– I hereby affirm that f am licensed under provisions of Chapter 9(commencing
;ZLU with Section 7000)of Division 3 of the Businem and Professions Code.and my license is REMOVE EHAKES INSTALL 1/2" CDX INSTALL 40 YR
Ow- in full force and cCfELLOVER 3 0 LB. REMOVE EXISTING WOODSHAKE S, INSTALL
t,M? License Cl •
�� °a1C
ARCHITECTS DECLA ASPHALT SHINGLES.
i a< I understand my plans shall be used as public or,
)yU
'm t Licensed Professional
OWNER-BUILDER DECLARATION
> 1 hereby affirm that 1 am exempt from the Contractors License Law for the
'00
following reason.(Section 7031.5,Business and Professions Code:Any city or county
$i which requires a permit to construct.alter,improve,demolish,or repair any structure
Z yy prior m its issuance,also requires the applicant for such permit to file a signed statement 4Z Valuation
Floor Area
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q.Ft. $12800
is (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 5 616 0 4 F �E�Number Occupancy Type
not more than five hundred dollars($500).
0 I,as owner of the property,or my employees with wages as their sole compensation,
will do the work.and the structure is not intended or offered for sale(Sec.7044,Buafnm Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sak.If,
however,the building or improvement is sold within one year of completion,the owner.
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li-
cense Law docs not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the contractor's
License Law.
0 I am exempt under Sec B&P C for this reason
Owner Dale
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
L]1 have and will maintain a Certificate of Consent to self-insure for Worker's compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers pe tion ins trance Cartier and Policy number arc: Q�
Cartier: 1Q. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I cenify that in the performance of the work for which this permit is issued,t shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z— CONSTRUCTION LENDING AGENCY
[�CA 1 hereby affirm that there is a construction lending agency for the performance of
pC> the work for which this permit is issued(Sec.3097,Civ.C.)
Lt7 Q Lendces Name
Lender's Address
U 0 1 certify that I have read this application and state that the above information is
LL. correct.I agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorize representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes.
CL (We)agree to save,indemnify and keep harmless the City of Cupertino against
F"t liabilities,judgments,costs and expenses which may in any way accrue against said City
U 2 in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREG LA /
IQ" Re-roofs
Signature of i mractor Date T of Roof
DOU TERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs.,hall be inspected prior to any roofing material being installed.
0 Yes p No
Will the applicant or future building occupant use equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new m Iterials for inspection.
District?
0 Yes 2 No
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safcty Codc,Sections 25505,25533 and 25534.1 understand that if the building
does not currently have a tenant,that it is my responsibility to notify the occupant of the
requirements which us be melt p'or to issuance of a Ccnificap of Occup Signature A Applicant Date
G� t- All roof coverings to be Class"B"or better
Owner au i d gent Date
CITY OF CUPERTINO
RECEIPT NUMBER: BS000001590
RECEIVED BY: PATRICIAG PAYOR: JEFF BRIDGEMAN RFNG
TODAY'S DATE: 06/08/07 REGISTER DATE: 06/08/07
TIME: 14 :22
3
BPERMFEE 07060061 $201.96
BSEISMICRE 07060061 $1.30
BUSINESS LICENSE TAX BRIDGEMAN/NANCHA $107 . 00
----------------
TOTAL DUE: $310.26
CHECK $310.2E REF NUM: #1390
TENDERED CHANGE
$310 .26 $. 00
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Address:
� bS L4 40, pc�Jt'-aro.- C� ,
Owner's Name: Phone#:
Contractor: , License#:
Contact: Cupertino Business License#:
Type of R iof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ 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 ❑ Provide Mfgr.Installation Specs.
I Have Read,Understand and Will Comply With Cu)ertino's Tear Off Policy:
Job Description: �)�� C{�ti/ ,L��iyc,tt�.
Residential IN Commercial ❑ V
Fire Zone: Yes ❑ No ❑ Confirmed with Planning D�t. if
there are any restrictions:
Cost of Project: Type of Construction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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 afire 2 to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be appliec.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:nspection is required.
6. Any roofing which is applied without f:xst obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be perfc rmed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee A$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 with the above stated policy on re-roofing.
Homeowner's Name: -'
Job Site Address: I a15`4 � -CL
Roofing Company Name: r
Applicant's Signature: 4 Date: 6'�f d7
Greg Casteel
Building Official
Revised 11/2/04