07100189 CITY OF CUPERTINO ' � ° '
BUIi.DlNG DI4ISION PERMIT ���TRA GT;t)�. �����T�ON �
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PERMIT NO.
BUILDI ��n�B�ss$RET AVE SHADOWF:�X ROOFING 07100189 .
PERMTT LSSUE DATE
�ER'S NAME:
OREN & MARIANNE SHELLEY 1 366 SA] �TTA FE Dn 10/26/2007
SANITARY NO. CONTROL NO.
PHONE:
(408)26�-2490
BUILDING PERMITINFO
ARC HI'I'ECT/6NGiNEER:
HLDG EL.ECT PLUMB MECH
� � 0 0
i p p LiCENSED CONTRACI'OR �ecu+RanoN Job Description
i v� I hcrcby affirm that I am licenscd undcr provisions aC Chap�cr 9(commcncing
; z � wiih Scction 7000) of Division 3 of thc Busincss and Profcssions Code ana m �icen� is REMOVE :�X I S T I NG � LAY 0 S B� R E P LAC E W 4 � YR A S P HA LT
� a a in (ull focce and eCfec 2
j � ? Licensc Ctazs � ` � L�. #
: F o p Con�racwr
� ARCHiTEC1'S DECLA ATION
i a Q 1 undcrstand my plans shall Ac uud as pubiic rccords
i4�
' u. F' Liccnsed Pcutcssional
: a a OW NER-BUILDER DECLARATION
j a� I hcrchy alTirm tha� ! am cxcmpt (rt�m �hc Contraaors Liccnsc Law for the
; p O (ollowing rcason. (Scctian 7W 1.5, Business and Profcssions Cadc: Any city or county
�°�, Pi which rcquires a pemiit to conswct, alur, impmve, dcmalish, or repair any s�cuexurc
� Z y prior to i�s issuancc, also ccquires thc applicant for such permit to file a signcd suicmcm �; Ft. Floor Area Valuation
< iha� he is licensed pursuant to the provisions oC the Conuactor's Lic�enx Law (C7uptcr 9 � $18 0 0 0
� t� $(commcncing wi�h Section 7000) of Division 3 oC Ihe Business and Profcssions Code) ur
��.. �hat he is exempt thcretrom and ihe basu Cor the allegcd eumptioa Any violation oC
Section 7031.5 by any applicant for a pertnit subjects U�e applicant to a civil penalty ot 3 7 510 0 3 J`.°'8� Number Oeeupancy Type
�rot more than fivc hundccd dallars (5500).
❑ I, as ownez o[ the property, or my employces with wages az the'v solc compenaation.
wilidothcwo:l:.andthesuuctweisnatintcndedoroffaedforsale(Sec. Required Inspections
and Professions Code: 'Che Conuacwr's License Law does not applY in an awner of
property who 6uilds or improves thercon, and who does such xrork himseltor thmugh his
own emplayccs. prrnided that such improvemen�s are not imended or oRe�ed C� sak. It.
however. the building or improvement is sold within one year of comp�uon. ihe owner-
builder will have �he burden of proving �6at he did noi build or improve [or pu�pose of
sak.).
❑ 1, as awner of tlu property. am uclusively convacting with licensed contractors a
conswct the project (Sec. 7044. Businas and Pcofessions Code:) The Cootraewr's Li-
cense Law does oot apply �o an ownu of PropenY who builds or improves 16e�. and .
who conUacts tor such piojects with a cronvactor(s) Gcensed pursuant w �he Conuutors
License Law.
am uempt under Sec. , B& P C fa thia reason
. ner Date _. .
WORKER'S COMPENSAT[ON DECLARATION
I hereby aflirto under penalty of pery'ury one o[ the following dec�A�•+�+<•
❑ I hs.�e and will maintain a Cenificate oC Consent to self-insure for Warkefs Canpcn-
sation, u provided for by Sation 3700 of the Labor Code. for the performanoe ot the
work for which this petmit is issued.
❑ I havc and will maintain Worker's Compensation Insurance, u �cquired by Section .
3700 oC the Labar Code. for the perfarmance of the worlc far which this permit is issued.
My Worker' ensai n G�su nce nrricr and Po numbcr arc:
Grtier. w Policy
CER77FiCA'IE OF EXEMP!'[ON FROM WORKERS'
COMPENSATlON INSURANCE �
(Chis sccUan nced irot be complctcd if the pctmit is for onc hunMA doUars (S1a0)
orlcssJ
I ceni(y that in thc perlortnancc of i6c work fw which �his permit is issued. 1 shall na
employ any person in any man�r so as ta bccomc subject tu ihe Workers' Canp¢nsation
Laws of Cali[omia. Datc
Applican�
NO"1'ICE TO APPLICANT: lf, aftcr making �his CcniGca�c of Ezcmp�ion, you should
become subja[ to Um Workcr's Compcnsation provisions of Ne Lat�or Codc, yw muu
�,� (orNwi�h comply with such provisions or �his permit shatl bc decmcd ecvokcd.
Z � CONSTRUCI70N LENDING AGENCY
F . � I hercby aCfirm ihat thcre is a conswction Icnding agency Cor thc per(wmancc of .
(Y, � �he wark for which this pennit is issucd (Scc. 3097. Civ. C.)
