06090228 CITY OF CUPERTINO > : ` '
BUILDING DIVISION PERMIT _ !C�I�RAC'r�� Z�����T�Q�i� ':
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BUILDING ADDRESS: L 1 TOS ROOF ING PERMIT NO.O F> O 9 O 2 Z H
�J598 NATHANSON AV •
. NER'S NAME: PERMTT LSSUE DATE
� BRIGGS JUDITH L 88 F� �ULSTICH CT � 09 25 2006
NE: SANITARY NO. CONTROL NO.
(408) :?98-9399
ARCHITECT/ENGINEER: BUILDING PERMIT 1NF0
BLDG ELECT PLUMB MECH
� 0 0 0
i O p LICENSED CONTRACTOR'S DECLARAT[ON
%� I hcrcby affirm Wat I am licensed unJct provisions of Chap�cr 9(commcncing Job Description
; z� W�� �tion 7IXIU) of Division 3 of ihc Business and Profcssions Codc, and my licensc is
>>y infuliforccandcffec �� ��, REROOI�- REMOVE EXISTING SHAKE� INSTALL OSB &
�,v� Z l,iccnsc CI s Lic. 8
;F ,'o �a�c co�uscwr S�A7z y� � ROOFE�ZS SELECT FELT . INSTALL LANDMARK TL SHINGL
�� ARCHITECTSDECLARATION CLASS A. 30 SQUARES
i a Q 1 undcrstanJ my plans shall bc uscd as public rernrds
)yU
j o y Liccnsed Pru(cssional
� y � OWNER-BUILDER DECLARATION
�< g I hcreby alTirm �hat 1 am cxemp� Crom ihc Contraztors Liccnsc Law fo� thc
p O following roason. (Scction 7031.5, Busincss and Prolcssians Calc: Any city or county
�,°, �i which rcquires a permit w cnnswct, al�cr, impmvc. dcmalish, or repair any swcturc
� Z} prior ui ils issua�c. also rcquires thc applican� for such permit to Glc a signcd sia�cmcnt
�_ � that hc is IicenscJ putsuant to thc pmvisions of thc Conlractur's Liccnse Law (Chapter 9 Sq. Ft. Floor Area Valuation
� �— (commencing wi�h Scction 7000) of Division 3 af thc Busincss and Profcssions Cadc) ur $ 8 3 Q'7
��� Ihat he is exempt thcmfrom and Ihe basu [or the allegcd exemption. Any violatlon of
Secdon 7031.5 by airy appiicant for a permit subjccts �he applicant to a civil penalty ot ppN Number Oeeupancy Type
noe more than five hundred dollars (5500).
❑ I, u owncr of ttie property, a my employces with wages az �heir solc compensation,
will do ihc work and ihe swcture is not intendcd or ofCered for saic (Sec. 7044. Husiness '
and Professions Code: The Conuactor's Liunte Law dacs not apply to an owner of Required Inspections
propeny who builds or improves �hereon, and who das such work himself or tlwugh his
own employces, providcd that such improvemtnLS are not inten�d or otfered Cor sale. l[,
however. �he building or improvement is sold within one year of complcGon, the owner-
builder will have the burden of proving that he did not build or improve for purpose af
sale.).
❑ I, as owner of the property, am eaclusively conuacting wilh licensed rnnvactors �o
wnstruct Uie pro�ct (Scc. 7044. Business and Protcssions Cade:) The Convacwr's Li-
cense Law does not apply to an owner of propeny who builds or improves ihemon, and , �� �
who conuacts Cor such projects with a conuaaar(s) licensed pursuant to ihe Convactofs 9 `"L /J
� icense Law. � Z���
1 am ezempt under Sec , B& P C for this rcaton � �
� �wner Date � /
WORKER'S COMPENSATION DECLARATION � ��
I hercby affirm under penalty o[ perjury onc o( the foilowing declarations:
❑ I hsve and will maimain a Certifcatc o[Consent to self-insure tor Worker's Compcn-
sation, as provided fw 6y Sectian 3700 of the Cabor Code, far �he performance of thc
work for which this permit is issued.
have and will maintain Worker's Compensation Insurance, u rcyuired by Section
3700 of ihe Iabar Code, Cw the performance of �he work far which �his permit is issued. '
My Worker's Compensation Insurance carticr and Policy number are:
Cartier. .5�� �l/✓Ill� Policy No.: Z�� ZZ�
CERTIF7CATE OF EXEMPTION FROM WORKEftS'
COMPENSATION INSURANCE .
