99070033 3 .4 - do
PERMIT R_
APPLICATION FOR CITY OF CUPERTwo NUMBER . 7
INSPECTION DIVISION PERMfT EJ(PIMTIO
REROOF PERMIT (408) 777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 100.DAYS OF PERMIT ISSUANCE OR
• 100 DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS
o3
C( cCbo- �� RESIDENTIAL COMMERCIAL OTHER
OWNER'S HAZARDOUS FIRE AREA
y�- C YES ❑ It yes understand
-I I a Class A
NAMH.or^ua� AA'F
X J- J-�-f l/l � NO roof assembly is required.
❑ Iruaal I.C.B.O.k
ADDRESS 11 Z2 7 0Ky u4-se AL), Lg CA-44S EXISTING ROOF COVERING
PHONE C O Q NUMBER OF EXISTING COVERINGS /
CONTRALCSOR'S -
r
NAME/ (D �Q 4S0✓l �' G—t--l0 TO BE REMOVED TO BE RETAINED
ADDRESSTYPE OF ROOF COVERING
CITY BZIP4 S (
_/ EXISTING
PHONEY 0�a �K•7 34 BUILT-UP ROOF ❑
LICENSE —7
NUMBER /02 ASPHALT SHINGLES ❑
UCENSED CONTRACTORS DECLARATION
I hereby affirm Mat I am licensed under prwislons of Chapter 9(commencing All Section WOOD SHAKES
7000)of Division 3 of the Rueness and Professions Code,and my license Is In full force and
effect
WOOD SHINGLES
License Gess Lic.Number '
Data Contractor OTHER(SPECIFY) 5EE ONNER-BUILDER DECLARATIONPROPOSEDI hereby affirm that I am exempt from the Contractor's License Law for the followng raeaon.(Sec.7031.6,Business am Profession,Code: Any clry or county which requires a permit toconstruct.alter,Improve,demolish,or repair arty structure,prior to Its Issuance,also requires the BUILT-UP ROOF
applQnt for such pemht to Ne a signed statement that he a licensed Nn uant to the prwalona
of her Contractors License Law(Chapter 9(commencing with Section 7000)of DMslon 3 of the
• Business and Professfons Cade)or Chet he is exempt Ihorefrom and ire basis fpr the alleged ASPHALT SHINGLES
exemption.Any violation of Section 7031.6 by any applkam for a permit sugects the applicant to
a dyll penalty of not more Man has hundred dollars
C]1,as owner of the property,or my employees with wages as their sole compensation,will do WOOD SHAKES ❑
the work,and the structure U not Intended or offered for este(Sec.7046,Business and Proles-
slonsCode:The Contractors License Law does not apply to an owner of property who bullds or WOOD SHINGLES
Improves thereon,and who does such work himself or through Ms own ampleyeee, rcMdaE that El
Improoemene are not intended or offered for sate.If,hovrever,the building or Pmprwamem
Is sold within erre year of completion,the owner4tuider will have Me burden of prwing that he did OTHER(SPECIFY) ❑
not Gdld or Impr.for purpose of sale.).
❑I,as owner of the property,am exclusively contracting wIM licensed contractors to construct
the project(Sec.7044,Business and Profeselons Code:The Contractors Ucease Law does not PROVIDE I.C.B.O.REPORT NO.
apply to an comer of property who builds or Improves thereon,and who contracts for such prolecte
wlth a cwtractor(e)Ilcensed pursuant to the Contractors License Law, PROVIDE MFGR.INSTALLATION SPECS.
❑1 am exempt under Sec. ,B&P.C.for this reason
Owner Date APPLICATION DATE VALUATION PERMIT FEE
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the following dedarellon:
1 have and will maintain a Certificate of Consent to self-i inure for Workers Compensation, OO Building
as provided for by Bectlon 3700 of the Labor Code,for the performance of the work for which this (/�� g .
perms orCode. J seismic
loll have and will maintain Workers Compensation Insurance,as rewired by Sectbn 3700 of Yh//1--s/-e-'7•-1.6((/�
t -Labor Code,for Me performance of Policy
work for whklr Mle permit is fseued.My Workers
�Compensstlan Insurance Dimer and Polley number are: Total
n\ 1
Carrier V r `�.O N nU1.Y Tn.1•S- PNWy N14StL'16-5 0o0 q
� PERMIT AUTHORIZATION DATE
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE NGC
(This section need not be coal I the permit Is for one hundred dollars($100)or lase.)