W A Lendcr's Namc
� z L.cnder's Address
V 0 � ccrtifY �ha� 1 have read Wis application and s�atc �hat �he abovc informatiun is
w � cortect. 1 agrce to comply wi�h all city and county ordinances and sute laws relating w
� U building conswction, and hereby authori�e represenutives of this city to emer upoa Ihc
� a abovc-mcntioncd pmperry for inspcction purposes.
(Wc) agree to save, indcmaify and kecp harmless ihe City of Cuperti�ro ag,ainst
E " � liabilida, judgmcnLS, cas�s and ezpenses which may in any way accruc againu said �ry /
U z in consequence oC �he granting of Ihis permiL Date �'� �+ '� ��
� APPLI UNDERSTANDS AND WILL COM P L Y W[ T H A L L N O N- P O I N f I s s u e d by: ��
S REGULAT[O
�� e-roofs �Z�
nature aC ��s�vco� T e of R �of
HAZARDOUS MA7ERIALS DISCLOSURE }�P
Will thc applicant or futurc building occupant storc or handlc ha•rardous material
:fined by the Cupertino Municipal Codc. Chap�cr 9.12. and thc Hcahh and Sa(Uy
..�c, Scction 25532(a)? All roofs :;hall be inspected prior to any roofing material being installed.
� y� �No ,
Will the applicant or future building occupant use equipment or devices wrhich
If a roof i:; installed without first obtaining an inspection, I agree to remove
cmit harardous air contaminants az defincd by �hc Bay Area Air Quality Maoagcmcm all new m aterials for inspecrion.
Disuict? w
❑ Ycs /� �'h�_
1 havc reaJ the ha�arGous materials requiremen�s undcr Chap�cr 6.95 of �tie Gli(w- /
nia Hcalth & Salcry Codc. Scctiau 25505.25533 and 25534.1 undcrstvid that iC�Ae bu�ldng G
docs �o� curtcnUy havc a tcnan4 �h it is my rcsponsibility to nodfy thc oaupant d �he
rcyui which must bc a�u�� or a c�Nr�� ora . nature� f Applicant Date
�� All roof coverings to be Class "B" or better
O cr or authorized agcnt
CITY OF CUPERTINO
2 ITEMS OF 2 PERMI�' RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: B11:: Lot:
APN ......... 37!i10030.00
DATE ISSUED.......: 10,'26/2007
RECEIPT #.........: BS�)00003094
REFERENCE ID # ...: 07:_00189
SITE ADDRESS .....: 10�E08 BRET AVE
SUBDIVISION .......
CITY .............. CU]?ERTINO
IMPACT AREA .......
OWNER ............: OR]�N & MARIANNE SHELLEY
ADDRESS ..........: 10�E08 BRET AVE
CITY/STATE/ZIP ...: CU:?ERTINO, CA 95014
RECEIVED FROM ....: SHi�DOWFAX ROOFING
CONTR.ACTOR .......: JE]ZRY SHAFFER LIC # 27342
COMPANY ..........: SI��,DOWFAX i�00FING
ADDRESS ... .......: 13�i6 SANTA FE DR
CITY/STATE/ZIP ...: SA]1 JOSE, CA 95118
TELEPHONE ........: (4�)8)265
FEE ID UNIT QUANTITY ;�MOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 18,000.00 255.96 0.00 255.96 0.00
BSEISMICRE VALUATION 18,000.00 1.80 0.00 1.80 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT : 257.76 0.00 257.76 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 257.76 #6373
---------------
TOTAL RECEIPT : 257.76
Community Development
10300 Torre Avenue
'' � Cupertino CA 95014
Telephone (408) 777-3228
GTY Of Fax (408) 777-3333
CUPEt�TINO
Buildin De artment
JOB ADDRESS: PERMIT #
�l a `�(d D l � �
OWNER'S NAME: ,�� S PHONE # ��- �S3 -- �,S'
GENERAL CONTRACTOR: FAX # - _ �-
I am not using any subcontractors:
Si;;na e Date
Please check a licable subcontractors and com �lete the followin information:
SUBCONTRACTOR BUSIrTESS NAME BUSINESS 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
lumbing •
Roofing � .-�
Septic Tank
Sheet Metal
Sheet Rock
,
Tile
— �l� �
er/Con ctor Signature ate
�� � VC�� ��
CITY OF I�UPERTINO
��t`' RE��OOF
CUPE�Tf�VCI PERMIT APPL,ICATION FORM
APN #� 5 �� O �� o Date: �� 2` O
Building Address:
l � ��
Owner's Name: Phone #:
� � �1 l. �� -��3-��s
Contractor. � License #:
� 2
Contac Cupertino Business License #:
Type of Roof 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 2_ ❑ 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: �
� " - �� �
Residential ommerci ❑
Fire Zone: Yes ❑ No [�/ Confirmed with Planning De�t. if
there are any restrictions: U
Cos f Project: Type of C Occupanc ro
v � �
Qry. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE 131dg Permit Fees BUILDING
BENERGY Energy BLTILDING
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 l�epartment
Subject: Re-roofing policy for the (�ity of Cupertino
1. Prior to permit issuance, you must agrE e 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 apprcval.
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:rst 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 irspection and the job is not ready,
you will be charged a re-inspection fee ��f $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 t1e job site at the time on inspection.
I understand and will comply wi#h the above stated policy on re-roofing.
Homeowner's Name: G��✓ �f�LG�S'
�
Job Site Address: �j�� � ��-�- /��-"(
Roofing Company Name: —
� /
Applicant's Signature: ��� Date: ,` 0�
Greg Casteel
Building Official
Revisec 11/2/04