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99080014 -3 �3 0 3 2 9 0?00/ PERMIT APPLICATION FOR CITY OF CUPERTINO NUMBER INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS II � �RIVe � RESIDENTIAL COMMERCIAL OTHER OWNERS 1,a l SNI - HAZARDOUS FIRE AREA NAME I vn/CFI/ 1 V I ZA YES ❑ It yes—I understand that a Class A rant assembly is required. q _ 14 NO ❑ Initial I.C.B.O.q ADDRESS tG� EXISTING ROOF COVERING PHONE U�. .Zh�S y� NUMBER OF EXISTING COVERINGS ' CONTRACTOR'S1 NAME I Ci I `OU 1"I NL� 1 TO BE REMOVED 1 TO BE RETAINED ADDRESS Irl l-/ � A VL �p� I�gyu3S TYPE OF 3OOF CVERIN CITY B ZIP [,�V o q, Kl� pAp` 1 ��j]�\ PHONE 1 U�` 12_L7 � I 1 67 BUILT-UP ROOF D AU(173 LICENSE 2 _ ��' ASPHALT SHINGLES ❑ 1999 D NUMBER LICENSED CONTRACTORS DECLARATION I hereby affirm that I em licansed under provisions of Chapter B(commencing with Section WOOD SHAKES ]000)of Dri 3 of the Business and Professions Code,and Try Worse Is In full force and By /5 2 WOOD SHINGLES License C `' L{c.NumEe �� Date C u IW L Oovf!IN OTHER(SPECIFY) ONTJere the ori CL LCA ROP ED hereby affirm Net I am exempt born the Contra ar's License ar a (Sec.7031.5,Business and Prolesebrvs Code: Any which req a permit to 7 construct,after,Improve,demolish,or repair any structure,prior to Its issuance,also requires the BUILT-UP ROOF ❑ applicant lar such permit to Idle a signed statement that he Is licensed pursuant to the provisions of the Contractors License Law(Chapter g(commerxdrg with Sedlon]000)of Division 3 of the Business and Profeeaiarus Code)or that he Is exempt therefrom and the basis for Ne alleged ASPHALT SHINGLES Elexemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to h a civil penalty of not rears then five hundred donars(551X)).): WOOD SHAKES 7 2 ❑I,as owner of that property,or my employees wkt h wages as their sole componsan,wOl CIO - ❑ the work,and the structure Is not InteMed or offered for seder(Sec.704 ,Business and Proles- ' sons Code:The Contractors License law does not apply to an owner of property who builds or WOOD SHINGLES ❑ Improves thereon,and!who who does such work meelf or through his own employees,provided that each improvements are not Intancetl or offered for sale.It,however,me lauittling or Improvement �r Is sold wkNn one year of completion,the owner-butider will have the burden of proving that he did OTHER(SPECIFY) Ylltd% (RWM not build or Improve for purpose of sale.). ,y E]1,as owner of the property,am exclurmay contracting with licensed contractors to construct the project(Sec.70",Business and Professions Code:The Contractors Ucense Caw does not PROVIDE I.C.B.O.REPORT NO. V apply to an owner of property who builds or Improves thereon,and who contracts for such projects with a contract«(s)Iiceaved pursuant to the Contractor's Ucenae Law. PROVIDE MFGR.INSTALLATION SPECS. El I am exempt under Sec. ,B 6 P.C.for this reenon Owner Date APPLICATION DATE VALUATION PERMIT FEE WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the folbwing dadaretbn: / I have and will maintain a Corsicana of Consent to self-Insure for Workers Compensation. Building as provided for by Section 3]0001 the Labor Cade,W the performance of the wadi for winch this ,(� '.�y�� senmp is issued. 