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CITY OF CUPERTINO
PERMIT
� TIi CT � iMA�TI�3�Y:
BI!KLDING DIVISION
BUILDING ADDRESS:
19765 STEVENS CREEK BLVD
CASTO ROOFING
PERMIT NO.
07110003
NER'S NAME:
PERMIT ISSUE DATE
YAMAOKA ASSOC INC
1938 OLD MIDDLEFIELD WAS
11/01/2007
PHONE:
SANITARY NO. CONTROL NO.
650 96 L-8922
()
ARCHI7'ECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions ode, and my license is
RE —ROOF , RMV EXTNG ROOF & RE PLC W BUILT—UP
in full force and eftec�l v�C -1-0y
LicenscCh J Lic.B
CAPSHEET, CLASS A,165 SQ
Damcontracto
ARCHrrEcm DECLA
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to concoct. alter, improve, demolish, or repair any structure
Sq. Ft. Floor Area
Valuation
prior to its issuance, also requires the applicant for such permit to file a signed statement
License Law 9
that he is licensed pursuant to the provisions of the Contractor's (Chapter
$47000
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
316 2 0 0 8 3 Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (5500).
.
❑ I, as owner of the property, or my employees with wages as their sole compensation,
Required fired Ins ectlons
q P
will do the work and the structure is not intended or offered for sale (Sec. 7044, Business
and Professions Code: The Contractor's License Law docs not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon, and.
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
1 am exempt under Sec. B & P C for this reason
_ wocr Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Workeees compensation Insurance carrier and Policy number arc:
•
Carrier.. f +'` tC-', wc± Policy No.: ZC7 — 2C1.j7
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for ane hundred dollars ($100)
or less.)
I certifv that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed revoked.
)
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lender's Name -
i cndees Address
1 certify that I have read this application and stale that the above information is
correct. I agree to comply with all city and county ordinances and state laws relating to
building construction. and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes
(We) agree to save, indemnify and kap harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accrue against said City
in the of this
Z�
consequence of granting permit.
APPLICANT UNDERSTA AND WILL COMPLY WITH ALL NON -POINT
Issued by Date `
.
SOURCE EGU 1*00 /
Re -roofs
+70�_ OfAoica&Coniractor Date
HAZARDOUS MATERIALS DISCLOSURE
Type Of Roof
Wil the applicant or future building occupant store or handle hazardous material
lefined by am Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
.,de, Section 25532(a)?
No
All roofs ;hall be inspected prior to any roofing material being installed.
❑Yes
If a roof i; installed without first obtaining an inspection, I agree to remove
Will the applicant or lure building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management
all new materials for inspection.
District? 1
❑ Yes 7�No
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505.25533 and 25534.1 undersand that if the building
does not currently have a tenant it is my responsibility to notify the occupant of the
requircmcn which must be w issuance a Certificate ar Pan
Signature of Applicant Date
All roof coverings to be Class "B" or better
O r auth d agent Date
(DI (k oc)03
CITY OF CUPERTINO
REROOF
C Ty of
CUPET�iNO PERMIT APPLICATION FORM
APN #( o 0&
,
BUILDING
Date: i
Building Address:
ICO LO's
eve s r
-B Ivc
Owner's Name:
BUILDING
BSEISMICOM
Phone #:
9 (., (' Q7 2,2
Q,a)ac,
5 f ,
Plan Check Fee
BUILDING
Contractor:A
Business License
BUILDING
License #:
Z a-7-
.. C
Contact: -
lends �
CA��
Cupertino Business License #:
�I
Type of Roof Covering:
Existing:
Pro os
Built
Bullt_Up Roof
-Up roof
❑ Asphalt Shingles
❑ Asphalt Shingles
❑ Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
73701"
Number of existing coverings
ElProvide I.C.B.O. Report #P
Provide Mfgr. Installation Specs.
❑ To be Removed
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
4 1
LZ, �Pn L�
Y em��,� 5
t✓o
-
Residential ❑
Mmmercial
C,
Fire Zone: Yes ❑ No
Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project;
Type of Constrruucti n:
Occupancy group:
Qty. if
A""];, Q A
FPP In
Fee Description
Fee Group
BPERMFEE
Bldg Permit Fees
BUILDING
BENERGY
Energy
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING
H «t--
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
Fax: (408) 777-3333
Building )Department
Subject: Re -roofing policy for the City 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 applie I without first obtaining all inspection
and written approval from the buildin,; inspector. A final inspection and
approval shall be obtained from the building inspector when the re -roofing
is completed.
3. All roofs shall be inspected prior to an,r roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre -inspection and/or tear off approval.
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 first obtaining an inspection,
will require the removal of all new mai erial down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail i ispection 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 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 the job site at the time on inspection.
I understand and will comply with the above stated policy on re -roofing.
Homeowner's Name: y a rn c .L {LCL h <5- S c; C .
Job Site Address: 19 s u s- S t e w (' v� ( rC e- r:IL D � v O
Roofing Company Name: CLS r 1 n L'
Applicant's SignatuDate:
Greg Casteel
Building Official
Revisf d 11/2/04
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT' RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: B1}:: Lot:
APN ......... 31620083.04
DATE ISSUED.......: 11,'01/2007
RECEIPT #.........: BS000003136
REFERENCE ID # ...: 07:_10003
SITE ADDRESS .....: 19"65 STEVENS CREEK BLVD
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA ......
OWNER YAI'IAOKA ASSOC INC
ADDRESS ..........
CITY/STATE/ZIP ...: ,
RECEIVED FROM ....: LI14DSEY CASTO
CONTRACTOR .......: CASTO, LINDSEY LIC # 21324
COMPANY CASTO ROOFING
ADDRESS 19:38 OLD MIDDLEFIELD WAY
CITY/STATE/ZIP ...: MOUNTAIN VIEW, CA 94043
TELEPHONE ........: (6'-)0)961-8922
FEE ID UNIT
QUANTITY
AMOUNT
PD -TO -DT
THIS REC NEW
----------
BAL
-----------------------
BPERMFEE VALUATION
----------
47,000.00
--------------------
514.08
----------
0.00
514.08
0.00
BSEISMICOM VALUATION
47,000.00
9.87
0.00
----------
9.87
----------
0.00
TOTAL PERMIT
---------- ----------
523.95
0.00
523.95
0.00
METHOD OF PAYMENT
AMOUNT
REFERENCE NUMBER
CREDIT CARD
523.95
MC
---------------
TOTAL RECEIPT
523.95
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
;K"A,
CITY OF
CUPEi�TiNO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
PERMIT #
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR: ' 4- Kc,
FAX #
I am not using any subcontract'
/O 7
Si ,nature Date
Please check ar)Dlicable subcontractors and com»lete the following information:
er ontractor Signature
//1 11 07
Date
SUBCONTRACTOR
BUSINESS NAME
BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
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
er ontractor Signature
//1 11 07
Date