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06060005 (2) CITY OF CUPERTINO _ - BUII.o NG DIVISION PERNIIT �NTRAC nR INF©RhIA11, BUIl1YING ADDRESS: DS GAT.OS ROOFING PE LINO.06060005 6379 ATHERWOOD AV OWNER'S NAME: •A PERMIT IS iUE DAIS JENSEN HOWARD 888 FAULSTICH CT 2006 E SA ARY NO, CONTROL NO. (408) 298-9399 AACHITECT/FNGfNEFR: BUG PERMITINFO BLDG ELECTLEC"rPLUMB ME61 z 0 0 0 cis LICENSED CONIRAC=S DECIARAMON Job Description C I barb,+form that 1 an human)under prorviaas of C1a'or 9(mmmeaint P UNSeuIm 7000)do"d"os 3 ofho Buinra W PWcW; n+Cade.and my lkenau mrauraa d RrseG�Ll X00707 REMOVE EXISTING COMP. kOOFERS SELECT FE n "' 1576A ' AND LANDMARK 40 SHING E [ IEED. is ION Iutt rd roy Plans shall Ec ui as pOWRr oro+ Lkcued Pmfcssbni �A O.1 1 apo -W'f Ece Ccir n z00 I.0 I bcmby inra Nat 1 am ucmpt rmm the Gmoamor!c:My L.sea the p o fallowing rnsvn.(Sakai 7W13,Buis and Pmfaioa Code:Ana dity or county $ which.uloiro a permh m®.mruct ai wprme,dcmoN4 or n-Im'o my sbuctum y prior m fts"..late,also requfte+tM appBuat fa such pumit m f k a itred vi"meet ; < Nutr'eB¢rcdpuauNmN pm kuo N Goosed+ avx awleh+pmr9 Sq.F FF7oorArea alitati 5 Sfcomtn,,Omgrlb Senior 700M Of Divi+bn 3 Of WC Bual.and Pmfuiam Codc)a _ Nu he u"IMPE nbeefmro uW de hale for rte al 4M oempi°r+ABY•Iowan of pb�ytlji[] Sctloo 70313 km by my APPln fa am a P °aibjc"'N . c 'Bso et m a&if PmilY of 3-6-91 PN b U l . 00 Occupancy Type not more Wmw w fledmd dollars($300). 1.a owar of Orn'.Pony.a my employ.with.,,oz as Nob sole aanMna oo. a lWthowak.aMNeeracvuebrotoitradrdaoffeedfaale(Scc.7041.Blames+ Required Inspections and Praesaoos Code The Conor ,IJ Law doo pmt appy m an ormr d 9 p property wM hWINa Iraprmt Memo.lad wIso d.say work himselfa Nmogb his owa no ky=pruvlde,i Nu sack imptvsemevu.vat"wendeda oferW fora>k If. kmx, ,obo,MjM orknpm.emmt is sold whbinoreYoar acompledmi.theawoe- haltra wi0 baso de Kaden of pmNng that M did aer build a irn m In,Pugmc of alp). ❑1.u ower Of the'°perry.am ocbro.rlY coau.cing mi Ilreaxd raoUtcmn m mrmtrucn de ii(Sec 70th.Basins+and Pmfesslau cada:)1be Coanooes u «nae lav daa ort apply in an owns a pr.gery i,bO boik+a l npir.thump.and who corn for sah pmjecb wIh a cmivaua(+)Ikemed peaant to Ne Camai Li,,aae taw. ❑l too aempt ondu Sm ,B h P C for Nks iumn Ovor Dae WORKS S COMPENSATION DEC3ARATION I booby affirm unott pea4yd Poij yoned ho fmlbwint declnufoec 1N.eend vrT minlaia aCeNBm¢dCans.r to xlf-r ^fa Wa ",Corr r anon.a pmrided for by Section 3700 of the labor Code,for Ne'cion..of the work fa vhkb this'croft u inu,l. M I base and will n imam Workes Compemarlm kt mrr as not mod by Secinn 3700 a We lana Code,for the pMarmume.(Ute work for welch is pcmu it ivuo& My Wor s Cmnprmaio.Imem¢artia and%lky nanba aro - cmic: .moi Cab .GU.•l11 poik Nu: ZZ79-Z4700' COMFICATE OF E%EMPTION FROM WORKERS COMPENSATION INSURANCE (Thu sc'Wmn.ed ant Ito caoVk if We permit la formehoMed doom(5100) or tut) 1 y0fy W t Io We pufarosae d de wvxt fa rhkh Wu pesmi.b'.....n.l WB nor emplo,any pcnm in my amorcr an u to bomme mbjcct to Ne Wakca'Comocconalloo Lam a Ullforrba Daft � Appllom NOTICE TO APPLICANT.9.aficr Contmaking Nis amo,t thE:<mr Cntlym"mold h me rmbyW..P y k Wxh pro it mpcaadon gv iiau of Nc labor C°dc,yw mus .J O faNwith mmpl,with nrh prmviianaaNis permin ahJlwdamcd motel 'Zz•y CONSTRUCTION LENDING AGENCY [-� 1bonoby arum lot Nero kammmtimImdint agerry sea Wo Perii.a fk > the vat for which Nu peanut b itimi(Sri 3097.Cre.C) W Lt,OWSName :D z ry Addro+ U0 1.Afy Nat 1 Nee rad Wit apgliutim and sate Wu Uc awa"Nam W m u V.F camp.1 sure in comply with ell city soil county a ¢ dloms and w+ slate]am m OU .Wing eowncW tion,mhereby aurborim rcpr rutircoftbis city to cnmr upno Uc W •bore-mentioned property for impection pur'ax (We)agree in am indemnify aril keep harmine Nc City of Cupertino stun rFrN liabllitlea,Judtmous.eala and eapensa wbkb may W any my 1c maimtaid City U Z incnis' oceathetnntlni,oflbiapeonOt. •"' APPLICANT UNDERSTANDS AN WILL COMPLY WITH ALIy NON-POINT Issued by: Date SOURCE REGU i X)- / Re-roofs SlNmao dApplioeVCo.wvua y Due HAZARDOUS MATERIALS DISCLOSURE Type of Roof WIBtiea CWernorfWo bpai Co t.obaotumma hulk haavdea sowncly u ellnd by hCupenim MaNclpal Code.Chau 9.11 lad Ue HdN sad Safuy cod •sa °°23v$a)7 All roofs shall be inspected prior to any roofing material being installed. [3 Y. iJJINa If a roof is installed without first obtaining an inspection,I agree to remove Will Ne applicant a more wilding aivpaa me cquiinni a dc.lw.Aicn colt baadaos air miarrionla o&fined by Ne Bay Arta Air Quality Mana{cmcw all new materials for inspection. Dipriu7 ❑Yo / gnu Ihaw.oad UmhaardwsmueWstryt3h 255a.tr Chmee d*aNe WiLdor. maHdN d:S.0y Cmdcsavw153034 Yrand15334.1 mWn,tiry Occolowihhat dau soncarrmUY Yore a —.w Nae In k mY.upaNhillry m mUfY Ue o¢vpmt Of Chic mgWremera °"' a'cew'm'earOc Signature of Applicant Date All roof coverings to be Class "B"or better owner a mthorircd stent .Tam aCOF Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 Fax(408) 777-3333 CUPERTINO Building Ike artment JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # GENERAL CONTRACTOR i d FAX # v I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information 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 • Owner/Contractor Signature Date Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-32228 11TI O Fax: (408)777-3333 C U EIVI 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. I New roof coverings sliall not be applied without first obtaining all inspection 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 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 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, W ill require the removal of all new material down to the sheathing, so a proper City inspection can be performed. 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. Homeowners Name: AWa /'01 __Job-Site-Address:__ _-_---___— - - - - - - - -------'-Roofu'ig Company Name: • O A plicant's Signature: Date: Q . Greg tee] • Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO �m 1 of 3 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36916010 . 00 DATE ISSUED. . . . . . . : 06/01/2006 RECEIPT 4 . . . . . . . . . : 34643 REFERENCE ID # • : 06060005 SITE ADDRESS . . . . . : 6379 ATHERWOOD AV SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : JENSEN HOWARD ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : LOS GATOS ROOFING CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481 COMPANY . . . . . . . . . . : LOS GATOS ROOFING ADDRESS . . . . . . . . . . : 888 FAULSTICH CT CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 TELEPHONE . . . . . . . . : (408) 298-9399 •FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ----- ------- -- BPERMFEE VALUATION 6, 000 . 00 126 . 36 0 . 00 126 . 36 0 . 00 BSEISMICRE VALUATION 6, 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00 --- ------ ----- -- TOTAL PERMIT 126 . 96 0 . 00 126 . 96 0 . 00