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99090116 3 OR 00 l' 3 9q 09 olI'(o PERMIT APPLICATION FOR CITY of cuPERTINO NUMBER INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408)777-3228 PERMIT EXPIRES IF WOW IS NOT STARTED WITHIN 100 DAYS OF PERMIT ISSUANCE OR 100 DAYS FROM LAST CALLED INSPECTION. • BUILDING ADDRESS O� 0 t ��VJ RESIDENTIAL COMMERCIAL OTHER OWNER'S �/y. / ////'''' 1 y y/� ,f�' / /� HAZARDOUS FIRE AREA NAME 10 A✓ 1 ' VSO 1 019e) OVJL _ VES ❑ ��iarMured, sA ✓i NO ❑ In[tkd I.C.B.O.N ADDRESS—g 7/�O // "✓�L/��{/ (� ��• - EXISTING ROOF COVERING PHONE OC7 7' - — F7/✓ NUMBER OF EXISTING COVERINGS CONTRACTORS NAME 6 ��C TO BE REMOVED TO BE RETAINED r'-'�C ' ADDRESS TYPE OF ROOF CORI Crry a ZIP EXISTING PHONE BUILT-UP ROOF 5 / LICENSE c NUMBER ASPHALT SHINGLES ❑ UCEN$ED CONTRACTORS DECLARATION I hereby afflrtn that I can licensed under proviskos of Chapter 0(commencing with Section WOOD SHAK S 7000)of DWision 3 of the Bu urneva and Professions Coda,and my license is In lull force and anew WOOD SHIN / S ❑ License class Dc.Number 4 Data Coronad« OTHER(SP CIFY) VV OWNER BUILDER DECLARATION PROPOSED `SEP 1 6 a) I affirm that am exempt from the e: Any or coup Lew for the brewing mason, lyl9 (Sec.]0315.Business end complier, or rep Cade: Arty city or county which Issuance, also s a parmll to •77 construct.eller,Improve,demolish,or any ,pbrloltel pursuant to the BUILT-U _kgOF of the o for such permit to Ills a alga t r 9(comm Net hw he licensed pursuant D the provisions }'- ol sin ss and Co ntractor's scions Lew(Chapter B is"e cJnptg with om and 7000)of Dfor the ala lee exempla end violation o of Code)or that he is eaampt ant o a end the bashe fon the alleged ASPHALT 3HI t exemption.Any violation a!Section 7031.5 by any applicant her a permit subjects the applkem to aavl penalty d not more Nan IHa hundred dollars(5500).): WOOD SHAKES I,as owner of the property,or my employees with wages as their sole compensation,will W t and the structure is not Intended or offered for sale(Sec.7044,Business and Proles- sionsCode: The Contmctore License Law does'not appy to an owner of papery who builds or WOOD SHINGLES improves thereon,end who does such work himself or Nrough his own employees,provded that ❑ such Impovarnents are not intended or offered for sale.I.havever,the Wilding or Improvement Is sold wilhun one year of completion,the owner-Wilder will have the burden of proving that he did OTHER(SPECIFY) ❑ - not build or Improve for purpose of sale.). ❑I,as owner of the property,am exclusively contracting wkh licensed contracotim to corstruct me project(Sec.7014,BUMness and Professions Coda:The Contractors License Law does not PROVIDE I.C.B.O.REPORT NO. apply to an owner of property who Wide or Improves thereon,and who contracts for such projects with a contractof(a)Ilconsed pursuant to the Contract is License Law. PROVIDE MFGR.INSTALLATION SPECS. ❑lame pl der$ec. ,BB P.C.fro mist Ovine WORKER'S COMPENSATION DECLARATION to APPLICATION DATE VALUATION PERMIT FEE I heraby affirm under penalty,of perjury one of the following deciaratlon: [I !] 7•— I have and will maintain a CorMicata of Consent to self-Insure her Worker7. s Compensation, - O^ ng 9 . as provided he00 d r by Section 37the Labor Coca,for the performance of the wok for which this V Buildi permit Ie headed. D ❑I have and will maintain Worker's Compensetlon Insurance,as refulred by Section 3700 of r Seismic the Labor Coda,for the performance of the work for which thus permit Is Issued.My Workers Compafsation Insurance canter and Policy number are • Total Canter PoncyNo. PERMIT AUTHORIZATION DATE CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE N.CQ (This section need not be completed It the permit is her oro hundred dollars($100)or lase.) I certify that in the perlormerce of the work for which this permit Is Issued,t shell rwf employ any parson in any manner so as to become subject to the Workers'Compensation Laws of Cell. All roofs shall be Inspected prior to any roofing material being forma. installed. If a roof is installed without first obtaining an Data Applicant inspection,I agree to remove all hew materials for inspection. NOTICE TO APPLICANT: If,after making this Certificate of Exemption,you shroud become Applicant understands and will comply with all non point subject to the Workers'Compensation provisions of me Labor Code,you must forthwith comply. pp P Y p with such provisions or this permit shall W deemed revoked. source regulations. I cauty Net l here read this application and state that me above lnformetfon is correct.I agree /• to comply with all city and wanly ortlineeeeea end slate laws relating to Wldlrgconatrucllon,end IIr cverings�q eclass rbetter. /rp7•r/� hereby authorize represenlatives of Wa city to enter upon the aoo'.e-manldnetl property iron In- U// specldn purposes. (We)agree to save,indemnify and keep hemtieas me City of CuperWa egelM eaNtltiee, judgmens,meb arid expns aes any may In away accrue against and Guy un c«lsesuence S AT RE OF APPLICANT DAT of I= granting of this permit. 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 OFFICE COPY INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO . BUILDING PERMIT INVOICE OPERATOR: christys Sec: Twp: Rng: Sub: Blk: Lot:36908013.00 INVOICE DATE. . ....: 09/16/1999 REFERENCE ID # ...: 99090116 SITE ADDRESS .....: 10289 E ESTATES DR SUBDIVISION ....... CITY .. ...........: CUPERTINO IMPACT AREA ....... OWNER ............: OBRADOVIC, JOHN ADDRESS ..........: CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-3312 CONTRACTOR ....... : LIC W COMPANY .......... : ADDRESS ......... . : CITY/STATE/ZIP ... . , TELEPHONE .... . . . . : FEE DESCRI POTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE --------------- --- --------- _ BPERMFEE P 97.00 0.00 97.00 BSEISMICRE P 0.50 0.00 0.50 --------- ------------ ----------- 97.50 0.00 97.50 ID -..__-_-DESCRIPTION--------- --------VOICE ID - DESCRIPTION FRAME 307 INSULATION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS C CITY OF CUPERTINO - BUILDING DEPARTMENT RE-ROOFLNG 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 J. i. 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 sheating at that time. LMPORTANT: 1. Flat roofs must have 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 CONIPLY WITH THE POLICY. I HOMEOWNER'S NAME: I fJH�✓ �l z ADDRESS: ZO Cg1 �Sr�rEs RE-ROOFING COMPNAY NAME: APPLICANT'S SIGNATURE: A- CITY OF CUPERTINO BUILDING DEPARTNIENT Re-ml7winword CITY OF CUPERTINO I• 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: chrietya COPY # 1 Sec: Tp: Rog: Sub: Blk: LGt:36908013.00 , DATE ISSUED....... : 09/16/1999 RECEIPT q......... : 10100 REFERENCE ID k ... : 99090116 SITE ADDRESS ... . . : 10289 E ESTATES DR SUBDIVISION . . . . ... CITY ..... . . . . ....: CUPERTINO IMPACT AREA . . ..... OWNER ... . . . . . .. ..: OBRADOVIC, JOHN ADDRESS .. .. . . ....: CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-3312 RECEIVED FROM .... : TIM CONTRACTOR ....... : LIC N COMPANY ........ .. : ADDRESS ........ . . : CITY/STATE/ZIP . . . . TELEPHONE ........ : FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL --""----- ------------- --- ---------- -----"'-- ---------- ---------- BggP��ERMMMFEE VALUATION 4,000.00 97.00 0.00 97.00 0.00 H� ICRE VALUATION 9,000.00 0.50 0.00 0.50 0.00 PERMIT : 97 50 0.00 97.50 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CASH 97.50 ------------ TOTAL RECEIPT 97.50 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 :r