99080211•
•
311 CG 27 d
4 clot O211
PERMrr
APPLICATION FOR CITY of CUPERTINO NUMBER
INSPECTION DIVISION PERMIT EXPIRATION
REROOF PERMIT (408) 777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN IN DAYS OF PERMIT ISSUANCE OR
IN DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS
_
RESIDENTIA COMMERCIAL OTHER
OWNER'S
HAZARDOUS FIRE AREA
3
0
YES ❑ It yes — I rode std d hat a Class A
NAME lyJ
I
rayl eseerndy b requiretl.
NO ❑ Initial I.C.B.O. B
,�
J
EXISTING ROOF COVERING
ADDRESS—a.IMt (i$ 1),&V& -
PHONE -
NUMBER OF EXISTING COVERINGS '
CONTRACTOR'S
G
TO BE REMOVED � TO BE RETAINED
NAME iy?4 )i1G
_b/7z&-.z [47t
ADDRESS
TYPE OF -ROOF COVERING
CrryazIP �cfvi LfnSF C7i_ ryS/23
EXISTING - ,
Q
PHONE
BUILT-UP ROOF ❑
NUMBER
ASPHALT SHINGLESkE]
LICENS RACTORS DECLARATION
'I hereby that em licensed under of Chapter B (commenting with Section
WOOD SHAKES
inion
]000) of Division 3 of the Business and Professions Cotle, end,my license is in full force and
usi ssunder Professions
eHB /
WOOD SHINGLES a
License Claes ` - Lk. Number
/
OTHER (SPECIFY)
Date /. f/! �y
w
' OWNER BUILDER CL
PROPOSED Ui
hereby irmBu that am exempt from the C: ore reason.
the Commu LicenseLew for ba fallayrequires
(Sec. Any
Business and Professions Code: Any city or county whioh requl
or coup a
, a permit b
cansb pair
construct, It Improve, or e, p or toliven Its lssusnce, alsorequiresprmi eme
so
BUILT-UP ROOF - ❑
tdemolish, a a
nt for suer,ch al stateny ment that licensed! pursuant to she praWs ma
applicant for such pennlf to file (Cheat statement that he
of the Contractor's Lew (Cheater with the
endng with
of DMebn 3 of theBuraine
70KMe
'
Code) or that he Is end the beets for the
antl Profeslcervaesions that h Is ex therefrom and a
ASPHALT SHINGLES �j—
eearmaee
y applicant to
violation antor
exemption. Any violationof Sect ion 7W1.5 by any epplkant bra Parrott subjects she epWcant to
applicant
_
e clvll penalty of not mora men live hundred doors
WOOD SHAKES
wner empbyeaevnmwages eatheir sae cnrtpessa ifill do
❑I,k, pre
❑
the work, end the abuaure nd Intended! or for sae (Sec. ]D44,
structure antl Probs-
and Is inor to and
a s not property
dons Cade: The Contractors License Lew does not apply to an owner of property who bullde or
WOOD SHINGLES ❑
Improves merman, and who does such work or through his own employees, s, PraN that
such I areedforf
not Intended th altered for sob. the ,,e
hi ti o improvement
within one year ill the en of i
hotbuwnhln oneyaarofurpose oft, the owner-builderwillhavemaburden of prwingthathedid
OTHER (SPECIFY) ❑
rot Wild or improve for purpose Of sale.).
p a, as owner a the property, am exclusively contracting with licensed cmtrecbre to construct
Me project (Sec. ]014, Business end Probssons Code: The Contractors Ucense law does net
PROVIDE I.C.B.O. REPORT NO.
apply to an owner of property who builds or Imradims thereon, and who contracts for such projects
with a contraaods) licensed pursuant to the Contractors Uceaae Law,
PROVIDE MFGR. INSTALLATION SPECS.
❑ 1 em exempt under Sec. a & P, C. kx this reason
Owner Data
APPLICATION DATE
VALUATION
PERMIT FEE
WORKER'S COMPENSATION DECIItRATION -
I hereby affirm crew penalty of perjury ane of the following declaration:
❑ 1 have and will maintain a Geneticists of Consent to "If4neure lar Workers Compermetlon,
L
Building
as provided Jor by Section 3]00 of fire Labor Code, far the performance of me work for which this
912-
per,m� is issued.
"a. end will malntaln Worker's Compensation Insurance, as required by Section 3]00 of
Seismic
W
the Labor Code, for the performance of the work for which this Remain is issued. My Workers
/
Compensation Ineurerrce carrier end FanJcy number are:
Total
Carder A n Poll, No.�Y
I
PERMIT AUTHORIZATION
DATE
CERTIFICATE OF FXFMPTION FROM WORK S'
/
l
'
COMPENSATION INSURANCE N.CQ
(This section need not he completed it the permit is for one hundred dollars ($100) or less.)
I certify that in the pmDrmartce of the work far which Into permit Is Issued, I shall not employ
All roofs shall be Inspected prior to any roofing material being
any person In any manner so as to become subject to the workers' Compensatlon Laws of Cali-
fornia.
installed. If a roof is installed without first obtaining an
Date Applicant
inspection, I agree to remove all new materials for inspection.
NOTICE TO APPLICANT: It, after making this Cenhlicate of Exemption, you should become
Applicant understands and will Comply with all non point
p y p
MN such pto rlwfalons or this permit e�pbe co ed m�L� r Code, you must fonhwim mmpry
Source regulations.
