99080138 3. Cp 2 - .Z l - .0 08 oil
PERMIT
APPLICATION FOR CITY of CUPERTINO NUMBERA1119M
INSPECTION DIVISION PERMIT EXPIRATION
REROOF PERMIT (408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 1110 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CAI IED INSPECTION.
• BUILDING ADDRESS
RESIDENTI COMMERCIAL OTHER
OWNER'S HAZARDOUS FIRE AREA -
NAME N(N C)\,r.�.?i ) ��_/�j�'� YES ❑ tl yes—I lmdarstaM that a C18s8 A
rad essertrby!&requhed..
No ❑ IrMal I.c.e.o.e
ADDRESS -� EXISTING ROOF COVERING
PHONE got ` NUMBER OF EXISTING C ERINGS 2
CONTRACTOR'S -
TO BE REMOVED TO BE RETAINED
NAME
ADDRESS LqAf l,, n TYPE OF ROOF C.
CITY d ZIP 1//[� V V' EXISTING
PHONE "' BUILT-UP ROOF
LICENSE
NUMBERJIMM 1-4 ASPHALT SHINGLES
UC C NTRACTORS DECLARATION A_
I hereby affirm that 1 arrlicensed under provisions of Chapter 8(commencing with Section WOOD SHAKES
7000)of Division 3 of the B nesa and Proleeabns Code,and my k enee h In full force antl
offs". WOOD SHINGLES
Ucense u r Lk.Number
DateConvenor OTHER (SPECIFY) El
___F 7� WNER� (UDERZMARIATIONI PROPOSED
I hereby affirm that I em exempt from following son.
the Contractors License Law far fire follong rea
(Sec.7031.5,Business antl Professions Cade: Arty city m county which requires a permit to.
con struct,alter,Improve,demolish,or repair an)'structure,prior to lb Issuance,also recums,the BUILT-UP ROOF _❑
apPkcanl for won Permit to its a eigned statement ter he Ie licensed purou int to Me prWl
of.the Contractors License law(Chapter g(commencing whit Section 7000)of Division 3 of the
Business entl Professions Code)or Ilial he Is exempt therel(om and the basis for the staged ASPHALT SHINGLES ❑
exemption.Any violation of Section 7031.5 by any applicant lora Permit subjects Me applicant to
e dull ponalry of not more then five hundred dollars(55(X).):
01,as owner ofthe property,or my empkryees MM wages as their ads compensation,will do WOOD SHAKES ❑
Me work,.rof the structure Is not Intended or offered for sale(Sec.704,Busness and Proles-
elons Code: The Convector'.Ucensa Law does not apply to an owner of property who bunds or WOOD SHINGLES ❑
Improves thereon,and who does such work himelf or through his awn employees,provided that
ouch improvemsras are not Intended or offered for safe.If,however,the building or Improvement
is sold within one year of completion,the owner-builder will have Me burden of proving that he Ntl OTHER (SPECIFY)
not bulb or Improve ler purpose of relclu 1 1 ✓✓
I,ecowner of Meproperty, an Pmfeehty mnimcdrig Tiwith Ilmneorcocenseroio Was not
aMe porgan(Sec. ofprperywh and Proleesicne Code:thereon,
and who
License Lew Was not PROVIDE I.C.B.O.REPORT NO.
apply to c en owner of property who bunt t or Improves therein,eso who contrera for such prgecta
with a contractor(s)n e r Sao
pureuent to Me Contractors ucense law. PROVIDE MFGR.INSTALLATION SPECS.
❑I am exartpl under Sec. ,B 6 P.C.for Mla neem
OwnerDate
WORKER'S COMPENSATION DECLARATION
- APPLICATION DATE VALUATION PERMIT FEE
TK)
I hereby etflmt under p.nairy of perjury one of the following declaration:
❑ have and Sill maln ain 378 of Meaateof Consent M see-formafar Welof
work
on, �II Building
u 01 ha tl for by Section 3700 of Ma Labor Coot, nt to performance of the work for Compensation,
MIs
pemnit Is Iaaued.
�lneve
and wN maintain Workers Compensa0on Insurancl as required by Section 3700 of Seismic
_M§Lebor Code,for Ma performance of Me work for which Mb permit Is Issued.My Workers
Compensation Inwrencel/ar eM Polity n mbar are: Total /
Cerner r reefer
Z_�JJ_q,t1� PERMIT AUTHORIZATION DATE
CERTIFICATE OF MPTION FROM WORKERS'
COMPENSATION INSURANCE IN1.C.)o O
I fele fy Mat I need not li completedthe
II the for
Is for one hundred tlofiere(510D)m less.) `( ( 7
1 Fortify that In Mennen so n to b the ss subject
for which Mie pemat le foamed,1 shell nal empty
any paroin m any manner so to to bemm,e sugect ro woM1ere'comnponsatkn Lawn of cell- All roofs shall be inspected prior to any roofing material being
fornix. Installed. If a roof is installed without first obtaining an
Date Applicant - inspection,I agree to remove all new materials for inspection.
NOTICE TO APPUCANT: It,after making this Cartlficete of Exemption,you al become
subject to the Workers'Campensellon provisions of the Lobar Code,you must forMwhh comply APPIICBnt understands and will comply with all non point
with such provinions or this permit"Obe deemed revoked. Source regulationS-
I certlty Met I have read this application and state Met tea above Information Ism rren.l agree- -
to herebycomply withallriry and county ormnencey and state upon relring to bunticn cl props tion,and All ref'G,OVBrIngS to,B CIa55'C' atter.
hereby t pure authorize repreeentetivee of MFs city to enter upon Me ebwe menl{oned property for In- /�/ //J /� }/�'bl?l
aper e) g purposes.
to Indemnity 0 City P e l C ��� Y _
We agree to.eve,pe s es entl kite hart'way the a of Cupertino a Inst IlabBlti
N menta,mute end expenses whin cosy In any way emrue against uic Gry�n coneepuence SIGNATURE OF APPLICA DATE
N the grening d 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 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 /4"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: ��il.etom)"aX2'Z
ADDRESS: 29Z� G ( l Vlwr Cif •r TO /y
RE-ROOFING COMPNAY NAME: 7 vt6
APPLICANT'S SIGNATURE: /l / J
• CITY OF CUPERTINO
BUILDING DEPARTMENT
Regmgwinword
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: chrlstya
Sec: Twp: Rng: Sub: Blk: Lot:36220020.00
INVOICE DATE...... : 08/19/1999
REFERENCE ID # ... : 99080138
SITE ADDRESS .....: 7825 LUNAR CT
SUBDIVISION ...... .
CITY . . ........... : CUPERTINO -
IMPACT AREA ...... .
OWNER ......... . . . : NAVAREZ, PETER
ADDRESS ....... . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5007
CONTRACTOR ... . . . . : KAHN, RUSSELL LIC N 17999
COMPANY ...... . . .. : CROWN ROOFING INC
ADDRESS ...... . . . . : 214 CRISTICH LN
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE .... . . . . : (408)369-7444
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
BPERMFEE P 197.00 0.00 197.00
BSEISMICRE P 1.40 0.00 1.40
--------- ------------ -----------
198.40 0.00 198.40
V ID ---.--- DESCRIPTION ---...- VOICE ID - DESCRIPTION
-------- -------- ------ ---------------
FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•