07100200 CITY OF CUPERTINO ' ' '
BUIL;OING DIVSSION pEg�IIT ,��1�'I'�A�TQ�.I����'�IflN
,. <. .: _;
. _ : _ . ...:
PERMIT NO.
BUILDI �c��a�,ssN BLANEY AVE CALIFORVIA ROOFING INC 07100200 .
pERMIT ISSUE DATE
�ER'S NAME:
PACIFIC GAS & ELECTRIC 1595 S lOTH ST � 10/29/2007
SANITARY NO. CONTROL NO.
PHONE:
(408)293-7977
BUILDING PERMCI' INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMH MECH
� 0 � 0
i p p LICENSED CONTRAC7'OR'S DECLARATION JO}] DeSCI7ptlOfl
; v� 1 hcrcby aflirm that t am licensed undcr provisions o( Chaptcr 9(commcncing
;z� withScction70(M))ofDivision3ofthcBusincssandProfcssionsCodc.andmyliccnseis TEAR OFE' EXISTING BUILT UP ROOF AND INSTALL VINYL
� a y in full focce an f�j
��? Licensc Clazs ��� J 1�.� Lic. # 6 � M PV �
. i ,,, p Da�c ConUactor
� ARCHITECI'S DECLARATION k .� �
i a a 1 undcrstand my plans shall bc uscd as public recorcis
)yV
' u. F"' Liccnud Pnifcssional
� y � OWNER-BUiLDER DECLARATION
�^ f hcrchy alTrm thnt 1 am czempt frum ihc Contractars Liccnsc Law for �hc
j p O following rcason. (Scction 7031.5. Busincss and Profcssions Codc: Any ci�y or rnunty
�°„ � which rcqui[cs a pertnit to conswc4 allcr, impmvc, dcmolLsh, or repair any snucwre
� Z y N, prior to i�c issuance, alsu requires the applican� (or such permit to file a signed sutement ��, Ft. Floor Area Valuation
-< tha� he is liecnscd pursuant to thc provisions of thc Convactor's Li��cnsc Law (Ctupta 9 `' $ 5 0 0 0 0
� F� (commencing wi�h Scction 7000) of Division 3 aC ihc Busincss and Profcssions Codc) or
��3 � that he is exempt thcccfrom and tNe bazis Car the allegcd exempdon. Any violation of
Section 7031.5 by arry applicant for a permit subjec�s �he applicant to a civil penalty of 316 0 3 0,4 5�N Number Oceupaney Type
irot morc than f ve hundred dallars (5500).
�[, as owner ot tt�e propecty, a my employeu with wages as their sole compenv�ion,
will do the work, and ilu suucwm is not intended or of:ered for sale (Sec. 7044, Hnsiness Reguired Inspections
and Profeuions Code: The Conuactor's Lianse Law docs not apply �o an owna of
propeny who builds or improvcs thereon, and who daes such wrork himself or thmash his
own employces, providcd thal such improvements are not in�ended or oReced Ca sale. lt.
however, the building or improvement is sold within one year of compktion, ihe owner-
builder will have the burden of proving that he did not build or improvc for pmpose of
sak.).
❑ I. as owrcr of che propeny. am uclusively conuacting with licensed contnctars w
conswct [he project (Sec. 7044. Businus and Professions Code:)'Ihe Coauaads [3-
ccnse Law docs no� apply to an owner of propeny who builds or impcows thc�eon, aad .
who convacu for such pmjects with a rnnuactorts) licensed pursuant to We Conuactors
Litense Law.
' am exemp[ undu Sec . B& P C for this eeswn
. ner Date _. .
WORKER'S COMPENSA770N DECLARATION
I ltercby affim� under penalty of pery'ury onc o( the folbwing dectaratians
❑ I hsve and will maintain a Cenificate of Consem to self-iasure for Workcr'sCompen-
sation, as provided for by Section 3700 aC �he Labor Code, for thc performarce af �hc
wor1: Cor which this pertnit is issucd.
❑ I havc and will maintain Workcr's Compensauon Insunnce, az�cquired by Scnion .
3700 oC thc Labor Codc, for thc performancc o( the work for which this permit a issued.
My Worker's Compensation Insucance c �olicy numbcr are:
Cartier. Poliry No.: ` d O O
ERTIFICA O EXEMFfION FROM WORKERS'
COMPENSATION INSURANCE �
(This scction necd mt bc completed if tAe permit is for onc hundred dallus (510�
o� Icu.)
I cenity thai in thc performancc of �hc work for which ihis permit is issucd, 1 shall no[
employ any person in any manncr so az w bccomc subject in ihe Warkcrs' Compensmian
Laws o[ Califomia. Datc
Applicant
NOTICE TO APPLICANT: [f, aftcr making �his CeniGcatc of Excmption, you s6ould
bccome subjcct to ihc Worker's Compcnsauon provisions of �hc Lal�or Codc, yau must
� O (or�hwi�h compty wiih such provisions or this pecmil shall bc dccmcd awokcd.
'"'' CONSTRUCfION LENDING AGENCY
F r ►��. I herchy affirtn �hat ihere is a conswction Iending agency (or the pedorman�z of .
p�„ �� work Cur which this pertnit is iuucd (Scc. 3097, Civ. C.)
LLl Q Lendcr's Namc
_ � Lender's Address
V � I certify ihat I havc rcad �his application and siatc that thc abovc info�mauon is
�� correct. I agree �o comply with all city and county oniinances and sute laws �cluing w
r-J J building conswction, and hetcby authori�e represcntativcs of �his city to cntcr upon tBc
� a abovc-mcntiuncd properry for inspccuon purposes.
(Wc) agrce to save, indcmni(y and kecp harmless Ihe City o( Cupertino agaiast
F " � liabiliva, judgmcnts, costs and expcnscs which may in any way accruc against said Gry
V z in consequcncc oC tAc g[an[ing of U�is permil. Date 1 ��,� U7
�—+ APPLICAM UNDE STAN ND LL COMPLY WITH ALL NON-POINf Issued by: ,` C�
SOURCE REG ONS.
f a �L� Re-roofs _.:.�/�
Signatureof I�canUCon wr � T e of R�of '
H OUS MATER[ALS DISCLOSURE Yp
Wi11 ihc applicant or futwc building accupant storc or handlc harardous matcrial
:fincd 6y the Cupertino Muni ' al Codc. Chapler 9.12. and thc Hca1W and SaCet7
.ac, Scction 25532(a)? All roofs ;�hall be inspected prior to any roofing material being installed.
❑ ras o .
wII thc applican� or futurc building occupant usc cyuipmcn� ar dcviocs a�hich
If a roof i;; installed without first ob aining an inspection, I agree to remove
emi� harardous air contaminan�s dcfincd by ihe Bay Area Air Quality Managcmcat all new m aterials for inspec ;lOCl.
Dis�rict?
❑ Ycs No � f
I havc rcad the ha�ardous materials requircments undcrChap�cr6.95 o(thc Califor- /� / �„ �� O�
nia Fkal�h & Safcty Codc, Scctions 25505, 25533 and 25534. I undcrstand ihat iCthc buiWin6 ��\J ��
docs not curtcnUy havc a �cnan4 lhat il is my responsibility to notify Uu occupmt of �he
rcyuircmen�s which musi bc me� prior u� issuancc o[ a Ccnificaic of Occupanry. S� Ie ppl ica t Date
L � Z All roof coverings to be Class "B" or better
Owncr or authorir.c ag ��
CITY OF l�UPERTINO
��``��' RE�ZQO�
CuP�t�T��vt� PERMIT APPI,ICATION FORM
�` l J�%C,�c�
APN # Date:
.�/� -� �?3 ��f5 l0 �°l o`I
Building Address: � � �
Owner's Name: � Phone #� S 1���
�' G
Contractor: � , , � License #: �� ���
0� � L OMI�i`. � w •
Contact: � Cupertino Business License #:
�. l L �,�;
Type of Roof Covering:
E�eist' g: Proposed:
�Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles �
❑ Other (Specify) ❑ Other (Specify) �{,�r/ �► `�1 �. �d 1�-��
Number of existing coverings ❑ Provide I.C.B.O. Report #
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Ha�e Read, Understand and Will Com ly With Cu�ertino's Tear Off Policy:
Job Description: � r D ,� � t ---- C � S d D � � �� � �- (� � � , �'
Residential ❑ Commercia
�, �ati r $ '
Fire Zone: Yes ❑ No C9/ Confumed with Planning e�t. if
there are any restrictions: U
Cost of Project: Type of Construc;tion: Occupa c�roup:
� p b06 0
Qty. if
Applicable Fee ID Fee Description Fee Group
� BPERNIFEE ]31dg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BLTILDING
BUSLIC Business License BiJILDING
. , Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
Fax: (408) 777-3333
Building l�epartment
Subject: Re-roofing policy for the C:ity 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 applieci without first obtaining all inspection
and written approval from the buildin� inspector. A final inspection and
approval shall be obtained from the bu lding 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 apprc�val.
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 f irst obtaining an inspection,
will require the removal of all new mat �rial down to the sheathing,
so a proper City inspection can be perfc�rmed.
7. � NOTE: If you call for a plywood nail utspection 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 m;nimum 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 ihe job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: 'T� r' �
Job Site Address: _� ��� U
Roofing Company Name: i ��
� ��
Applicant's Signatur � Date: t V �- d �
Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIZ RECEIPT OPERATOR: bethe
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 31603045
DATE ISSUED.......: 10/29/2007
RECEIPT #.-•.•••-•: BS000003106
REFERENCE ID # ...: 07100200
SITE ADDRESS .....: 10900 N BLANEY AVE
SUBDIVISION .......
CITY .............: CUFERTINO
IMPACT AREA .......
OWNER ............: PACIFIC GAS & ELECTRIC
ADDRESS ..........: 90C LIGHTPOST WAY #150
CITY/STATE/ZIP ...: MORGAN HILL, CA 95037
RECEIVED FROM ....: CAL ROOFING CO
CONTRACTOR .......: HAFPER P CAMPBELL LIC # 28096
COMPANY ..........: CALIFORNIA ROOFING INC
ADDRESS ..........: 15�5 S lOTH ST
CITY/STATE/ZIP ...: SAI� JOSE, CA 95112
TELEPHONE ........: (4C8)293-7977
FEE ID UNIT QUANTITY PMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 50,000.00 540.00 0.00 540.00 0.00
BSEISMICOM VALUATION 50,000.00 10.50 0.00 10.50 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT : 550.50 0.00 550.50 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 550.50 8435
---------------
TOTAL RECEIPT : 550.50
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
Community Development
fi . ``'�,� ' 10300 Torre Avenue
; ��:. �
.�• ;` < ,�:= Cupertino CA 95014
Telephone (408) 777-3228
CITY OF Fax (408) 777-3333
CUPEI�TINO
Buildi:n De artment
JOB ADDRESS: 1 �� 00 .�\ +����� � 1 PERMIT #�� 1 OU �Z�C�
/1V
OWNER'S NAME: 1.,� PHONE #�(D� ?,�� �trl.
GENERAL CONTRACTOR: .�-, �;r,. FAX # �{ ;�,,�. �0
I am not usin any subcontracto . �� �-
g
Si�;nature Date
Please check a licable subcontractors and com �lete the followin information:
SUBCONTRACTOR BUSIrIESS NAME SUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
IIectrical
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