(This scction necd not be complctcJ if the pe[mit is for onc hundred dollars (S I00)
or Icss) •
I cenify thxc in thc performancc of thc work for which U�is pertnit is issucd, 1 shall not
employ any person in any manncr so as to bccomc subject �o the Workcrs' Compcnsauon
Laws of Cali(omia Datc
Applicant
NOTICE TO APPLICANT: If, afur making �his Ccni�catc of Ezcmption, you should
become subject �o the Worker's Compensation provisions o( tAe Latwr Cade, you must
, O fonhwith comply with such pravisions or this permi� shall bc dccmcd mrokcd.
z '" CONS7RUCTION LENDING AGENCY
(-� � I herehy alTirm Ihat thcre is a conswcuon Iending agenty Cor thc performancc uf
fY, � thc work fur which Utis permi� is iuucd (Scc. 3097, Civ. C.) ,
W� Q L,cndcr's Namc .
� z Lcnder's Address
(� � 1 certify that t havc rcad this application and sia�c �ha� thc abovc intormatiun is
w �"' cortect. I agrce to comply wi[h all city and county ontinances and state laws relaiing to
� U building conswction, and hcreby authoriie rcprescn�a�ivcs of this ciry to cntcr u�n thc
� a ahovc-mcntiuncd propcny for inspcclion pur�wses.
(Wc) agrea to save, indcm�ify and kccp harmless �hc Cily of Cupcnino against
H � liabiliues, judgmcnts, cosLC and expcnscs which may in any way accruc againsl said City
V z in canxquencc aC thc granting of �his pertnit.
�"� APPLICANT UNDERS'fANDS AND WILL COMPLY WITH ALL NON-POIM Issued by: Date �i �C.. (� rjCs
SOURCE REGUL � :--� � �/ �
� � � 2 � °� Re-roofs ��
Signaturc of Appliant/Conuactor Datc
HAZARDOUS MATERIALS D(SCLOSURB TJr� Of T<.00f
Will Ihc applicant or futurc building occupant starc or handlc hmardous matcria!
dcfincd 6y the Cupenino Municipal Codc, Chap�cr 9.12, and �he Health and Safety
,.:a��. QY� zssssce�� �o All roofs shall be inspected prior to any roofing material being installed.
Will thc applicant or fulurc building occupant usc cyuipment or dcvices which If a roof i s installed without first obtaining an inspection, I agree to remove •
emi� harardous air contaminan�s az dcfincd hy the Bay Arca Air Quality Managcmcnt all new rr aterials for inspection.
Disirict?
❑ Ycs �}No
I havc read the ha�ardous matcrials rcyuircmcn�s undcr Chap�cr6.95 of thc Califor- �`7
nia Hcalih & Safcty Code, Sections 25505, 25533 and 25534. l undcrstand ihaz iC ihc building �` � �� 9_ Z S � G/�
docs no� currcn�y have a tcnan4 ihat i� ' my responsibili�y to noul'y Uic arupant of ihc � v
rcyuircmcn�swhich � ���� rac��;r�a�oro��,P�,�y. Signature ofApplicant Date
��� �/ � ZS"�4�
Owncr or au�horiicd agcnt o„� All roof coverings to be Class "B" or better
CITY OF c;UPERTINO
; m 2 of 2 PERMIT RECEIPT OPERATOR: amyw
COPY # : 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 326�63012.00
DATE ISSUED.......: 09/;?5/2006
RECEIPT #•........: 361<36
REFERENCE ID # ...: 060'a0228
SITE ADDRESS .....: 105'a8 NATHANSON AV
SUBDIVISION .......
CITY .............. CUP]�RTINO
IMPACT AREA .......
OWNER ............: BRIc�GS JUDITH L
ADDRESS .. .......
CITY/STATE/ZIP ...: ,
RECEIVED FROM ....: LOS GATOS ROOFING
CONTRACTOR .......: RAN])Y BROWN LIC # 23481
COMPANY ..........: LOS GATOS ROOFING
ADDRESS ..........: 888 FAULSTICH CT
CITY/STATE/ZIP ...: SAN JOSE, CA 95112
TELEPHONE ........: (4013)298-9399
FEE ID UNIT QUANTITY ATROUNT PD—TO—DT THIS REC NEW BAL
---------- ------------- ---------- --�-------- ---------- ---------- ----------
BPERMFEE VALUATION 9,000.00 158.76 0.00 158.76 0.00
BSEISMICRE VALUATION 9,000.00 0.90 0.00 0.90 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT : 159.66 0.00 159.66 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 286.62 18�)4
TOTAL RECEIPT : 286.62
Community Development Departrnent
- BuiIding Division
� � City of Cupertino
10300 Torre Avenue
C� �F� Telephone: (408) 777-3228
� U P E�T ��V O Fax: (408) 777-3333
Buildin� Departrnent
Subjec�: Ize-roofing policy for �JZe Ci�y of Cuper�i�o
1. Prior to permit issuance, you must agree to comply with 1997 UBC Star►dards
and manufacturers specifications cn re-roofing.
