99080193 PER
APPLICATION FOR CITY OF CUPERTINO NUMB
INSPECTION DIVISION PERMIT EXPIRATION
REROOF PERMIT
(408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN MVS OF PERMIT ISSUANCE OR
WI DAYSS FROM LAST CALLED INSPECTION.
BUILDING
- ESADDRESS
L V� J 4, 1.01.5-3 GaYcL-;6,cV U, ' RESIDENTIAL COMMERCIAL OTHER
-
HAZARDOUS HAZARDOUS FIRE AREA
YES ❑ It yes-I understand that a Class A
NAME oof assembly is required. _
NO Initial I.C.B.O.tl
ADDRESS 5 ✓�'� G EXISTING ROOF COVERING
PHONE NUMBER OF EXISTING COVERINGS
CONTRACTOR'S
TO BE REMOVED TO BE RETAINED
= NAME
ADDRESS TYPE OF ROOF COVERING
` CITY 6 ZIPPOA17
EXISTING I\1
PHONE r CCII�� BUILT-UP ROOF ❑
LICENSE
NUMBER ASPHALT SHINGLES ❑
LICENSED CONTRACTORS DEhapter (c 1I �
hereby affirm that em Business
licensed!and
Pr provisions of Chapter B(commencing win Section WOOD SHAKES fY3�IT /
7000)of Division 3 of Ma Buslneea entl Proleselann code,and my license Is In lull force and
enact. /, n� n'/ WOOD SHINGLES ❑
License Clens Lb.Number YGf ��fY�
Date Contractor OTHER(SPECIFY) ❑
OWNER-BUILDER DECLARATION PROPOSED
I hereby affirm that I am exempt from the Contractors Ucrosa Law for the following reason.
(Sec.7031.5,Business and Profesabnn Code: Any dry or county which requires a permit to
construct,alter,Improve,demolish,or repair any structure,prior to its Issuance.also requires the BUILT-UP ROOF El
for Such permit to fib a algnad statement that he b licensed pursuant to the prov Slone
• of the Contractor's Llcense Law(Chapter B(commencing with Section 7000)of Division 3 0l the
es 'J
Busins and Professions Code)or that he Is exempt therefrom and Me basis for the alleged ASPHALT SHINGLES sT9Y
exemption Any violation of Section 7031.5 by any applicant for a permit Subjects the applicant to
e cMI penally of not mors than five hundred dollars($500).):
❑1,as"net of the property,Orr try,employees with wages es their We compensation,will do WOOD SHAKES ❑
the work and the structure le not Intended or offered for sale(Sec.7044,Business mc!Protea.
alone Code:The Contractors ucsme Law does rot apply to an owner of meperry who Wide or WOOD SHINGLES
Improves thereon,and who does such work himself or through his own employees,provided Met ❑
uch Improvements are not Intended or offered for sale.If,however,the building or Impravament
Is add wnhln one year of compkllon,the miner-bulber will have the burden of proving Mat he did OTHER(SPECIFY)SPECIFY)
not bulb or Improve for purpose of sale.). ❑
❑I,mn arol Mepmperry,amexdushelywntredln wllh lkaraetl contractors to cortetruct
Me project(Sao.7044,Business and Professions Code:The Contractors License Lew does not PROVIDE I.C.B.O.REPORT NO.
apply to an owner of property who bulbs or Improves thereon,and who contrecta ler such projects
with a contractor(a)licensed pursuant to Me Contractors License Law. PROVIDE MFGR.INSTALLATION SPECS.
• ❑I em exempt under Sec. ,B a P.C.for Mb reason
Owner oats ON DATE VALUATION PERMIT FEE
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following deckretlon:
w` ❑1 have and will mamaln a Certificate of Consent to aelfansure for Workers Compemetlon, Building
as provided for by Section 3700 of the Labor Code,ler Me performance of Me work ler which Mle 8
Permit is issued. [�[` "
❑I have and will maintain Workers Compensation Insurerwa,es requlretl by Section 3700 01 66g1 n $eISmIC �`�.6
Me Labor Code,for the performance of Me work ler which this pendt b Issued.My Workara 9 2r J^
Compennad 1 urancecerrier and Poll number ere: II Q'd Total
Carrier Y/�r /�� V Polky N I If P MU- UT I DATE
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE IN
(Thio Section sti cwt be completed If the permll Is leon
r e hundred tlollaze fill 00)or bite.)
I certify that In the performance of the work ler which this permit Is Issued,I shell not employ
.any person In any manner So as to become Subject to the Workers'Compensation Laws of Celle All roofs b a I be inspbcted pfforto any roofing material being
fornia. installed. If a roof is installed without first obtaining an
Data Appaoam inspection,I agree to remove all new materials for inspection.
subleon to th Works n Coompelantio�r�slonls off tihe LLaatbor Cof Exemption,eue�i II ftrwq Applicant understands and will comply with all non point
with such provlelons or this permit Shell be deemed revoked. Source regulations.
I cortlfy that I have rand this application and Stele Mat Me above Information Is correct.)agree
to comply with all city and county ordinances end state laws relating to bulklrp construction,entl All roof co sto be class"C"or better.
hereby aunnerize representatives of this city to enter upon the above-mentioned prop"ler In-
_ r spectbn purposes.
(We)agree to Save, Indemnlfy and keep harmless the City of Cupertino against Ilablllties, �
. judgenpe
to,conte entl expenses which may In any way accrue against geld CityIn coAesquence
of ® granting of this permit SIGMAPPLICKINT 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 ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION
OFFICE COPY '
i
• 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.
1. 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.
IMPORTANT:
1. Flat roofs must have a 'Y<" 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: �gQE&/— 16_'olxF
ADDRESS: 1(2�/ SS 2 /OL3 64606A1114RE—ROOFING COMPNAY NAME: /,573 G,4rd5
APPLICANT'S SIGNATURE:
• CITY OF CUPERTINO
BUILDING DEPARTMENT
Re-roogwinword
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: yvonnek
Sec: Twp: RnB: Sub:.Blk: Lot:32608068.00
INVOICE DATE. . . . . . : 08/26/1999
REFERENCE ID # . . . : 99080193
SITE ADDRESS . . . . . : 10653 GARDENA CT
SUBDIVISION .. . . . . .
CITY . ........ . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . ....: PEAKS
ADDRESS . . . . . .....: 10653
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-1614
CONTRACTOR ....... : RADONICH, GARY LIC # 17814
COMPANY .......... : LOS GATOS ROOFING
ADDRESS .......... : 1771 SMITH AVE
CITY/STATE/ZIP ... : LOS GATOS, CA 95030
TELEPHONE ........ : (400)350-1233
NOTE: THE FEES LISTED ARE ONLY THOSE DUE BEFORE PERMIT PRINTING
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ ----------- .
BPERMFEE P 177.00 0.00 177.00
BSEISMICRE P 1.20 0.00 1.20
--------- ------------ ------`---
178.20 0.00 178.20
ID DESCRIPTION VOICE ID DESCRIPTION
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS