06090241 CITY OF CUPERTINO
BUILDING D;IVls1ON PERMIT CONTRACT IR II 'FORMAITIQN"r-a
n4
BUIfDING ADDRESS: ING PERMn'N00 6 0 9 0 2 41
10394 S 13LANEY AV
OWNER'S NAME: PPRNID ISSUE DATE
MOGENSEN STEVEN 265 WREN WAY 09/26/2006
NE SANITARY NO. CoNIROL NO.
(408) 374-7421
ARCF rfEC(ENGINEER: BUILDING PERMIT INFO
BION ELECT PLUMB ME61
0 0 0 0
ioo LICENSE DCOMRACnORSDEC1AR 9(
1 brafCh' - Job Description
chy a1B,m that I ro Ilanrd urukr proricmi of Cbapm+ mmmurcNt P
vlw5<lion"1f"1B)of We Ebc;.andlior �.�aga�am YS.—i,
mrailroaydc �fU REROOF- TEAR OFF SHAKES, INSTALL OSB, 30LB FELT
40YR COMP, 32 SQUARES, CLASS A.
.rp pyo — TS DE L
ARCHITECTS b,doS DECD
1 uMasmd my Plod rAll be rvN u public mxrN
anU
.O Licvucd Pmfouoml
OWNER-BUILDER DECLARATION
nC 1 IembY o(Scot on 11. csuopt fromo ibc CanhactC,Liccvc Law Jr.ft
dy
❑O folbwint mason.l5ceiloon co,d Sd,t,am yWPafdcW ih.-rony city memyy
SS which ms a pami,m amYnc4 spar,m fosse,demolish,sur mash oil yrvcNrc
-� ,�I;e�,tifa�q„1„I;to,kp��i�;�irs�colhnrp�rilOi ;;e�ia.p�v Sq.FL Floor Area Valu
�$ (cmimylmnt with Scuba 700M Division J of the Burins viol Pmfeaimn Code)on
.. mat he is e ,,4 thomfoodt and w boost for w slkgrd tooddplm.ABY rlNaum of pp�.7 h
Socbd 71131.5 by am apphcm ”
tIt,a pvmitmica,me appnerd m-d.0 PtmhY m 36�J1INuu er00 Occupancy Type
oa mom thm It.wmddd
md iar,ISM
❑4 u owrra of di PtoPatY,sur my rmPlymn with�atn u OeL tole cmaperwdaa.
win do the wool."ne umnwe is oatiyuded or afford far ak(S..1 .Busincs, Req Inspections
aired IeC[IOn$
anmu d P.11io Cada The Courecmr,I.I.law does cot apply b m suns of P
,,my who bulk,m iaplo.a dhnmt,and wito lux, ch wort hWelf m wroth hu
awn empbym,pmvkod Uw such impro vmtcm art not mWdrd or aRaed for ale R.
kmvnc,me buiking sur hopoov isWd within arc yru or mopkuon.the owre,- _
buil&,wN hart the burden a MOM,ms,k did not ddk or linpeose for purpose of
❑1.a owry of the property.am escl®vCly cmuardnt vim lo
mliviou d cwuacras o,uoa U project(see.l 'Bum.sad Pmt(s —cast:)The Cmuemr,U.
cmuo n am -
Ls.doapply n m owar of prrprrds who bulk .n,sur Impmthem.arrd�
sum couaued for prvdens wimaa,ouaaor(,1Bansed punoant to Le Cmmanar,
whon
slam aorta nods see ,Bh PCfor lilt won D(/.�
rc
Dust,
V
WORKFR5 COMPENSATION DECI.MtATION J
Ih,rby sfyim mosrp=ftyof paJory na of On,following drsWafiau: I'///
I hs.e snd wti msinuln a C.n;Ocom of Camem m sJf-intoe for Workers Conan- Cr
1031�
an,u provided for by Slim 3700 of w labor Code,fm the performance of w
rt for which uus Pumlt is Laced
I have mid will msiouin W.W1 Cmopvoatioo Inwana,u rogdred by Sccuon
of the Iabm,Cods,for me pafmmmsx ofUne wort far witch this permitu dozed .Worters C prdodjon buormcc amin and Policy numberurier. Polly Na:
ffiCATE OF EXEMMON FROM WORKERS
COMPENSATION INSUILs NCE
(Thu mlm neW trot ho.dolod R We farm,u for arm hurdred dollars(5100)
or )
I certify Uny lo me perfmmm¢of tlm work for welch this pennil u cued.I shill oro
c.,loy soy person in my nunrerso u b ccome subject to Oe Workers'Cootomodm
Laws a Caliromia.Dare
ApPliaru
NOTICE TO APPLICANT.If.afro nodding this Ccnificno of Eacmptiun,you shoed
be sobiat tome warkar'.Can'ossu n pm wmu a w labor Code.you most.,O fmhwiW comply wilt such wuo iom a Nu permit shall W Leered newkeE.
z^ CONSTRUCTION LENDING At3ENCY
I h achy sff.rm lh r them Us cvnw,Kliaa ladint ateory for the perftmm.of
FG'>
onto work for which this peonil st Lauth(See WT.Clr.C.)
W Q I<no,rs Nsrnc
az Lender,Adaw
U O 1 ccnify Unit,I hoc rood this app,Wdm aM marc my d,c sbo c Irdomatiun u
ry F" mnma 1.,.on comply vim At city and county aNnncci and.,,,,Isis rtWing m
rJ U budding cmc ion.and hcroby amhonM mfnmtivn of this City to cma upnn me
W shove-menu.d arcs y for uupscuon purpnm,.
(Wc)at to ave,iMrmrdfy and keep harmlca the City a(Copcnino agairul
WbWdoo,judtf co cow and n,c+ta,whkh my w my way amus agunst said City
Uz in comegpeoaW grnungaf this parols
^ APPLICANT U ERSTANDS AND WILD COMPLY WITHALLNON-POINT Issued by: Date
SOURCE
Re-roofs
Si
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will the Vdic"t or future budding occupam yore sur Nadk bradcm moods!
u deBmd by the Cuperd w MuNcipal Codc,ChsNon,9.12 and the HcilN ami Sfay
Code.Socrim 25572(,)1 All roofs shall be inspected prior to any roofing material being installed.
❑Ya
If a roof is installed without first obtaining an inspection, I agree to remove
WLI the applicant o,Not.Wilding occupam us equipment or devices which
emit ba,arLous m,conumiwns u defined by ms Bay Arca Air Quality Myugemsot all new maSSS als for inspection.
Dirtrial /
tJ Yn /
Ihave madwhy mycdaumyuhcntm5t1.I CMlwa thAif Unc Califon" �_ rs rj - 66
ria Hralthh yCNc,S¢tiun]5505,25533 wI USX.I wderand,hatifup btuldlnt GGA 6 6
d¢,rql a hY.0 a IC(IarIL Ihdt it v my rC{pRS bllily b mNlfy II,C aRlrpml Of me
mgnh ' /ytnm amotRnrW ao .Cud], ofQvpmy. Sign [ureofApplicant Date
q-2Z��' All roof coverings to be Class"B"or better
a wmanirai agent Dem
CITY OF CUPERTINO
am 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . .. 36911052 . 00
DATE ISSUED. . . . . . . : 09/26/2006
RECEIPT # . . . . . . . . . : 36204
REFERENCE ID # . . . : 06090241
SITE ADDRESS . . . . . : 10394 S BLANEY AV
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : MOGENSEN STEVEN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
RECEIVED FROM . . . . : P & R ROOFING
CONTRACTOR . . . . . . . : PAUL DUCHSCHER LIC # 24511
COMPANY . . . . . . . . . . : P & R ROOFING
ADDRESS . . . . . . . . . . . 265 WREN WAY
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408) 374-7421
*FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- --- - ------ --------- ----- - ---------- ----------
BPERMFEE VALUATION 11, 000 . 00 180 . 36 0 . 00 180 . 36 0 . 00
BSEISMICRE VALUATION 11, 000 . 00 1 . 10 0 . 00 1 . 10 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
TOTAL PERMIT 286 . 46 0 . 00 286 . 46 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- - --- -------- -------------- ----
CHECK 286 . 46 2735
TOTAL RECEIPT 286 . 46
•
Community Development
1J 0300 Torre Avenue
CA
Cupertino95014
Telephone(408) 777-3228
C[Ty OF Fax(408)777-3333
WUPEkTINO
Building Department
JOB ADDRESS: 3 S I �arkCkPERMIT toI l CQ'q
OWNER'S NAME: PHONE # —
GENERAL CONTRACTOR: FAX #
am not using any subcontractors: N/ —Z
X2�
0 Signature Date
Please check applicable subcontractors and complete the followinginformation
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
• 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:
Job Site Address: /a 5 F ev S• �I
Roofing Company Name: Vim(,C> L K
Applicant's Signature: - Date: 2
1' Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO ouoq oaLfl
REROOF
• CUPEk�TINO PERMIT APPLICATION FORM
APN# --FD-
3W9 - 11 -05"), Date: 2 , 2 2-
Building
Building Address:/D C
O �
Owner's ame: Phone#:
Contractor LLicense#:
Rf� O o tT'1 �t
Contac V C/ Cupertino B 'ne� j icense #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 54,1"A'sphalt Shingles
�r Wood Shakes ❑ Wood Shakes
O Wood Shingles ❑ 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:
ew- o g44, k-_ k5f4 0 ,5 - /T - lej4vCaP,
Residential Commercial �2� , CIaSS
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are an restrictions: LJ
Cost of Project: /O �GU Type of Constructi Occupancy group:
d U ao'
Qty. if
Applicable Fee ID 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
C