2. New roof coverings shall not be applied without first obtaining a;� ;ris�ectian
and written approval from the bui]ding�nspector. A final inspection artd
approval shall be obtained from th � building inspector when the re-roofing
is completed.
3. AIl roofs shall be inspected prior tc any roofing instaIlation.
4. To receive a final sib off from the ��ity, the follovving steps are
required:
1) Pre-inspection and/or tear off aj�proval.
2) In-progress inspection approval
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed, a plywood itail inspection is required.
6. Any roofing which is applied withc ut first obtaining an inspection,
will require the removal of aIl new :naterial down to the sheathing,
so a proper City inspection can be F erformed.
INIPORTFiN'T
1. Flat roofs must have a m;n;mum of 1 /4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.U. report is required to be ��n the job site at the time on inspection.
I understand and will comply with the ab��ve stated policy. on re-roofing.
F '�
� Homeowner's Name: �� ��' � - �
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. TZoo�'ing Company Name. .
G�%G��/ O
A plicant's Si� ature: Date:
Greg teel
Building Official
Revised 1/30/03
Printec on Recycled Paper
Community Development
�,�
I0300 Torre Avenue
� ` � � Cupertino CA 95014
,
Telephone (?08) 777-3228
CITYOF Fax (408) 777-3333
CUPE�TINO
�uildin De artment
JOB ADDRESS: / ,� , PERMIT #� A � rn �
/� S� � �� //l L J '� ���-,,-> > (/�.r! v,<_
OWNER'S NAME: ' � � ,��, PHONE # �J - �
GENERAL CONTRACTOR � �� � �, - ' FAX #
;
I am not using any subcontractors: r � "" �
, �ignatvre Date
Please check a licable subcontractors and coin lete the followin information:
- SUBCONTRACTOR BUS:_NESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
IIectr7.ca1
Excavation
Fencing
Flooring. Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathir�g
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
• __ _ _ _ - _ _
- - __ _ _ _ _ _ _ _ _
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Sib ature Date
_ ���� �� ����a�c�NO �(� � ���
_ �����
�u���T�t�o PERMI�' A�'PLICA'�ION FORM
�
APN # � Z � — � .. �'� � , _ Date:
�'y'�
Building Address: �. �/, � ' �
� L'� C7 �� J/`'.�,� -f- � � � _
Y .;7 L, �
Owner's Name: � ' Phone #:
,���' L, / ,y',.,� �' , �� ;�� �:� G- - /.�'�� � �
Contractor: - h��ne #: G" License #:
�, , � �'�0 JO
Contact: �- Phcrne #: ���� Cupertino Busin��i� nse #:
/
Ty��e of Roof Covering:
�xistang: Proposed:
❑ BuiIt-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles � Asphalt Shingles
'� Wood Shakes ❑ VJood Shakes
❑ VJood Shingles ❑ Wood Shingles „
Q Other (Specify) � Other (Specify) ��- C� S�
Number of existing coverinas 1 ❑ Provide I.C.B.O. Report #
y� To be Removed '� Provide Mfa . Installation 5pecs. S S d��
/
I Have Read, Understand and VJill Com ly With Cu ertina's Tear Off Policy:
3ob Descripti n: ��, �l > � �` L,�-E.. ��.,y� _, c i � � i ; �, � �.� ��= , � > � � ��� �� /� � •� �;-�� .� ��� �' ���'- -
. �� � , � . _ �> �. � L����� � ! , �- <� �� � = zv::�� �T L-- � ,�z Z �� , �
Residenti Commercial ❑ 3O � ��G'�'/ /�— .
Fire Zo�e: i'es ❑ Na Confir�ned v,�ith Planniag De,�t. if.
there are any restrictions: LJ
Cost�f Project: _ Type o Cc�nstnzcti : Occupancy � 1 f ,
��`� /' O� /C ��/
<
Qty. if
A licable Fee ID Fee Descri tion Fee Grou
BPERMFEE Bld Permit Fees BUILDING
BENERGY Enera BUII.DING
,_.v -_ _ .... ,.. .
-- ---- - ---- � ._ ,
BSEISMICRE_ __ ._-r __ __ --- -S�isnuc_Eee.R.es -_� __ _. _ _: : _- -- -- B-IJILDIl�TG - ___ --
_
B S�i� Seisnii� SL�DI3�i�
BPLANCHK Plan Check Fee BUII.DING
BUSLIC Business License BUILDING