06040151i..8
CITY OF CUPERTINO
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CONTRAUr0R�INT�aORMATION
BUILDING DIVISION PERMIT
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BUILDING ADDRESS:
YESSNE FAMILY TRUST
PRm`r NO06040151
22268 BELLEVUE AV
OWNERS NAME:
Pl'lt ISUEDAJE
YESSNE FAMILY TRUST
ION&
SANnAAY NO, CONTROL NO.
(408)429-8638
ARCHTTECTyEN'GINEF
BUfIDING PERMR INFO
BLDG EIFLT PLUMB NFC31
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LICENSED CONIRACIORS DECLARAnON
Job Description
1 h=by a1Brm Ika 1 ro [i¢ undo pm+idcas a! Cupar 9 (mmmc,ming
wid Srsdun 70701 of DMcon 3 o(de Buinnw Proreaio« CMx. aM my lkemm Is
b f.11r—aM n. %
TEAR OFF CLASS B SHAKE 40 YEAR CLASS A COOL ROO
LDleenm Caa - �Cam�ar.«Kfka
UNDER SOLAR
IwWmaanJ my pWu.IWl be weduPabUc recmtda ,
Limucd Prvru.l«ul
OW NER-BUILDER DECLAAAnON
I bcmby air m that 1 am uempl ram Ne Cmuamoh Lirc«x Lw for 0e
-
blbwin, . (Safi. 7M IJ. Butinac aM ftktadau Code: Any aly, «mumy
wbkh I Wma . permit W amnnbl alb(, knpmfe• dem,tllah. «m'aix any a,rfum
u -La
Sq. Ft. Floor Area
Valu$ib4200
dPrtk
mbis.aa ,MWth,e��aboC�...Tf (mp.9
(eameoan, with Semi. 7,100) M Dwi.bn Sar the itk WPakauo«ctd)«
dta he u esmp, dvxfmm arta Ih buff f« the gkgad ..Lplm. My vblaim ar
APN Number
Occupancy Type
Seim 70315 by arty appllnnt f« a pamil atajecb the aPPB tto amr0p 11Y of
°a °°a d'° huvdrtdd°
35701094.00
Q L a ewer of dk praP.7. «uy empbym with vaga u thew ale.=Ptaiallu,
RequiredIns ections
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aM Parevd«a Code: The Cmeaorf Ll— Law don W. apply if a o.nex
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pro«imptme.Ib tmpmadwho
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kawaer, debti amWW
ateli
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bullda wiB bare Ih 4vdcn of pmWng thu he did mt buia « Impme f« p«pa.e a!
ft did
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WORKERS COMPENSATION DEC1_ARAnON
I hcrtby aBkm undo penally of pajuynoc of Nc following dmlaraionc
❑ I W.e aM wW eaiwin.CertiGae of Caucm b al(-Wum Warkxf. Camper-
W
arim, a provided r« b Secnm 3'!00 a( the Lab« Code. f« tM pcRaamata d tM
wart f« which dif pamit U l»urd
Q 1 law aM will .tMale watch Cnatpe .dim ITIS . a n uind by 3m6on
.
37(10 d the 1 Code. r« de pu(onnana a(Ne work f« wbkh tbb pcnnit k Tamed.
My Watch Cm)pxuatbn btmran rtim ed mlk munbm arc:
Cana Polley Na.
— - —ICER7IFlC OFEKF1ONINSURA WORKERS
`— COMPENSATION OIBURANCE
r '
(Tbu.cmlm sW m be mmPivd Ume permk Is f« onx bonded OOBaa:trot
m lav)
1 atifY dot ie d,c perfarm. a tM wnrt f« which ma'c ' Y IaucE, l>b.R n«
cmplq any pmmn in any m.aar a a b b«me abjxm m We Warta, Campooadm
Im N Calif mia_ Dab
NODCCEE TO APPLICANT. V. afbr matin, dk Ccm lbe at Ea Mkan. you Nauta
Eacame.ubjcm b Ih wa s Cmpcua0on pmrWma o(tbe Mbar Code lo• mon
fmhw,, comply rid,«h pmK . 0sk pmnil,ball W d mmkcd.
n CONSTRUCTION LENDING AGENCY
I Iemby afim du deb h a mauoim 1m 11 tte f«de Par«m•nmd
> mc. f« whkh dif prmlLL k iamd(Sm. 3m, Cir, C)
Lender: Name
.
