99090166 � Q��� PERMIT
APPLICATION FOR CITY of CUPERTINoJ NUMBER
INSPECTION DIVISION PERMIT EXPIRATK)N
:t REROOF PERMIT (408)7773228 - PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 190 DAYS OF PERMIT ISSUANCE OR
190 DAYS FROM LAST CAI IED INSPECTION.
OBUILDING ADDRESS ,1 / - {/J� I
/— .
/ D L kf}/V c to 1 RESIDENTIAL COMMERCIAL OTHER
OWNER'S HAZARDOUS FIRE AREA
A I U VES ❑ If yes—I understand that a Class A
NAME ,' l L I C / 1 � roof asSemMy Is required.
/ NO Initial I.C.B.OA
ADDRRESS Z1yE b /4C EXISTING ROOF COVERING
NUMBER OF EXISTING COVERINGS S
PFON ° L 3
CONTRACTOR'S
NAME �t li^
S IZl l ( TO BE REMOVED TO BE RETAINED
ADDRESS - IYPE OF ROOF COVERING
CITY B ZIP f � 41
EXISTING ///
PHONEZoa 6 yo,? - 69Z - $733Y BUILT-UP ROOF E-1 ! ��
NUMBER
LICENSE -�5-9 ,7 5-iJASPHALT SHINGLES 1W
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed untler provisions of Chapter 9(commencing with Section' WOOD SHAKES 11QN
]000)of Dlvislon 3 of the Business and Professions Cade,and my license is in full force and
effect. WOOD SHINGLES
Dere ❑
License Class Lk.Number 7 5"q 1 Shp _
-L17-9contractor 9 SHilRtL.-1 ( f�.00F/�+g OTHER (SPECIFY) /❑ r
OWNER-BUILDER DECLARATION I
!
(r—,�
PROPOSED D If t
I hereby affirm that I am exempt from the Conformers License Lew for the following reason.
(Sac.7031.5,Business and Profession Cone: Any dry or county,which requires a permit to
construct,alter,improve,dengllsh,or repair any structure,prior to its sentence.also r tares the I
applicant for such permit to lib a aignad sW emeni that he is l renB L -UP OOF SEPo+ 1999
of the Connectors Dceree Lew(Chelator h(commenting with om 'v �n
Business and Professions Cade)or that he b exempt therefromto I S
exempfion.Any solaten of Sectlon 7031.5 by any applicant for a pa p
e civil penalty of rot more than live hundred dollars($500).): y
C]1,as owner of the property,or my employees with wages u theirm
the ward,end the slmcture is not imancad or offered for sale(Sec.' se
cions Code:The Contractors License Law does not apply to an ownepe II I ES ❑
improves thereon,and who does such work himself or through his ow
such improvements are not Intended or offered for sale.It,however,teh t id build Minoneve for purpose ofn.iheowner-Wlltler will nava I ❑rot bald or improve for f comply io sale.).
❑I,as owner al the property,am exclusively contras ring with II
the project(Sec.]044,Business end Professions Cade:The Con t PORT NO.
apply to an owner of property who builds or Improves thereon,and wwith a contractur(s)9cansetl pursuant to the Contractor's License Le1 am exempt under Sec. .C.for fhie reason PROVIDE MFGR.INSTALLATION SPECS.
o«ner DaAPPLICATION DATE VALUATION PERMIT FEE
WORKER'S COMPENSATION DC-CLAAATII hereby affirm under Penally of perjury one of the following decla /b�,I have and will maintain a Certificate of Consent to sag-Insure fors CompenWan' Building
as prodded for by Section 37M of the Labor Code,for the pedormence of the work for which MIs
permit is issued.
E]I have and will maintain Worker's Compensation Insurance,as required by Section 3]00 of 581smIC III,yp
the Labor Cotle,for Me pedormenw of the work for which MIs permit Is Issued.My Worker's 0 Z d //a00
,
Compensation Insurance carder and Polley nu`" er are: , z Total lk /
Combat STATt f V^jQ Policy No. PERMIT AUTHORIZATION DATE
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE n reN.C{]
"a section not be completed it the permit is for one hundred tlollers(S 100)or less.)
I cemily that In Me performanro of the werx for which MIs Permit Is Issued,I shall rot employ, G
any person In arty manner so as to become subject to the Workers'Compensation Laws of call- All roofs shall be inspected prior to any roofing material being
forms. 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: It,after making this Certificate of Exemption,you should become understands and will coon
subject to Me Workers'Compensellon provisions of Me Labor Code,you must forthwith reply A pPIICzn1 ply with all non point
with soon provisions or this Permit shall be doomed revoked. Source regulations.
I certify that I have read this application and state that the above Information Is cathect.I agree
to comply with all city and county ordinances and state laws retailing to building construbfian,and All roof coverings to beclass or better.
hereby authorize refxesenetivoe of has city to enter upon Me above-mentioned property for in-
"
suection purposes,
(We)spree to save;indemnify and keep harmless the City of Cupertino against Ilebifties,
Judgments,costs and expenses whlch may In any way aroma against said Citym cansequeroe
of the prenting of ihie permit. S ATURE 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 ACCESSTO ROOF SHALL BE PROVIDED FOR INSPECTION
.OFFICE'COPY
CITY OF CUPERTINO
1 of 1 BUILDING PERMIT RECEIPT OPERATOR: n&ncyc
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:35703015.00
DATE ISSUED...... . : 09/28/1999
RECEIPT N. ....... . : 10166
REFERENCE ID q .. . : 99090166
SITE ADDRESS ..... : 10251 A RANCHO PL
SUBDIVISION . ..... .
CITY . ... . . . . ..... : CUPERTINO
IMPACT AREA . . .... .
OWNER ... . . . ...... : NO ALICE J
ADDRESS .. . . . . .... :
CITY/STATE/ZIP ... : WEBSTER TX, 77598-
RECEIVED FROM .... : TIM
CONTRACTOR . . ..... : LIC N
COMPANY . . . ....... :
ADDRESS . . . .. ..... :
CITY/STATE/ZIP ... .
TELEPHONE . . . . .... :
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
__________ _____________ __________ __________ __________ __________ __________
BPERMFEE VALUATION 11,000.00 167.00 0.00 167.00 0.00
BSEISMICRE VALUATION 11,000.00 1.10 0.00 1.10 000
o
__________ __________ __________ __________
Z PERMIT 168.10 0.00 168.10 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ____________ __________________
CHECK 168.10 1157
------------
TOTAL RECEIPT 168.10
VOICE ID DESCRIPTION VOICE IO DESCRIPTION
........ ............................ —..... ........ _..................
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 609 ROOF IN-PROGRESS
•
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: nanCyc
Sec: Tp: Rng: Sub: Blk: Lot:35703015.00
INVOICE DATE..... . : 09/28/1999
REFERENCE ID # . . . : 99090166
SITE ADDRESS ... . . : 10251 ARANCHO PL
SUBDIVISION ... . . . .
CITY . . . . . .... . . . . : CUPERTINO
IMPACT AREA . .. . . . .
OWNER . . ... . . . . . . . : HO ALICE I
ADDRESS ... . . . . . .. :
CITY/STATE/ZIP . .. : WEBSTER TX, 77598-
CONTRACTOR . . . .... . LIC #
COMPANY .. . . . ..... :
ADDRESS .. . . ...... :
CITY/STATE/ZIP ... .
TELEPHONE . . . ..... :
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
_______________ _-- --------- ------------ ________---
BPERMFEE P 167.00 0.00 167.00
BSEISMICRE P 1.10 0.00 1.10
--------- ------------ -----------
168.10 0.00 168.10
ID ........DESCR=PT=O:.-.---_-_ VOICE ID ....... .DESCRIPTION
. .. ........ .................
IS FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•
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 J.
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 %<" 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: A L Gc 40
ADDRESS: 7-115;- Lr�7/,Ac LN Alacg rJ 9///
RE-ROOFING COMPNAY NAME: nSV�RwL� I` D D FiAI 6
APPLICANT'S SIGNATURE:
• CITY OF CUPERTINO
BUILDING DEPARTMENT
Re-rwi7winword