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99100061 q l0 D06 { 3 Z2 3 PERMIT APPLICATION FOR - CITY OF CUPERTINO NUMBER REROOF PERMIT - INSPECTION DIVISION PERMITERPIRATI (408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN IN DAYS OF PERMIT ISSUANCE OR 100 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS Q RESIDENTIAL COMMERCIAL OTHER - OWNER'S .HAZARDOUS FIRE AREA NAME L I 141/L ",-5� 4 YES ❑ Ry�ride stand hI a Class A aY Is NO ❑ Inii I.C.B.O.M ADDRESS J 12-Q ys�,�� Q.�-r EXISTING RODE COVERING '7 PHONE 2SZ- ZS8 7 NUMBER OF EXISTING COVERINGS / Q 0 CONTRACTOR'S NAME �K� /�O CC( 9 TO BE REMOVED TO BE RETAINED ADDRESS Z y/ I r ST � 2 TYPE OF ROOF COVERING Cil-1'BZIP - (� t, / EXISTING - PHONE ` T—�b/S BUILT-UP ROOF ❑ LICENSE NUMBER ASPHALT SHINGLES ❑ LICENSED CONTRACTORS DECLARATION hereby ethrm that I em Incensed under provision.of Chapter S li(commencing eis In with Section WOOD SHAKES.EDD � 7000)of Drvisicn 3 of the Business and Profesakxat Cotle,and my license is In full force eM Q��\�—�y'Lllr enea. 9 2 WOOD SHINGLI LJcanae Cleve `_. / Lk.Number ZI IGS - Data � ' IZ f / Convect« OTHER(SPECI VCT 12❑nn OWNER-BUILDER DECIARATION D I hereby eltlrm then I em exempt from the Contractors License Lew for the following reason. OSE ❑ ' (Sec.7031.5,Business acrd Profe.slana Code: Any city or county which requires a permill to By construct,after,improve,demolish,or repair any structure,prior to Its Issuance,sLm requires the -UP"ROO epplkant for such permit to life a signed statement that he Is licensed pumuant to the provisions of the Contractor's Ucenm Law(Chapter B(commencing with Section]000)of Division 3 of the Business end Professions Code)or that he Is exempt therefrom and the basis for the ellaged ASPH HIN E$ exemption.Any violation of Section 7031.5 by any eppikent for a permit subjects the applicant to a cIVII penalty of not more than five hundred cliars(5500).): ❑I,as owner of the property,or my employees with wages as their vole compenea0on,will do WOOD SHA ❑- me work,and the structure Is not intended 04'Offered f«sale(Sec.7044,Business and Frahm. ski Code:The Convector'.Ulcerate Lew does not apply to an owner N property who builds or Impros.thereon,arM wio does such wvMhlmseft«through hisown ampkryeee,provided that WOOD SHINGLES El such imprrnements are not Intentleal or ovorw for sale.IL however,the building«Inprovement - issotdMlltln ane year ofcompletion,Ups aw•ner-bullderwill""the panders ofprovingmet hedid OTHER SPECIFY rot build or Improxe for purposeale. of s ). El ❑I,as owner of the property,em exclusively convecting with licensed contractors to construct the project(Sec.7044,Business end Professbrm Code:The Contractor's Ulcerous Law does not PROVIDE I.C.B.O.REPORT NO. apply to an owner of property who Wild.or Improves thereon,and who convects for such profects with a contractor(s)licensed pursuant to the Conbaco's License Lew. PROVIDE MFGR.INSTALLATION SPECS. ❑1 em exempt under Sec. ,B.O P.C.for this meson owner Date WORKER'S COMPENSATION DECLARATION APPLICATION DATE VALUATION PERMIT FEE ' I hereby affirm under penalty of perjury one of the following declaration: pp ❑I have and will maintain a Certificate of Consent to self-Insure for Worker's Compensation, /O Building as provided for by Section 3700 of the Labor Code,for the Performance of the wort,for which this — / p arra tyq Issued. ^ haws entl will mountain Worker's Compentsmon Insurance,as required!by Section 37W o1 / ' /O, �� $eISmIC the Labor Code,for the performance of the work for which Ihis permit Is Issued.My Worker's (// Compensation Issuance carte eM�°Iky number are: Total Carrier ft%+'.. 1 w`4 PNIcy1o.N5'-9?00J`l`W PERMI AUTHORIZATION DATE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE �/Z^�q (This section neetl not be completed g the permft Is for one hundred tldlers($1100N))o or lase.) I cerdfy that in the p slormence of Me work for which Ibis permit Is Issued,I shall not employ any person In any manner so as to become subject to the Workers'Compensation Laws of Cell. All folifs sRdtrbe inspected prior to any roofing material being joints. installed. If a roof is installed without first obtaining an Date Apist cent inspection,I agree to remove all new materials for inspection. NOTICE TO APPLICANT: If,after mak ng this Certlllcale of Exemption,you should become A Ilcant understands and will subject to the Workers'Compensation pro,leons of fire Labor Code,you must lorihwlth comply PP comply p y WI th all non point with such Provisions or Ihls permll spar be deemed awaked. source regulations. I certify that I have reed thio application and state that the above Information is correct.I agree to comply with all city and county ordinances and state news relating to building construction,and All roof Coverings to be class"C"or better. hereby authorize represonthtiv¢s of this city to enter upon the abmv-mentioned property for In- �eWen agreeto /0-1 Z-99 (We)agree to save,expenses and keep harmless the Clry ai Cupertino against 11, Ikbllltlea, of the tee costs and expenses which may In any way accrue against said City in consequeree • of me granting of this perms. SIGNATURE OF APPLICANT DATE 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 ACCESSTO ROOF SHALL BE PROVIDED FOR INSPECTION OFFICECOPY CITY OF CUPERTINO - BUILDING DEPARTMENT RE-ROOFING POLICY 1. Prior to permit issuance, you must agree to comply with U.B.C. standards and manufacturers specs on re-roofing. 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 shall 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 shearing at that time. LMPORTANT: 1. Flat roofs must have a '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: Lf I Cal 49 ADDRESS: /1743 RE-ROOFING COMPNAY NAME: (foe,COr APPLICANT'S SIGNATURE: • CITY OF CUPERTINO BUILDING DEPARTMENT Re-roof7winword INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO BUILDING PERMIT INVOICE OPERATOR: karenb Sec: Twp: Rng: Sub: Blk: Lot:36221033.00 INVOICE DATE... .. . : 10/12/1999 REFERENCE ID # 99100061 SITE ADDRESS . . . . . . 1128 DERBYSHIRE DR SUBDIVISION .. . . . . . CITY . . . ...... . . . . : CUPERTINO IMPACT AREA ... . . . . OWNER . . . ....... . . : ISHIDA ATSUSHI AND LILLIAN Y ADDRESS . . ...... . . : ' CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-5072 CONTRACTOR ....... : CORPORATION LIC # 20585 COMPANY . ......... . CONRADO COMPANY INC, THE ADDRESS .......... : 14363 SARATOGA AVE CITY/STATE/ZIP ... : SARATOGA, CA 95070 TELEPHONE ........ : (408)667-2095 FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- ------------ ----------- BPERMFEE P 146.90 0.00 146.90 BSEISMICRE P 1.10 0.00 1.10 --------- ------------ ----------- 148.00 0.00 148.00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ........ ............................ ........ ............................ FRAME 307 INSULATION ROOF TEAR OFF 602 ROOF PLYW000 NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS • CITY OF CUPERTINO 1 0£ 1 BUILDING PERMIT RECEIPT OPERATOR: karenb COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot:36221033.00 DATE ISSUED....... : 10/12/1999 RECEIPT #. .. ...... : 10320 REFERENCE ID # ... : 99100061 SITE ADDRESS ..... : 1128 DERBYSHIRE DR SUBDIVISION .. .... . CITY .. . . . . . . ..... : CUPERTINO IMPACT AREA . . .... . OWNER . . . . . . . ..... : ISHIDA ATSUSHI AND LILLIAN Y ADDRESS . . . . . ..... : CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-5072 RECEIVED FROM .... : ALAN CONTRACTOR . . . .... : CORPORATION LIC # 20585 COMPANY . . . . . . .... : CONRADO COMPANY INC, THE ADDRESS . . . . . . .... : 14363 SARATOGA AVE CITY/STATE/ZIP ... : SARATOGA, CA 95070 TELEPHONE . . . . . . .. : (408(867-2095 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAD ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 11,000.00 146.90 0.00 146.90 0.00 BSEISMICRE VALUATION 11,000.00 1.10 0.00 1.10 0.00 PERMIT 148.00 0.00 148.00 0.00 `NOTE': THIS RECEIPT HAS FEE CREDITS TOTALING: 20.10 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 148.00 ------------ TOTAL RECEIPT 148.00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 305 FRAME 307 INSULATION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF SAMNS 604 ROOF IN-PROGRESS •