07100023 CITY OF CUPERTINO °
BUiLD;rVG DN15.!JN PERMIT ���� ���� ������
; _ . .....: _ ; .:
-"" PERMfT PtO.
BUI[,DING ADDRESS:
10341 CHERRYTREE LA R J BEA]J ROOFING 07100023 •
PERMIT ISSUE DATE
OWNER'S NAME: ,
RICHEY FREDERIC L AND CHERYL 6355 CO'['TLE RD
SAMTARY NO. CONTROL NO.
JNS:
(408)353-4028
BUILDING PERMITINFO
ARCHITECT1ENGiNEER: BLDG ELECT PLUMB MECH
0 0 0 0
i p � LICENSED CONTRACTOR'S DECLARATION JOtJ DeSCilpt1011
: V C t hcrcby aCfirm that I am licenscd umlcr provisions of Chaptcr 9(commcncing
,Z� withScction7000)ofDivision3ofihcBusinessandPraCcssionsCadc REMOVE �XISTING SHINGLES A1VD REPLACE WITH ASPHALT
�� y in full Corce and e�� � Q Z �
��z C,icenscCi ���x. SHINGLE3
: F �p Datc - Con�racwr
�� ARCHITEC['S DECLARATION
i a a 1 undcrswnJ my plans shall bc useJ as public rccords
)yV
' a y Liccnscd Pm(cssional
: � < OWNER-BUILDER DECLARATION
°} J I hcrchy alTirm ihal 1 am cxcmpt Cram thc Contractor's Liccnsc Law far thc
� p o Collowing rcason. (Sccuon 7031.5, Busincss and ProCcssions Codc: My city or county
�°„ �i which rcquires a permit ta cnnswc4 altcr, improve, dcmolish, or repair any structu�c
° z} prior ui i�s issuancc, also rcquims thc applicant for such permit io filc a signcJ sutcmcn� , Ft. FlOOi AI'eS Valuation
< tha� hc is liccnscd pursuant to lhc provisions oC ihc Convactar's Liccnsc Law (Chaptcr 9 `>q �, O O O
Y F� (commencing with Scction 7000) of Division 3 oC �hc Busincss and Profcssinns Codc) or
,�, �� that he is exempt thcrcfrom and the basis for �he ailegcd exemQUon. Any violation a(
Section 7031.5 by arry applicant for a pecmit subjects �he applicant to a civil penalty ot Number Oeeupaney Type
n o[ m o r e t h a n f i v e h u n d r e d d o l l ar s ( SSUO). 3 1. 6 3 3 � 5 5��
❑[, u owner o[ tl�e propercy, or my cmployces with wages as their so(c compensadon,
wil] do Ihc work, and ihe stcucture is notintended or ollered for salc (Sec.7044 s�ness Required Inspections
and Professions Cadc: The Conuacror's License Law docs not apply to an owner of
property who builds a improves ttiueon, and who daes such work himsel[ ar �heough Ais
own emplayccs. providcd that such improvements aze not intendeA or otlered Cor sale. l[.
however, ihe building or improvement is sold within one year of complction, the owner-
builder will have the burden of proving ehat he did not build or improvc [or pucpose af
salc.).
❑ I, as owner o( ihe property, am ezc►usively conlracting with licensed contractors to
construct the penject (Sec. 7044. Business and Pro(essians Cade:) The Convactor's Li-
ccnse Law docs notapply a an ownerofpropeny who buildsarimprovestheteon,and,
who convacts Cor such projecis with a conuactar(s) licensed pursuant W the Contracwr's
License I.aw.
❑ I am uempt under Sec. . B& P C tar this reason
Owner Date _ .. _:
WORKER'S COMPENSATION DECLARAT[ON
1 hercby aflirm under penalty o( perjury one o( the following deciarations:
�vc and will maintain a Ceni6ptc of Conscnt to self-insure [or Workc�s Compen-
sation, u providcd for by Secdon 3700 oC [he Labor Code, for the performancc of ihe
work (or which ihis pertnit is issued.
0 I havc and will maintain Worker's Compensation Insurance, u required by Scction ,
3700 oC thc Labor Codc. Cw thc pcdormancc ot �he work (or which this permit is issued.