ISMe1. Add
jI Certify dal I hate tud dda appOcuiM aM fob dw do amw hdom b
mm" I n= W m Ply wkh all aly aM minty oWinanma aM a•„ law rtLGng m
building cmw«lian, ma bmcby imt ren np, ntai a Nis city W ener upas ie
y.bort-mmtiunc0 pmpxny fa mpxim Puryoav
(We) .'rex to arc. indemnify and =P haeme: de Cly of Cvpanim agaim
nII.biGOa.JWgmelW.emu aM opens: wbkh may N my way aa¢,gala. saki Cry
ittz APPA 3 jHq? tattle oS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date 2__'r
SOUR
Re -roofs
Type of Roof
'%r-
HAZARDOUS MATERIALS DISCLOSURE
wit be,,,,Brno «fmux bWWing Omupad mm «IUMk. baaNma maM
u deRrbd by Ne Cupem. Mwtiapal Cob. Chapter 9.1Z aM do HW O aM Sa(ay
Cadc. Saida 2553$,)7j_Qm�
All roofs shall be inspected prior to any roofing material being installed.
0y. e
If a roof is installed without firs[ obtaining an inspection, I agree to remove
Wit] db al «fuuue hiUftg o pul = equipment «dcW w b
emir ,Va ,,a air mauminaua as &feed by 0e Bay Am Air Qallly Maoagcmem
all new materials for inspection.
D Cerin?
Qy.
I Aare mad the bs, d mawialarequhxmma mkitb.pler6.95ofthCak(«-
WaHallhS.rnyCab,Sxcti M505.25533 aW 755N. 1 uw=M datirde ddlding
dm. nm fumy tya nmiry deo Lade
b Gib
Signature of Applicant Date
_
All roof coverings to be Class "B" or better
«am«md.ge D,b.
CITY OF CUPERTINO
am 1 of 1 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 35701094.00
DATE ISSUED.......: 04/25/2006
RECEIPT #.........: 34127
REFERENCE ID # ...: 06040151
SITE ADDRESS .....: 22268 BELLEVUE AV
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: amyw
COPY # : 2
OWNER ............: YESSNE FAMILY TRUST
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-2703
RECEIVED FROM ....: FRED WORRELL
CONTRACTOR .......: LIC # *OWNER*
COMPANY ..........: YESSNE FAMILY TRUST
ADDRESS ..........:
CITY/STATE/ZIP ...:'CUPERTINO CA, CA 95014-2703
TELEPHONE ........:
•FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
BPERMFEE VALUATION 45,000.00 496.80 •0.00 496.80 0.00
BSEISMICRE VALUATION 45,000.00 4.50 0.00 4.50 0.00
BUSLIC FLAT RATE 1.00 105.00 0.00 105.00 0.00
TOTAL PERMIT : 606.30 0.00 606.30 0.00
METHOD OF PAYMENT
-----------------
OTHER
TOTAL RECEIPT :
•
AMOUNT NUMBER
------------ -------
606.30 VISA
606.30
Its
CITY OF
OCUPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
zZUS Fel(eyue-
PERMIT #
(56'0 YO/r/
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR. r /
FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
Y z r-06
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 rote n
p
Septic Tank
Sheet Metal
Sheet Rock
,,gees
6�
Y z r-06
Date
-SCC
S Cnror
CUPEkTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
0(004'0151
Qty. if
Annlicable
Fee ID
F
Fee Description
Fee Group
BPERMFEE
Bldg Permit Fees
BUILDING
Building Address:
22Z69
3e�e tt e
Owner's Na e:
BSEISMICRE
P one #:
BUILDING
-I-
Seismic Commercial
Contra tor:
Contra
BPLANCHK
License #:
BUILDING
BUSLIC
-3 Sr£Le�
2
Contact:
Cupertino Business License #:
/
� O 4 V
Type of Roof Covering:
Existing: ` "'+.
Pro sed:
Po
❑ Built -Up Roof
❑ Built -Up roof
.0' Asphalt Shingles
Asphalt Shingles
ood Sha es
SJ. Wood Shakes
ung es
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings
❑ Provide I.C.B.O. Report #
❑ To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
/CA2 O- —
O
Residential.
Commercial E] 54(4-e
Fire Zone: Yes ❑ No [g
Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project:
Type of Construction: Occupancy group:
L
Qty. if
Annlicable
Fee ID
F
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
0 41
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 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,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
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 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: Y255 I4 Q
Job Site Address: Z Z L 468 15C ( I Py O e
Roofing Company Name:
Applicant's
• Greg Casteel
Building Official
Revised 11/2/04
Date:_V_L,/Q6