I cerifty that In the performance of the work for which MIs permit Is Issued:I shall not employ
any person In any manner so ore to become subject to the Worker,'CorawnsatiobLaws of call. All roofs shall be inspected prior to any roofing material being
tor"°. installed. If a roof is installed without first obtaining an
Date Applicant inspection,I agree to remove all new materials for inspection.
su e�ct to the WE TO orkem'Co It,
rsation rwnisionls of the Labor you you should become Applicant understands and will Comply with all non point
a pe p you must forthwith comply
prpr�
to c such with all cry
or d c permit ordinances
and deemed teaawn,r X1 r r g at'
I cortity that l hove read Min applIcatlon end state Mat the alcove Information Is correct.l agree �`J
to comply with all clry and county ordinances end see Iowa relating to building construction,aM A r rID O b0 CIaSS°}(ryr better.
herebypurposes.
urp authorize reprssenletivee of MU dy to enter upon the above-manlloned property for Iry
epeCien(We)agree tos. tD 7�.Q Ca
(We)spree to save,Intlemnlly and keep hermfow 9re City of Cupertino epelnat IlebWtlss,
Iutl tib,coals end expenses which may In any way accrue against saki Ory In consequence
of z granting of this permit. I RE OF APPLICANT 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
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: nancyc
Sec: Twp: Rng: Sub: Blk: LOC:36944006
INVOICE DATE......: 07/23/1999
REFERENCE ID k ...: 99070033
SITE ADDRESS .....: 20300 PACIFICA DRIVE
SUBDIVISION ......:
CITY ... . .........: CUPERTINO
IMPACT AREA .......
OWNER .. .......... : COMMUNITY MANAGE. SERV.
ADDRESS .......... : 7S7 UNIVERSITY AVE.
CITY/STATE/ZIP ...: LOS GATOS, CA 95031
CONTRACTOR ....... : LIC #
COMPANY .......... :
ADDRESS .......... :
CITY/STATE/ZIP ... . ,
TELEPHONE ........ :
FEE DESCRIPTION CHR TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
BPERMFEE P 107.00 0.00 107.00
BSEISMICRE P 0.50 0.00 0.50
--------- ------------ -----------
107.50 0.00 107.50
V CE ID -----.- DESCRIPTION VOICE ID - DESCRIPTION
.. ........... ........ ...... ..............
FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF IN-PROGRESS 604 FINAL REROOF
• 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.
J. 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 shearing at
that time.
IMPORTANT:
1. Flat roofs must have a %d' 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: C, _ o
ADDRESS: �d 3d � ` � C�p �� .
RE-ROOFING COMPNAY NAME:
APPLICANT'S SIGNATURE: ,�� it
. CITY OF CUPERTINO
BUILDING DEPARTMENT
Re-roof/winword
CITY OF CUPERTINO
1 of 1 BUILDING PERMIT RECEIPT OPERATOR: nancyc
COPY q 1
Sec: Twp: Rng: Sub: BIR: Lot:36944006
DATE ISSUED....... : 07/23/1999
RECEIPT 4. ........ : 9690
REFERENCE ID 9 . . . : 99070033
SITE ADDRESS .... . : 20300 PACIFICA DRIVE
SUBDIVISION . .... . .
CITY . .. . . . . . .... . : CUPERTINO
IMPACT AREA ...... .
OWNER COMMUNITY MANAGE. SERV.
ADDRESS . . . ...... . : 757 UNIVERSITY AVE.
CITY/STATE/ZIP . . . : IAS GAIOS, CA 95031
RECEIVED FROM . . . . : TIM
CONTRACTOR .... . . . : LIC q
COMPANY . ...... . . . :
ADDRESS . ..... . . . . :
CITY/STATE/ZIP . . . .
TELEPHONE .... . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
BPERMFEE VALUATION 5,000.00 107.00 0.00 107.00 0.00
BSEISMICRE VALUATION 4,500.00 0.50 0.00 0.50 0.00
PERMIT 107.50 0.00 107.50 0.00
METHOD OF PAYMENT AMOUNT NUMBER
CHECK 107.50 1475
TOTAL RECEIPT 107.50
VOICE ID DESCRIPTION VOICE IO DESCRIPTION
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•
99070033
• 20300 PACIFICA DRIVE 07/23/199
COMMUNITY MANAGE . SERV.
WOOD SHAKES TO ASPHALT SHINGLES
0 $4500
36944006
•