My Worker's �C Q ation� y [ ,, n�sur�a . nce I ,carricr and Policy number are:
Cartier. .� ' � , v' `� Policy No.: �
CERTIF7CATE OF EXEMPfION FRO W RKERS'
COMPENSATION INSURANCE
(7'his section necd not bc complcted if the permit is !or anc hundred datlars (S 100)
or IcssJ
I cenify that in thc performancc of thc work for which ihis permi� is issucd, l shall not
nmploy any person in any man cr so �q ubject io thc Workcrs' Compcnsatian
Laws of Cali(omia,.pa
Applicant rir •
NO'i'ICE TO APP CA : If, aftct making ihis Ccnificatc of Encmption, you should
bccome subjcct to thc Workcr's Compcnsation provisions of �hc Labor Codc, you must
� O forthwith comply with such provisions or this pccmi� sha0 bc dccmcd ccvoked.
Z '"' CONSTRUCf10N LENDWG AGENCY
� r�-� 1 hereby a�rm ihat there is a conswction (ending agency Cor the perfortnancc uf .
.(�. � ihc work fur which this permit is issucd (Scc. 3097. Civ. C.) ,
W Q Lendcr's Namc
� � C,ender's Address
U � ( cercifY tha� 1 have read Wis application and statc ihu ihc a6ovc inCortnatiun is
w �"'� cortec� I agree to comply with aIt city and county oniinances and suk laws rclaiing to
Q U building conswction, and hcrcby authorive rcprescmativcs of this ci�y to cntcr �pon thc
� W above-mcntioncd property (or inspecuon purposes.
a (Wc) agrce to save, indcmmi(y and kccp harmlcss lhc City of Cupertino against
�„F', � liabiliuu, judgmcn�s, cos�s and ezpenses which may in any way accruc against said City
U z in consequcnce aC thc granting af U�is permit. Date /� e-?
� APPLICANT UNDERSTANDS AND WILL COMPI.Y WI'fH ALL NON-POINT Issued by
SOUR� F,G(JLA NFiQ S. 2 � �-!��
`�-- (�.e.l��. �c� 7 Re-roofs `
Signawre of plicanUComractor � T e of R oof
HAZARDOUS MATERIALS DISCI.OSURE YP
Wilt thc applicant or futurc building occupant storc or handlc harardous matcrial '
az dcfined by the Cupertino Municipal Codc. Chaptcr 9.12. and the HeatW and SaCcty
co�� Scction 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
p Ycs .�H'� ,
� If a roof is installed without first ob[aining an inspection, I agree to remove
WiII thc applicant or futurc building occupan� usc cyuipmcnt or dcvices which
� cmi� haiardous air contaminan�s u cicfincd Ay thc Bay Arca Air Quality Managcmcn� all new rr aterials for inspection.
Disuict?
❑ Ycs �.M�
1 havc �cad the ha�arGous maicrials requiremcn�s undcr Chap�cr 6.95 o(�hc CaliCor- .,r
niaHcalih&SafctyCodc,Scctions25505.2S533and25534.1urn1crswndihaziCihcbuilding • + "
docs �o� curtcntly havc a tcnan4 �a� il'u my responsibility lo notiCy thc occupant nf �hc -
requi en�s whic ust be met prior w issuance o( a Ccnifica�e o(occu�ancy. 7 Signature of Applicant Date
L��
All roof coverings to be Class "B" or better
Own r or thori•r.cd agcnt ���
CITY OF (�UPERTINO
' �;" RE�ZOtJF
CUp T1N0 PERMIT APPL�ICATION FORM d�`���a3
R.
APN # Datei� � �/�^
3/6 - 33 - 055 � �
Buildin Address: � �� f �
�
Owner's��me: Pho e #:
��n.�e, � 6S �
Contract • --, ; Licen e
S � ��3�3��
Contact: 1 Cupertino Business Licen #:
� vl
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof O Built-Up roof
.B�Asphalt Shingles ��Asphalt Shingles —�
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Nuinber of existing coverings ❑ Provide I.C.B.O. Report #
�To be Re�noved ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Com ly With Cupertino's Tear Off Policy: ❑
Job Description: � � L `�
`�.� ��. C �L � � .�� I !✓J `JI� I , J ���
Residential.0' Co ercial ❑ �"'/ .Sff�-
Fire Zone: Yes ❑ No Conf'irmed with Planning D�t. if
there are any restrictions: L�
Cost of Project: Type of Constru:tion: Occupancy groul:
� ��
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BIJILDING
BENERGY Energy BUILDING
� BSEISMICRE 5eismic 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 I�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 appliecl without first obtaining all inspection
and written approval from the building 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 uispection 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.
IMPORTAN'T
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 1he 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: ,� ���1 � ` 11�i
Roofing Company Name:
Applicant's Signature: Date: ��?"L'�
Greg Casteel '
Building Official
RevisEd 11/2/04
Y Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
Fax: (408) 777-3333
Building l�epartment
REROOF TEA R O�F POLICY
1. You must schedule an inspectic�n for the tear off the da,y before
you wish the inspection to be nlade. The procedure is to call the
Building Division (408) 777-32�:8 bet�ween the hours of 7:30 a.m. and
3:30 p.m. to request a next-day inspection.
2. When the roof is torn off, the n�ils have been removed or driven in,
and all of the dry-rotted wood has been replaced, you must call the
City Building Division. An ins pector will be there within one hour.
There are special hours for this service: from 7:30 a.m. to 10:30 a.m.
and 1:OOp.m. to 3:30 p.m., Mon day through Thursday and from
7:30 a.m. to 10:30 a.m. and 1:00 p.m. to 2:30 p.m. on Friday. (Note:
Building inspectors are on lunch break from 11:30 a.m. to 12:30 p.m.
and will not be called during tr�at time. City Hall is closed be�ween
� 12:00 and 1:00 p.m. daily.)
3. If you call for a tear-off inspeciion and the job is not ready, you will
be charged a re-inspection fee c►f $176.18. The re-inspection fee must
be paid before another inspec�:ion can be scheduled.
Greg Casteel
Building Official
Revisec� 8/13/04
CITY OF CUPERTINO
2 ITEMS OF 2 PERMI7' RECEIPT OPERATOR: bethe
COPY # : 1
Sec : Twp : Rng : Sub : B1}�:: Lot :
APN ........: 31E33055.00
DATE ISSUED.......: 10�02/2007
RECEIPT #•••.•••••� BSC�00002864
REFERENCE ID # ...: 077.00023
SITE ADDRESS .....: 10=41 CHERRYTREE LA
SUBDIVISION .......
CITY .............. CUF'ERTINO
IMPACT AREA .......
OWNER ............: RIC:HEY FREDERIC L AND CHERYL A
ADDRESS ...........
CITY/STATE/ZIP ...: CUF'ERTINO CA, 95014-2073
RECEIVED FROM ....: RJ BEAN ROOFING
CONTRACTOR .......: BE��N, ROBERT JAMES LIC # 20511
COMPANY ..........: R �� BEAN ROOFING
ADDRESS ..........: 63��5 COTTLE RD
CITY/STATE/ZIP ...: SAPI JOSE, CA 95123
TELEPHONE ........: (4(i8)358-4028
FEE ID UNIT QUANTITY ��MOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 7,000.00 137.16 0.00 137.16 0.00
BSEISMICRE VALUATION 7,000.00 0.70 0.00 0.70 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT : 137.86 0.00 137.86 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 137.86 565
---------------
TOTAL RECEIPT : 137.86
Community Development
- 10300 Torre Avenue
� � Cupertino CA 95014
Telephone (408) 777-3228
CITY OF Fax (408) 777-3333
�UPEt�TINO
Buildin De artment
JOB ADDRESS: � ( , ^ � � � � PERMIT # �� 1 D ��
�vt�
O R'S NAME: C PHONE # - 6 0- j d c�
GENERAL CONTRACTOR � FAX #
I am not using any subcontractors: �2 _l,l�� _ / ���� �
Si;nature Date
Please check a licable subcontractors and com �lete the followin information:
SUBCONTRACTOR BUSIl`1ESS 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
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
lo '� �"7
Owner/C tractor Signature Date