I certify that I have rsstl this approach. antl state that the above Information Is comea.I agree
to campy with ell day antl county ordinances and state laws relating to building construction, ane!
All roof coverings to beclas or better.
hereby authorize representatives of this city to enter upon the above-mantlaned property far In-
spection purposes.
(We) agree to an", indemnify and keep harmless the City of Cupanlnoagemet liabilities
ju,147 rs, costs end expenses which may In any way accrue against said Clty in caneequenca
- 61 E O A ANT DATE
of the gmnUrg of titin permit
PRE -INSPECTION:
PLYWOOD:
IN -PROGRESS:
INSP. DATE
INSP. DATE
INSP. DATE
TEAR OFF INSPECTION:
BATTENS:
FINAL:
INSP. DATE
INSP. DATE
INSP. DATE
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION
OFFICE COPY
•
CITY OF CUPERTINO - BUILDING DEPARTMENT
RE -ROOFING POLICY
;
I. Prior to permit issuance, you'must agree to comply with U.B.C. standards and
manufacturers specs on re-roofin;.
2. New roof coverings shall not be applied without first obtaining all inspections and written
approval from the building inspector. A final inspection and approval shall be obtained
from the building inspector when the re -roofing is completed.
3. All types of roofs.shatl be inspected prior to any roof being installed.
4. In order to receive a final, you must complete steps 1,2, and 3.
t. Pre -inspection or tear -off approval
2. In -progress inspection approval
3. Final inspection approval
a. Operable smoke detector verification
5. If plywood is installed, a plywood nail inspection is required.
6. If any roof is applied without first obtaining an inspection, you will be required to remove
all new material down to the sheating and a building inspector will inspect all sheating at
that time.
LVIPORTANT:
1. Flat roofs must have a %" per foot slope, or demonstrate that there is no ponding.
2. I.C.B.O. reports are required to be on the job site at the time of inspection. If you do not
have one, contact the building department.
WE UNDERSTAND THE ABOVE POLICY ON RE -ROOFING AND WILL COMPLY
WITH THE POLICY.
HOMEOWNER'S NAME:
ADDRESS:
RE-ROOFPIG COMPNAY NAM
APPLICANT'S SIGNATURE:
• CITY OF CUPERTINO
BUILDING DEPARTMENT
Re-roo0winword
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
•
FEE DESCRIPTION
_______________
BPERMFEE
BSEISMICRE
CITY OF CUPERTINO
BUILDING PERMIT INVOICE
Ser. Twp: Rng: Sub: Blk: Lot:31629089.00
INVOICE DATE......: 09/31/1999
REFERENCE ID # ...: 99080211
SITE ADDRESS .....: 19627 AMHERST DR
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: LIN FONG 1
ADDRESS ..........:
CITY/STATE/ZIP .... CA 95014
OPERATOR: christya
CONTRACTOR .......: MARTINEZ, JAVIER LIC 4 21207
COMPANY ..........: WINTER ROOFING INC
ADDRESS ..........: 151 WYANDOTTE DR
CITY/STATE/ZIP ...: SAN JOSE, CA 95123
TELEPHONE ........: 4083638052
CHK
P
_
P
VIDFRAME - D.. CRIPTION
601 ROOF TEAR OFF
603 ROOF BATTENS
Ll
TOTAL FEE PAID -TO -DATE BALANCE DUE
_________ ____________ ___________
127.00 0.00 127.00
0.70 0.00 0.70
_________ ____________ ___________
127.70 0.00 12270
VOICE ID DESCRIPTION
307 INSULATION
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS
0
305 FRAME
601 ROOF TEAR OFF
' 603 ROOF BATTENS
F— -I
L J
307 INSULATION
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS
CITY OF CUPERTINO
I• 1 of
1 BUILDING PERMIT RECEIPT
OPERATOR: chrlatya
COPY # 1
Sec: Twp: Rng: Sub:
Blk: Lot:31629089.00
DATE ISSUED.......:
08/31/1999
RECEIPT $.........:
9931
REFERENCE ID b ...:
99080211
SITE ADDRESS .....:
19627 AMHERST DR
SUBDIVISION .......
CITY .............:
CUPERTINO
IMPACT AREA .......
OWNER ............:
LIN FONG 1
ADDRESS ..........:
CITY/STATE/ZIP ....
CA 95014
RECEIVED FROM ....:
TIMO
CONTRACTOR .......:
MARTINEZ, JAVIER LIC
k 21207
COMPANY ..........:
WINTER ROOFING INC
ADDRESS ..........:
151 WYANDOTTE DR
CITY/STATE/ZIP ...:
SAN JOSE, CA 95123
TELEPHONE ........:
4083638052
FEE ID
UNIT QUANTITY
AMOUNT PD -TO -DT
THIS AEC
NEW DAL
---------- ------------- ---
BPERMFEE VALUATION 7,000.00
___ ----------
127.00 0.00
127.00
0.00
BSEISMICRE VALUATION
7,000.00
0.70 0.00
0.20
0.50
PERMIT
---------- ----------
127.70 0.00
---------- --""-----
127.20
0.50
METHOD OF PAYMENT AMOUNT
NUMBER
-----""---------
CHECK
------------
127.20
------------------
1780
TOTAL RECEIPT
---••
127.20
VOICE ID
DESCRIPTION
VOICE ID
DESCRIPTION
305 FRAME
601 ROOF TEAR OFF
' 603 ROOF BATTENS
F— -I
L J
307 INSULATION
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS