07110151 CITY QF CUPERTINO �
BUILDING DIVISION PERMIT ����������������� '
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BUILDING ADDRESS: PERMIT NO.
910 FERNGROVE DR COSMOS �OOFII�IG 07110151 .
PERMTf ISSUE DATE
%NER'S NAME:
GERNER RICHARD E AND SHIRLEY 1901 OL� MIDDLEFIELD WAY 11/27/2007
PHONE: � 7 7 SAMTARY NO. CONTROL NO.
(650)96a-7663
BU(LDING PERMI'C INFO
ARCHITECT/ENGINEER:
BLDG ELECI' PLUMB MECH
� � � 0
y O p LICENSED CONTRACTOR'S DECLARATION JOb DCSCT1pU0I1
;� � I Mecby affrtn that I am licenscd urufer provisions of Chaptcr 9(commencin;
v Z � wiW Secdon 70(xl) of Division 3 of ihc Buvness and Protcssions Code. and my license is T/ � EX I S T I NG T&�'i , RE P L C E W 4 P LY T& Ci
°? y in fu0 force and effect ".�3G 7� — C� !�./
,v� Z Licensc Clua u L�. �
'n t- � Daic -- Controctor
� ARCHiTECI'S DECLARATION
�� l undcruand my plans shall be uscd u pubiic cccordc
�qU
� a y Liccnsed Rufcstional
y � OWNER-BUILDER DECIARATION
1 hcrcby alTirm that 1 am excmpt frum Ihe Conuactors Licenm Law for ttic
� p O [ollowing �cason. (Secdon 7031.5, Busineu and Professiona Cafe: Any city or wunty
R,°, � which rcquiccs a pcm�it to conswct, al�er, impmvc. dcmolish, ar �cpair any strucwrc
y z y prior w ia issuancc, alw icquims the applicant for such permit �o filc a signcd su�emcnt
_< tha� hc is licenscd pursuant �o thc provisions o( ihc Conuactur s Liccnsc taw (Chaptcr 9 Sq. Ft. Floor Area $ 8 8 g O Valuation
y F- �(commenang wi�h Section 7000) of Division 3 of ihe Business and Professions Code) or
y �.. that Ae is exempt tlu�aefrom and the basis for �e a►�cgcd eumpdon. Any violanon of
Secuon 7031.5 by s�ry applicant tor a pem�it subjecu �he applicant w a civil penalry of 3 7 5 3 8 0 3 0�(� Number Oeeupaney Type
not mote ehan five hundred dollars (SS00�
❑ I, u owner o[ Uie propatY• ar my cmployces witA wages u thc'v solc compensaUon,
will do �he work �nd ihe suuctuee is not imeedod or ollered for sak (Sa. 7044. Husinesa Re uired In s ections
and Rofeseiona Code: 71�e Conuactor's Lia.nse Law doet not apply m an ownu of 9 p
pmperty who builda or improvrs thereon, and who does such wort himself or Uuongh hia
own employca. pmvided that such improvementa are not in�ended w oliered (or sala I[.
howeva, the building or improvement is sold within one yeer oC compteuon, d�e owner-
builder wiR have the burdu� of pcoving ihat he did not huild or improvc for purpaee of
saleJ.
❑ I, u awmr oC the propeny, tm uclusively conuacting wi�h licenaed cronuactors to
consuuct the project (Sec. 7044. Business and Profeuions Cade:)'Ihe Coauxtnr's Li-
cense Iaw docs not apply to an owner of propeny wha huilds or improves Iheeeon, and ,
wMo rnnuac�s for sucfi projects with a conuactor(s) licensed pursusnt to ihe Convactors
License Law.
� 1 am exemp� undu Sec. , B R P C for this rca.wn
.+ner Date
WORKER'S COMPENSAT(ON DECLARATION
1 hercby aQ'irm under penalty o[ pe�jury ono of the fallowing dalarations:
❑ i hsve and will mainuin a Ceni[icam of Consent w ulf-insae fw Workcrs Compcn-
sation, ss providcd for by Section 3700 of �he Labor Code. for ihe performancc oC thc
wark for which this permit is issucd.
I have and will maintain Worlcer's Compensation Insuronce, as �equired by Section .
37 of thc Labor Codc, for thc pedormmce of �e worr for which �his permit is issued.
My Workers Com nsa�ion lnsurance carricr and Policy number aze:
Grtiu: ���� Poliry No.: �� � �/�''�
CER7'IFICATE OF EXEMPfION FROM W ORKERS'
COMPENSA710N INSURANCE '
(ILis section necd not be comple�ed if the permit is for onc hundred dollus (S I00)
or Icss)
I cenify Wat in tdc perfo�nancc of ihe work fw which �his permit is issuc4 ( shall not
employ any person in any manncr so a4 �o bccomc wbject to the Worlccn' Compensation
Laws of Cali(omia Datc
Applicant
N017CE TO APPL.►CAM: If, allcr making �his Ccrtifica�c of ExcmpGon, you shoulJ
become subjcct to the Worker's Compcnsation provisions of �hc Labor Codc, you muu
, O fortMwiW comply wi�h sueh provisions or this permit shall6c dcemcd mrokcd.
� '"'' CONSfRUCTION LENDING AGENCY
[.~.� . t hem6y �rm �lut il�cro is a consuucUon Iending agency (or ihe performar�ce u( .
p�., � thc work (or which this permit is issued (Scc. 3091, Civ. CJ
W Q Lendcts Namc '
� z C.cnde�s Address
V 0 I certiCY ihat 1 have read �his applicuion and suic ihu thc a6ove infarmatiun is
w�" cortcn. I agree w comply wi�h alt eity and county oniinances and sute Iaws relating to
� U building consuuction, and hereby authori�t reprcsentaGvcs of U�is city w cntcr upon Ihc
W aAove-menGoned pmpcny for inspeciion purpuses
a (Wc) agrce to save, indcmnify and kecp harmless the Ciry of Cupertino against
�, � liabilitiu, judgmcnts, cosLS and expenscs which may in any way ucn�c against said Cily ^�
V Z in consequence oCthc gnnting of this permi� Date � i n / E�
�+ APPLIC UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: --�-
SOUR ULATlONS.
���a�'`'� Re-roofs
Signaturo of Applicant/Contracwr �e� T of F .00f
HAZARDOUS MATERIALS DI LOSURE YPe
�11 �e applicant or fuwrc building occupant storc or handlc hvardous ma�crial
kfined by the Cupenina Municipal Code. Chaptcr 9.12, and the Healih and Safcty
,�. Sectjon 25532(a)? +�� All roofs shall be inspected prior to any roofing material being installed.
❑ Ycs �.DIo
( If a roof : s installed without first obtaining an inspection, I agree to remove
Will ihc applicant or futurc building occupant usc equipmcn� or dcviccs which
emit ha•r.udaus air contaminants at defincd Ay �he Bay Area Air Quslity Managcmcm all new n iaterials for inspection.
as����
❑ Yes �u
1 havic ecacl ihe hvardous maicrials requimmenu undcr Chap�cr 6.95 of Itic Califor- ��✓ ^1� ��
nia Hcalih & Safcry Codc. Scctions 25505, 25533 anJ 25534. t wdcrstand Uiu iCihc building O� �
does not currcn�ly havc a tcnsnt, �hat it is my responsibility w rwdCy the occupant nf ihe
rcyui cn hich must be met priar �u�� ora c«ur�� oro��P�ry. Signature of Applicant Date
� �`� '� All roof coverings to be Class "B" or better
Owner or author'v.cd gc a�
� CITY OF ��UPERTINO
RE=l�OOF
CUPEI�TINO PERMIT APPLICATION
a 0/.� /
APN # Date:
� - � � //- � 7- � �
Building Address: �
� CO ��-�t � r� ✓ � � � .
Owner's Name: Phone #:
� (�ic�� �E'�'^�� �t7�� zs
Contractor: Phone #: ( � " �G ��--76 6 3'
�5 �C-s ����-� �t
S Fax #: 6sZ� — �H�— �F'v s _
Cupertino Business License #: Contractor License #:
78 s' �r� �
Type of R.00f Covering:
Existing: Proposed:
� Built-Up Roof � Built-Up roof
Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles o Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report #
�To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: ,—�-^„� �_ ��� � �
�(� o ������ „ � �Q �, �'� �� �� �-
Residential Commercial ❑
Fire Zone: ` Yes ❑ No ❑ Confirmed with Planning Dept. if
' there are any restrictions: L�
Valuation: � o � �
c�
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
� —�
Signature
Community Development Departrnent
. Building Division
City of Cupertino
10300 Tone Avenue
Telephone: (408) 777-3228
Fax: (408)777-3333
Building �Department
Subject: Re-roofing policy for the ��ity of Cupertino
1. Prior to permit issuance, you must agr��e to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the buildin � inspector. A final inspection and
approval shall be obtained from the biilding inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to an:;� roofing installation.
4. To receive a final sign off from the Cit;�, the following steps are
required:
1) Pre-inspection and/or tear off appr�val.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed, a plywood nai] inspection is required.
6. Any roofing which is applied without Eirst obtaining an inspection,
will require the removal of all new material down ta the sheathing,
so a proper City inspection can be peri ormed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection feE of $176.18. The re-inspection fee must
be �aid before another inspection cari 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 the job site at the time on inspection.
I understand and will comply with the abov � stated policy on re-roofing.
Homeowner's Name: � � U �` � � � � E' f
Job Site Address: !( ��� �I ��i1 � �' �
Roofing Company Name: C�S ►"" �����°" 5
(� e �l rr' 7 U�
Applicant's Signature: �-�L C _ Date:
Greg Casteel
Building Official
Revi.ed 11/2/04
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 37538030.00
DATE ISSUED.......: 11/27/2007
RECEIPT #.......... BSC00003340
REFERENCE ID # ...: 07110151
SITE ADDRESS .....: 91C FERNGROVE DR
SUBDIVISION .......
CITY .............. CUF'ERTINO
IMPACT AREA .......
OWNER ............: GEF'NER RICHARD E AND SHIRLEY
ADDRESS ..........: 91C� FERNGROVE DR
CITY/STATE/ZIP ...: CUF'ERTINO, CA 95014
RECEIVED FROM ....: EDVIARD GREGORY
CONTRACTOR .......: CO:�MOS, RICHARD LIC # 18844
COMPANY ..........: CO:>MOS ROOFING
ADDRESS ..........: 19(11 OLD MIDDLEFIELD WAY #22
CITY/STATE/ZIP ...: MOiTNTAIN VIEW, CA 94043
TELEPHONE ........: (6`i0)969
FEE ID UNIT QUANTITY ��MOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ----------- ---------- ----
1REROOFRES SQ FEET 24.00 312.00 0.00 312.00 0.00
BSEISMICRE VALUATION 8,880.00 0.90 0.00 0.90 0.00
-�--------- ---------- ---------- ----------
TOTAL PERMIT : 312.90 0.00 312.90 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 312.90 MC
---------------
TOTAL RECEIPT : 312.90
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ---------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
605 FINAL REROOF
i
nov 26 07 04:46p Cos�os Roofin� [650}969-9905 p.2
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