13 �l,l„ W— Seismic J�ZIL yrrr�have and will mal none Workers Compensation Ineurence,as required by Secilon 3700 of (, w tKe LNmr Cotler,for the performance of the work for which this permh is Issued.My Workers Comprrace lon Insurance carrier and!Policy number are: Total pV� Carrier � - l Policy No. ` I-`l$-)Ofr,'�J PERMIT AUTHORIZATION DATE CERTI CATS OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE N.C.[] (This vection need not be completed it the permh Is for one hundred dollars(S100)or leas.) I codify that In the performance of the work for when this permit is issued,I shell hat erePlay, any person In any marmer w as to became subiset to Ne Workme'Compensation Lawn of D81L All roofs shall be insp ed prior to any roofing material being foredo. installed. If a roof is installed without first obtaining an Date Applicant inspection,I agree to remove all new materials for inspection. NOTICE TO APPLICANT: If,after making this Certificate of Exemption,you should became Applicant understands and will comply with all non point subject to the Workers'Compensation provisions of Ne Labor Code,you must forthwith comply PP P Y P with such proNsbnv or this permit shall be deemed revoked. source regulations. I canity that I have read this opal and state that the above Information le coned I to comply with all city and county ordnances and state laws relating to banking cons and Hirripof coverings to be classb or better. hereby authorize representatives of this city to enter upon the above-meribrod or arty far In. spechon purposes. �(We)agree to save,Indemnity and keep hermleas the Cly of Cupertino a net lladlltiea, of the ntht�ol Ne expenses which may a err,way awue agahmt sale Cary In aeras � IGNATUR F APPLICA T 9a^ g per RE-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 • 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 shearing 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. nI HOMEOWNER'S NAME: ADDRESS: �'f��1 AOL.-a / k1t �,uoNv RE-ROOFING COMPNAY NA Ul1�l t4W APPLICANT'S SIGNATU • CITY OF CUPERTINO BUILDING DEPARTMENT Re-mof/winword INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE Y, CITY OF CUPERTINO • BUILDING PERMIT INVOICE OPERATOR: nancyc Sec: Twp: Rug: Sub: Blk: Lot:36230032.00 INVOICE DATE...... : 08/03/1999 REFERENCE ID # ... : 99080014 SITE ADDRESS ..... : 7495 MOLTZEN DR SUBDIVISION ...... . CITY .. . . . . . . ..... : CUPERTINO IMPACT AREA . ..... . OWNER . . . . ....... . : NIZZA RICHARD ET AL ADDRESS . ........ . : CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-5048 CONTRACTOR ... .... : PROCTOR, PAUL LIC # 19698 COMPANY . . . . ...... : R E ROOFING ADDRESS . . ........ : 108 OAKLAND PL CITY/STATE/ZIP ... : LOS GATOS, CA 95032 TELEPHONE ........ : (408)925-9995 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 Building Permit Fee Code Checklist Qty. if Applicable Fee ID Fee Description Fee Group • p.�.� ' _� FiQ�S:TiR_�'L�3Tt�O'�.;Ti'P;X�=�^': y. . BUIh�ING--;;;::�; r BCONSTAX CONSTRUCTION TAX BUILDING BENERGY ENERGY BUILDING BENERGYADD ENERGY ADD MULTI BUILDING BOVERTIME INSPECTION OVERTIME BUILDING BPERMFEE BLDG PERMIT FEES BUILDING BMITIGAT HOUSING MITIGATION FEE BUILDING BPLANCHK PLAN CHECK FEE BUILDING BPLANCKADD PLAN CHECK ADD MULTI BUILDING BPLANCKREP PLAN CHECK REPEAT FEE BUILDING BREINSPECT REINSPECTION FEE BUILDING BSCBLVD SCB SPECIFIC PLAN BUILDING BSEISMICOM SEISMIC COMMERCIAL BUILDING 71 BSEISMICRE SEISMIC FEE RES BUILDING ESPECIAL SPECIAL INSPECTION BUILDING BSWIM SWIMMING POOL BUILDING ZADDCHG ADDRESS CHANGE BUILDING BELEC1001 ELEC 600V>1000A ELECTRICAL BELEC200 ELECT SVCS 600V <=200A ELECTRICAL BNEWMULTI MULTIFAMILY RES ELECTRICAL BREMBUSWAY REMODEL BUSWAYS ELECTRICAL BREMFIXT LIGHTING FIXTURES ELECTRICAL BREMMISC MISC APPARATUS ELECTRICAL BREMNRAPP REM NON-RES APPLIANCE ELECTRICAL BREMPOLE POLE/PLATFORM FIXTURE ELECTRICAL BREMPOWER POWER DEVICE/APPARATUS ELECTRICAL BREMRECEPT RCPTL, SWITCH &OUTLETS ELECTRICAL BREMRESAPP REMODEL RES APPLIANCE ELECTRICAL BREMSIGNAD RMDL SIGNS ADD BRANCH ELECTRICAL BREMSIGNS REMODEL SIGNS, MARQUEE ELECTRICAL BREMTHEATR THEATRICAL LGHTNG FIX ELECTRICAL BSF&2FAM SINGLE & 2 FAMILY ELECTRICAL BTEMP TEMPORARY POWER ELECTRICAL BTEMPSVCS TEMP DIST SVCS ELECTRICAL EPERMITFEE ELEC PERMIT ISSUANCE ELECTRICAL F1 EES 4EqffAN[CA BBOILERI BOILER <= 100,000 BTU MECHANICAL BBOILER2 BOILER >100KTO500KBTU MECHANICAL 650ILER3 BOILER >500K TO 1M BTU MECHANICAL BBOILER4 BOILER>1M TO 1.75M BTU MECHANICAL BBOILER5 BOILER > 1.75M BTU MECHANICAL BREMACOVER AC UNIT>10000CFM MECHANICAL BREMAPPLI APPLIANCE INSTALL MECHANICAL BREMHEAT HEATER INSTALLATION MECHANICAL BREMVENFAN VENT FAN SINGLE DUCT MECHANICAL • BMNEWMULTI NEW MULTI-FAMILY RES MECHANICAL BMNEWSF&2F NEW SF&2F RES BLDGS MECHANICAL Building Permit Fee Code Checklist BREMAIRHAN A/C UNITS <= 10,000CFM MECHANICAL • BREMFURN RELOCATION OF FURNACE MECHANICAL BREMFURNOV RELO FURNACE > 10K BTU MECHANICAL BREMINHOOD INSTALLATION OF HOOD MECHANICAL BREMRELOCA RELOCATION OF HOOD MECHANICAL BREMREPALT REPAIR/ALTER HEATING MECHANICAL BREMVENSYS VENTILATION SYSTEMS MECHANICAL MPERMITFEE MECH PERMIT ISSUANCE MECHANICAL ZQE F,R DE7,,EMEMEW'GREEMEN:T ,; EMNNING;',9 rl ZDIRTM DIR TENT MAP PLANNING ZFULLHR FULL APPL BASE + HR PLANNING ZFULLTM FULL APPL TENT MAP PLANNING ZFULLUP FULL APPL USE PERMIT PLANNING ZFULLZONE FULL APPL ZONING PLANNING ZGPAMEND GENERAL PLAN AMEND PLANNING ZLIMAMEND LIMITED AMEND PLANNING ZLIMTM LIMITED TENT MAP PLANNING ZLIMUP LIMITED APPL USE FERMI PLANNING ZMATEMPUP MIN AMEND TEMP USEPERM PLANNING ZMINHILLEX MINOR APPL HILL EXC PLANNING ZMINSIGNEX MISC SIGN EXCEPTION PLANNING ZMINTM MINOR APP TENT MAP PLANNING ZMINUP MINOR APPL USE PERMIT PLANNING ZMISCASA MISC ARCH SITE PLANNING ZMISCEXT MISC TM AND UP EXT PLANNING ZMISCFENCE MISC FENCE EXCEPTION PLANNING ZMISCGEN MISCELL APPL GENERAL PLANNING ZMISCPCINT - MISC PC INTERPRETATION PLANNING ZSIGN SIGN FERMI PLANNING ZTEMPSIGN TEMPORARY SIGN PLANNING ZVARIANCE DIRECTOR VARIANCE PLANNING LN{�TL RSL i is . PEF,i[t WJSSU E Z 2 M V.F1M6[C=Z BNUMULTI NEW MULIFAMILY RES PLUMBING BNUSFD NEW SINGLEFAMILY RES PLUMBING BPBACKFLOW ATMOSPHERIC VACUUM PLUMBING BPCESSPOOL CESSPOOL PLUMBING BPFIXTURE PBLG FIXTURE PLUMBING BPGAS GAS PIPING SYSTEM FEE PLUMBING BPINTERCEP IND WASTE INTERCEPTOR PLUMBING BPREPIPE REPIPE OF FIXTURES PLUMBING BPSEWAGE SEWAGE DISPOSAL PLUMBING BPSEWER SEWERS PLUMBING BPSPRINK LAWN SPRINKLER/BACKFLO PLUMBING BPSTORM STORM/RAIN WATER PLUMBING BPTRAP KITCHEN TRAP PLUMBING BPVENT ALT OF DRAIN &VENT PLUMBING BPWATER INSTALUALTER WATERPIP PLUMBING BPWHEATER WATER HEATER/VENT PLUMBING • BPWSVCS MAIN WATER SERVICE PLUMBING