06030173�CUPERTINO *° �
BUILDING DIV PERMIT CONTRACTOR-INFtORMATION "%
BUILDING ADDRFss FkUbH3LWO.
UbU3U1 /_3
BUBB RD
OWNER'S NAME: PERMITLSVBDAM
CALIFORNIA STATE OF 229 S RAILROAD AVE 03/30/2006
E SANITARY NO. CONTROL NO.
(650) 342-3200
ARCHfTECT/ENGINEER: BURRING PERMrr INFO
BLDG EIE.LT PLUMB MECH
rcrc 0
LICENSED CONIRACIORS DECLARATION Job Description
I M by affirm that 1 un 1i under"Osiom oc f Ch,,, 9(mmca
min$ P
f E wdmserda,Joao)aDmonn3oruKeunR.,wPmr�la.acaa�.awmrli. i. REPLACE EXISTING CO1 1 $ NT ROOF
in con raa Yeerten i-IlCn 2N ,VD
LJceruc
Licata
Wu �rrELTS DECLARATION
< I umcra,nJ my plans ahvl he usm u gbd<ncarN MAY _ 2006
Licrned PmfeWmal
OWNER-BUILDER DECLARATION
v�a f I maiso.IHrm that I am camopr from the Gnnla na CO IJccnrc City
for the
0o whoaingm comt1Sfi.Tnct B.ai c. mpnw,.d am Code:Any em amammy $40000
$E which its.,.i=.Omani,to cmunct slur,improve.de Mich,a mpW my urvnm i _
fy^ thitM i1,,cmcc.dsul to ftm visiOiiaof fa wchpermitm B =Lam sukmcnt
�< thatmcocccmadpuraumto the nrv1 3oftConuara'a l.iane Luw(Cnaper9 Sq. FL Floor Area alua[ion
. i�$ (cmnmc4ing with SaYlan]000)aDivislm3aNC BuMreu am Pmfrusiam Cade)a
Q —
that he h eumpt thcefmm and the bwila ren Ila alkpcd eaempdm Any v W.itic 9f
s«�Ianro3l.sbya".Wicantra.pe,maaabYctameit'lirmttott penanya um Occupancy Type
ea mom than frw hroAed dol($500L .
❑Lo w.J""pmpmry,amy uopaMdcAwahwmgeuumekmk mm,Buri n. .
wlB do the comm.co me.vuc cn h not IoaudcC ao w do Tomsk 154.toOfd.Busitt of
w Pmfcuimu eke:lx Conuanar,I.iansi Law aa4 na•vw3'm Y a,,,w a Required Inspections
plop tMnwho bvlkLaOd ma,umumu,a is am not
wkhime3raduoughbis
ownc .tis bu.ldint r thatmelt hnpmwaenu tae va'vueof capR .fa oak a.
however,du building a improwmem I,sold did on year to Mpm tion,the awn a
builder will Ww de bvAen a Pmvl^C mu M db m ddb a Improve for purpuc a
uk.).
I•u awsra a the property,am eaclmiwly comr.cdng wim liccved coavano..b
coovmm the Mjcm(See 1004,Boa.am R Osdao Coda)The Camr coot'.L4
ceme Law data on,apply m Y ov.'ner aW pmy wen build,a Impmvu 0emun.and,
who mmncu far welt pojms with.conu.nafa)licuaud paw,m in me Conu.cur.
I luw.
I am,aempt undo See ,B k PC for this mason
Owner Dak
WORKERS COMPENSATION DECLARATION
1 busby inn other PiMzky of perjury me oI the folkwiog d4lwlmu:
❑In,w,m cool I.
cwnmma da,[, nCiu for
wakcr, athe
Y f n hick this
f c hY S4dm 3-100 of me Laha Code.fa the peRonnarta a me
cork for which Nia permit is'n..-A
❑1 haw and will maintain Wms Compcmarian Insur.0ei,as egMmm by Senkn
3'100 of thc Mbar Codc.far dc perfammct,of me work for which this pmmk h la{ued.
My Work es Canpeualion buwm,cc curia am Po icy number arc:
cmni . Vr Q'A Policy No.: 000'$-/3/— Z S
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(ITh am01m aW icor be mmpkrm If me Nnnit b faun humrtd Wiens($1001
a kaa)
1 r f.thar m the perfarmarun of ere wen ra wnkb thispermit is i:Lea.I,col na
e "airypersonincoymumrwuWbecomewbjecruthe Wakes'CnmpeuWw
Laws of california.Due
NNOTICE TO APPLICANT:If.after nuking this Ccnifiom of Eaanpt m.yen ahoold '
bttmme wb}ect b the Woriu.Canpemuion pmvi.iom a the labor Code.you mm0
.JO forthwith comply with,ucn provisions a this pcooll hull bcdaaeE mekcd.
'Z CONSTRUCTION LENDING AGENCY
[-+ - Ibcmby afllrm duo inert hacatawuka knding.pney ra thc performrec of
LL> de work for which this puma h iawm(Sc 3091,Ci,C)
W Q LtMdeYs Name
U 01 aNfY that I luw ruin mu appdcuion am aur mar de chow Inrormaum u
ly V cancer I.gra w comply withall city W county vNlnuera am stae laws mWing m
0 Nildingcnmuucuon.analt,mbyaudwrim rtp ,scMafi..rthi1 city mcmerugm me
W .how.mcmioncd property fa lmlectim purges.
(We)agree to UW,indemnify and kap bnnkaa the C'ty or Cuprnino.Lumr
1:1) Ihbllitiu,judgmcau,tens and cspcnac,which may in my way arcwc against said City
UIn cmuNirn¢or me grandeg a this permit.
^" APPLICANT UNDERSTs NDS.IND'Wil COMPLY WRA ALL NON-POINT Issued by: Date
SOURCEE
/3nAua Re-roofs
Is
pp taHr DOUS MATERIALS DISCLOSURE Type of Roof
Will Ihe.PPlicwl a fuuac building ov:upaii ase a hawk haYNom m.tuhl
as defuod by de CupeNnn MUM upai .Chapxr 9.12.and the Health and Sal
code.ser as32f°+
Y. All roofs shall be inspected prior to any roofing material being installed.
❑Tm
Will dm applicant a foam building occopam toe cqulpmmt a dei.which If a roof is installed without first obtaining an inspection,I agree to remove
hanOdwa air mnu nimnh Y do by me Bay Mot Ah Quaky MYagrnent all new materials for inspection.
DislnYt .}{
Yu u
I hue mail dR bnoodom mauriala no W tsmcnis tamer Cmpta695 of t Calif.-
nhH kh&S,fuyCodc.54ibns25SW.25533 am USX l undcaud N,tllthe Wilding
door na euemly hive I UmAL.1 mu it h MY MSPWWHIILY to nodfy me oavp.m of me
mgaaaneaawhkn nr.cerdracaear. Signature of Applicant Date
30 bb All roof coverings to be Class"B" or better
. nt ere
CITY OF CUPERTINO
2 of 2 PERMIT RECEIPT OPERATOR: conniew
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35720023 . 00
DATE ISSUED. . . : . . . : 03/.30/2006
RECEIPT 4.. . . . . . . . . : 33789
REFERENCE ID # . . . : 06030173
SITE ADDRESS . . . . . : BUBB RD
SUBDIVISION' . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CALIFORNIA STATE OF
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95;014
RECEIVED FROM . . : IZMIRIAN ROOFING
CONTRACTOR LUTHER IZMIRIAN LIC # 27747
COMPANY . . . . . . . . . . : IZMIRIAN ROOFING & SHEET METAL
ADDRESS . . . . . . . . . . : 229 S RAILROAD AVE
CITY/STATE/ZIP . . . : SAN MATEO, CA 94401
TELEPHONE . . . . . . . . : (650) 342-3200
OE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---- ------ ---------- -- -------- ---------- ----------
BPERMFEE VALUATION 40, 000 . 00 453 . 60 0 . 00 453 . 60 0 . 00
BSEISMICOM VALUATION 40, 000 . 00 8 .40 0 . 00 8 .40 0 . 00
---------- ---------- ---------- --------- -
TOTAL PERMIT 462 . 00 0 . 00 462 . 00 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 776 . 79 VISA
TOTAL RECEIPT 776 . 79
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
•
I-! �-
CITY OF CUPERTINO
G ' REROOF
• CUPERTINO PERMIT APPLICATION FORM
APN# 3!51 ; ZO , 02,3
2 Date: 3I 19I O fo
Building Address:
%(D\-50 b
Owner's Name: Phone#:
Ca 'CYa n CIL() S 'iotb- X15 a- -I 1 'd Z
Contractor: License#:
Contact: Cupertino Business License#:
4Z 7--7-7 'i
Type of Roof Covering:
Existin Propo -
Built-Up Roof Built-Up roof CC 1'2_55 A)
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
❑ Tobe Removed ❑ Provide Mfg.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic
Job Description:
Residential ❑ Commercial
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
O 7c70
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
•
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 LC.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: Cal _Tans C/o Fo- 1 54Y s�
Job Site Address: 1 0 130 a�bb
Roofing Company Name:
Applicant's Signature: Date: c
• Greg Casteel
Building Official
Revised 11/2/04