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990800720 L7 C49aS0o1T2 PERMIT 'APPLICATION FOR CITY OF CUPERTINO NUMBER - INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408) 777-3228 PERMIT EXPIRES IF WORT( IS NOT STARTED WITHIN 160 DAYS OF PERMIT ISSUANCE OR 160 DAYS FROM LAST CALLED INSPECTION. BUILDING ADDRESS RESIDENTIAL, COMMERCIAL OTHER OWNER'S - HAZARDOUS FIRE AREA T �I.�IN/1f YES If yes assA NAME 11U IASOyt is reband uttedhat . - mol 8990mf9Y a regtaretl. NO _ InNal LC.B.O. R NO oakAxes-� - EXISTING ROOF COVERING ADDRESS NUMBER OF EXISTING COVERINGS t �JC J LW - -, �"-�-1 go PHONE CONTRACTOR'S Y7 �� Ie ��C;�A 1�C NAME i-� UU ` TO BE REMOVED) TO BE RETAINED 11� 04 ADDRESS Cj I G*p,(. �+, `,t - TYPE OF ROOF COVERING } v CnTYSZIP t I'`tYl'�ieW . .- PHONE 650 - q� - EXISTING BUILT-UP ROOF - LICENSE NUMBER ASPHALT SHINGLES 'LICENSED DECLARATION hereby that em prACTOR9 d under pr, of Chapter B (commencing with Becton - under WOOD SHAKES iaffirmnion urines Professions 7000) of Division 3 of the Business eM Prblesslons Code, end my Ilcenee le In lull lone and exact. License Clava C Uc. Number _ WOOD SHINGLES Data 3- 3- q Li connacta \�f✓S�S\�e 1AC� 14, Y) F-1OTHER (SPECIFY) OWNER -BUILDER DECLAAATI I hereby affirm that I em exempt from the Contractors License Law for the foilowing rseem (Sac. 7031.5, Business enc Professions Cotler Any dry or county which requires a permit M PROPOSED IUl construct, after,Improve,demolish, or repelr my stwoure, pprior to da laeuence, also requires the BUILT-UP ROOF D applicant for such permit to file a signed statement that he o Ibeuseci Pursuant to the provolone of the Contractors Ucenas Law (Chapter 9 (cammenchg whh Section 7000) of Division 3 of the 1' lQV(10 �ggg Business and Prof lore Cade) or that he o exempt Uher<trom and She basis for Ura alleged ASPHALT SHINGLES exemption. Any violation of Section 7031.5 by any apPIXwI for a permit stuf a the applicant to e dvil penalty, of not more than five hundred colors ($500).): WOOD SHAKES C] 1, as owner of the property, or my employam with wages us their able compensation, will do ❑ rQ' the work, and the structure is not Intended or offered for Bale (Sec. 7044, Business and Proles- - alons Code: The Contractors License Lan does not appy to an owner of progeny who builds or WOOD SHINGLES Improves thereon, ono who does such work himaN or through his own empoyeas, provided that such Improvemeno are not Imandeo or offered for sale. It, however, the bulltling or Improvement Is sold within one year of completion, the owner-bullder will have the burden of proving that he did OTHER (SPECIFY) El build or Improve for purpose of sale.). ❑ I, as owner of the property, am excluavery cordrachrhg with licensed corrtw om to cons W ct the project (Sec. 7044, Business and Proleselons Code: %a Contractors Ucense Lew does hot PROVIDE I.C.B.O. REPORT NO. apply to an owner of property who builds or Improves thereon, al who contracts for such projects - MM a contrwor(e) licensed pursuant to the Contractors License Law, PROVIDE MFGRINSTALLATION SPECS ❑ 1 am exempt under Sec. ,B 8 P. C. for this reason . . , Owner Aare APPLICATION DATE VALUATION PERMIT FEE WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury, one of Ute following declaration: ❑ I have will Certificate Consent to for Workers Ccmpansatlon, and maintain a of self -Insure as provided for by Section 3700 of the Labor Cocs, for the performance of the work for which tho p bi 1 �J &0 gulldln g permit Issuedve �'j{ q -- Seismic h wd Insurance, m repulsed by of Worker's Compensationwork ❑ have ane will maintainPerformance -'—' .the Lobar ('.ode, for the performance of Me work for which this permit o osued. My workers b. My drk - O CorrpenInsuranceon Ineunpe carrier and Policy number ere : Total ��./� �ifi CerrlortbA lin5uiI I�xni?, Policy No. WC3�126 PE THORIZATIO DATE CERrIRCATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE N.C{] (This section need rot be completed If the Permit Is for one hundred dollera ($100) or less.) I cardty That In the performance of the work for which this permit is Iasu . I shell not amq v/ any person In any manner w as to become sub) to the Workers' Compensation Laws of Call- Vl All roofs Sh be inspected prior to any rooting material being tome. n installs If a roof is installed without first obtaining an _ Date k-3- qq Applip,n, Q,�iV✓)L� ► / I yw-i o inspection, I agree to remove all new materials for inspection. NOTICE TO APPLICANT: If, after making this CMIIk:ete of Exemption, you should bemme Applicant understands and will Comply with all non point PP P Y P suNec to the Workers' Compensation provisions of the Labor Code, you must foremyth comply with such provisions or this permit aheipbe deemed revoked. source regulations. I urtlry that I have read Ink application end state that the above informetlbn Is correct. I agree to comply with all city enc county ordinances and state lewa relating to bullring constructkn, and All roof coverings to be class "C" Or better. hereby authorize representatives of this dry to enter upon the above-mentioned property for In. spactlon pu mass. (We) agree to save, Indemnify amt keep harmless the City of Cupertino against Ilebllitles, '/ Y. --? Judgments, coots and expenses which may In any way accrue against debut City In consequence SIGNATURE OF APPLICANT DATE of the ranting of the 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 of Cupertino Plan Check Division 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department Subject: Reroofing policy for the City of Cupertino. 1. Prior to permit issuance, you must agree to comply with 1994 UBC Standards and manufactures specifications on reroofing. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the building inspector when the reroofing is completed. 3. All roofs shall be inspected prior to any roofing installation. 4. To receive a final sign off from the City the following steps are required. 1) Preinspection and/or tear off approval. 2) In progress inspection approval. 3) Final inspection approval. • a) Spark arrester installation. 5. If plywood is installed, a plywood nail inspection is required. 6. Any roofing which is applied without first obtaining an inspection, will require the removal of all new material down to the sheathing so that the proper Cityinspection can be performed. We understand the above policy on reroofing and will comply with this policy. Homeowners Name: Address: Reroofing Company N Applicants Signature: Joe Antonucci ' (Chief Building Official) iantii• q?7"3 oreDnonnr ACORD. CERTIFICATE OF LIABILITY INSURANCE DATEMM DO YY 07/(02/99 PRODUCER Construction Unit THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ABD Ins. and Financial Services Island Parkway, Suite 300 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. $ nont, CA 94002-4110 INSURERS AFFORDING COVERAGE _ INSURED Responsible Roofing, Inc. INSURERA:Legion Insurance Company _s 918 N. Rengstorf Ave., Suite "B" Mountain View, CA 94043 INSURER B: INSURER C: _$ $ GENL AGGREGATE LIMITAPPLIES PER: 7 POLICYI PRO F—I LOC INSURER D: INSURER E: I COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE POLICY NUMBER IPOLICYEFFECTI VE1POLICY EXPIRATION DA I LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE) OCCUR EACH OCCURRENCE $ FIRE DAMAGE (Any one Ike) $ MED EXP(Any one person)_ PERSONAL& ADV INJURY _ _s GENERAL AGGREGATE _$ $ GENL AGGREGATE LIMITAPPLIES PER: 7 POLICYI PRO F—I LOC PRODUCTS-COMP/OP AGG S AUTOMOBILE -- _ — — LIABILITY ANY AUTO ALL O W NE D AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Eases dent) S BODILY INJURY (Per person) $ BODILY INJURY (Per accltlent) $ PROPERTY DAMAGE (Per accident) $ -- ARAGE LIABILITY ANYAUTO AUTO ONLY -EA ACCIDENT S OTHER THAN EAACC AUTO ONLY: AGO $_ $ EXCESS LIABILITY_ —I OCCUR u CLAIMS MAD _ DEDUCTIBLE RETENTION $� EACH OCCURRENCE $ $ _AGGREGATE 5 S _ S A WORKERSCOMPENSATION AND EMPLOYERS LIABILITY WC30672698 07/01/99 07/01/00 Yi LTORYLMTS GER E.L. EACH ACCIDENT $1, 000, Q00 E.L.DI SEASE-EAEMPLOYE Sl, 000, 000 ELDISEASE-POLICY LIMI Sl QQQ QQQ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BYENDORSEMENT/SPECIALPROVISIONS TY OF CUPERTINO k0 TORRE AVENUE RTINO, CA 95014 SHOULD ANY OF THE ABOVE DESCRIBED POLCIES RE CANCELLED BEFORE THE OIRRATION DATE THEREOF,THE ISSUING INSURER WILLJU9CK QRHSypAAIL3-Q_DAYS WRITTEN NOTICETOTHE CERTIFICATE HOLDERNAAIEDTOTHE LEFT_CWX/9LEk9LRy0}QyQ7Q]gp[X AL,URD25.5 V/97)l of 2 #M165612 AFR 0 ACORD CORPORATION 1988 INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO BUILDING PERMIT INVOICE Sec: Twp: Rng: Sub: Elk: Lot: INVOICE DATE......: 08/11/1999 REFERENCE ID # ...: 99080072 OPERATOR: chiiStya SITE ADDRESS .....: 22647 OAKCREST SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... I OWNER ............: ADDRESS ..........: 22647 OAKCREST CITY/STATE/ZIP ...: CUPERTINO, CA 95014 CONTRACTOR .......: EDMORE, PAUL M. LIC # 105 COMPANY ..........: RESPONSIBLE ROOFING INC ADDRESS ..........: 918 N RENGSTORFF CITY/STATE/ZIP ...: MOUNTAIN VIEW, CA 94043 TELEPHONE ........: (650)969-6151 FEE DESCRIPTION CHK --------------- --- BPERMFEE P BSEISMICRE P V' ID _v__-__ DESCRIPTION FRAME 601 ROOF TEAR OFF 603' ROOF BATTENS 0 TOTAL FEE PAID -TO -DATE BALANCE DUE --------- ------------ ----------- 197.00 0.00 197.00 1.40 0.00 1.40 198.40 0.00 198.40 VOICE ID DESCRIPTION 307 INSULATION 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS