09070067 CITY OF CUPERTINO T r�
BUILDING DIVISION PERMIT � �
BUILDING ADDRESS: PERMIT NO.
1079 KENTWOOD AVE R E ROOFING & CON2TRUCTION 09070067
\IER'S NAME: INC PERMIT ISSUE DATE
PHONE: SXNItA CONTROL NO.
(408) 626-9320
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Q O p LICENSED CONTRACT'OR'S DECLARATION Job Description
m C I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z w with Section 7000)of D'isjo of the Business and Profc�ons C and my license is
��y in full force andeffect� 7I'7 �� lam? REROOF REMOVE EXISTING 2 LAYERS OF COMP, INSTALL
j an z License ass
y�c Date onD.E,-r. - NEW 30# ASTM FELT AND LIFETIME COMP CLASS A 22
ARCH CI'SDECII4A N -
a< I understand my plans shall d as public rdc`rds SQUARES
�aU
U.t; Licensed Professional
n
0.< OWNER-BUILDER DECLARATION
1 hereby atTrrm that 1 am exempt from the Contractor's License Law for the
Ep O following reason.(Section 7031.5,Business and Professions Code:Any city or county
K Pi which requires a permit to construct,alter,improve,demolish,or repair any structure
v zy prior to its issuance,also requires the applicant for such permit to file a signed statement
_G that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
Y.
t– (commencing with Section 7000)of Division 3 of the Business and Professions Code)or 9 O O 0
y .. that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by&try applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom than ere hundred dollars(s500). 35930013 . 00
❑1,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.Business ns Required Inspections
and Professions Code:The Contractors License Law does not apply to an owner of fl P
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 sale.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.).
❑I,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 does 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.
❑I am exempt under Sec B&P C for this reason
vner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑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
for which this permit is issued.
I love and will maintain Worker's Compensation Insurance,as required by Section
3 f the Labor Code,for the performance of the work for which this permit is issued.
My WorkCeesstcompensation�insurance carrier and Policy number are: (,
Carrier b 1 r t I G 1�1/t NM Policy No.:
CERTIFICATE OP EMPITON FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is formic hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.I 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
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued(Sec.3097,Civ.C.)
WLI.Q Lender's Name
Z Lender's Address
V 0 1 certify that I have read this application and state that the above information is
LL h� correct I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authorize representatives of this city to enter upon the
U above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit Date (((
r7•17-
CANT UNDERSTANDS AND WILL COMPLY WITH�LL ONFOINT Issued by
17
GULATIONS C -7
` 7 Re-roofs
s.
HAZARDOUS MATERIALS DISCLOSURE Date Type of Roof
Will the applicant or future building occupant store or handle hazardous material
m defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
'ode,Section 25532(a)? i All roofs ;hall be inspected prior to any roofing material being installed.
❑Yes .P 1 No
Will the applicant or future building occupant use equipment or devices which If a roof i installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management" .., `new materials for inspection.
District? i
❑have
Iread the hazardous materials requirements under Chapter 6.95 f the Cali for-
trial Health&Safety Code,Sections 25505,25533 and 25534.1 tmdcrstand that iftbc building
does not currently have a tenant that it is my responsibility to notify the occupant of the /
require me S°h must be-tget P r to ijut , of a Cerificare of Oc ancy
��//, � �{O's1 Signature o Pipplicant Date
Owner or authariTl�eg"", ✓ Date All roof coverings to be Class'n"or better
CITY OF CUPERTINO
3 ITEMS OF 6 PERMI" RECEIPT OPERATOR: SylviaM
COPY ## 1
Sec: Twp: Rng: Sub: Bl}:: Lot:
APN 35930013 . 00
DATE ISSUED. . . . . . . : 07/07/2009
RECEIPT #. . . . . . . . . BS000008142
REFERENCE ID # . . . : 09070067
SITE ADDRESS . . . . . : 10'79 KENTWOOD AVE
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER CA7TEY HARRY C AND CATHERINE J
ADDRESS 10'79 KENTWOOD AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5806
RECEIVED FROM . . . . : RE ROOFING
CONTRACTOR . . . . . . . : PROCTOR, PAUL LIC # 20615
COMPANY R ]'' ROOFING & CONSTRUCTION INC
ADDRESS 15230 CLYDELLE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95032
TELEPHONE . . . . . . . . : (408) 626-9320
FEE ID UNIT QUANTITY ;UMOUNTPD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----------
1BCBSC VALUATION 9, 000. 00 1. 00 0 .00 1. 00 0 . 00
1BSEISMICR VALUATION 9, 000 . 00 0 . 90 0.00 0. 90 0 .00
1REROOFRES SQ FEET 22 . 00 286 .00 0 . 00 286 .00 0 . 00
- --------- ---------- ---------- ----------
TOTAL PERMIT 287. 90 0 . 00 287. 90 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEt�TINO
Building Department
JOB ADDRESS: PERMIT #
OWNER'S NAME: J-K�� PHONE #4 0�- b 2(, `' -2U
GENERAL CONTRACTOR: -1k FAX# b.2-L- - 1
..-,--
I am not using any subcontra ors:�,
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
a_,ev
CITY OF CUPERTINO
RE ROOF
CUPEkTINO PERMIT APPLICATION
7";;7-
APN # Date: �
Building Address:
Owner's Name: ; Phone #:
S�L4
- L,6
HOA: Yes ❑ No If yes, provide leiter from HOA
Contractor: Phone #: 1 u
6),J� !�(,�C t t��J` (etc Fax #: Do l l b I
Cupertino Business License #: Contractor License #
Type of F:oof 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)
umber of existing coverings 2. ❑ Provide I.C.C.E.S. Report#
To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: cvL, , q 12 _-_A`q Y_)t' (,u,LPI
Residential Commercial
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; j ,,, , ' }
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09
CITY OF CUPERTINO
I ad REIZOOF
CITY OF
CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
IBCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1 BSEISMICO Seismic Commercial B
1REROOFRES Re-roof Residential B 1SFDWLR00F
l 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
/ 1BSEISMICRE < Seismic Residential B
1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1 BSEISMICRE Seismic Residential B
1BUSLIC Business License B
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 Ciiy,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 nai 1 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 fe: 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 or.the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: wI
Job Site Address: IJ �=
�., ` � n
Roofing Company Name: �?' (� I r�' J t 4w1 Tl U'� 1\1J
Applicant's'Signature: i "�'�"� Y Date:
Greg Casteel
Building Official
Revis!d 07/30/08