99090127 -3 -7 o -3
PERMIT
APPLICATION FOR CITY OF CUPERTINONUMBER
REROOF PERMIT INSPECTION DIVISION PERMIT EXPIRAT ON
(408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 1M DAYS OF PERMIT ISSUANCE OR
1B0 DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS /�p� �� �
/OSS �Tf rc—c-tpvG �Y� RESIDENTIAL COMMERCIAL OTHER
OWNER'S - HAZARDOUS FIRE AREA
/ YES ❑ M yes-I urdersten!that a Class A
NAME
L�g CD"ns%,gmC27 coo,assemblyisrequired.
NO ❑ InftW I.C.B.O.b
ADDRESS
' EXISTING ROOF COVERING
PHONE NUMBER OF EXISTING COVERINGS
CONTRACTOR'S ,
NAME /�L � �-l�J'—<�!/]/NG' TO BE REMOVED O BE RETAINED
ADDRESS �1/ /� ��,m��� , ' ) ' �2� C �� T�' VERIN
crry s ZIP 7�`7 �I (� ! EXISTING
PHONE �7L / �1�� BUILT-UP ROOF / ��
LICENSE / c�l�L
NUMBER v ASPHALT SHINGLES ❑
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am Ilcenae t under provlelans of Craftier 8(coa nyancing with Section WOOD SHAKES ❑
7000)of Diviskn 3 of the Business and Pefeasiara Code,and my lfcense Is In full force and
affect.
n' ? WOOD SHINGLES ElLcense Clears `/��J/C Lk.Number � 7,91'!r2—
Oita �_
Z �/ Contractor � ��e�V r-' OTHER (SPECIFY) ❑
OWNER-BUILDER DECLARATgN PROPOSED
I hereby affirm thm at I aexempt from the Contractors Lkense Lew for Ne foeawing reason.
(Sec.70211.5,Business and Pefteslora Code: Any city or county which requires a cannot to //�^���
construct,alter,moral demolish,or repair any structure,prior to Its Issuance,also requires the BUILT-UP ROOF
applicant for supermit to file a signed statement that he Is licensed pursuant to the provisions LJ,
ch
of the Cootrectors License Law(Chapter B(commencing with Section 70(X)of DMskn 3 of Me I'JI
• Business and Professions Cape)or Met he Is exempt therefrom and the bests for the alleged ASPHALT SHINGLE
dvill Penalty of not more then five huviolation of Section n1.5 dred ed da�eerep(.S�OOrhj(I SEP
a permit subjects the applicant to SEP O,� 1999 hll
• ❑I,ssawneroltheprowrty,ormyempWyeeewilhwageeashelrwiecargensatbn.wi%do WOOD SHAKES U
Me worn,and the structure Is not Intended or offered for sale(Sac.70",Business and Profes-
sionsCode:The ContmctorsLoaners Lew does not apply to an Owner of property who Wilkie or WOOD SHINGLES
Improves thereon,and who does such work himself or hw
rough his on em loyees.provided that By ❑
such Irthprovehhherha are not Intendetl or offered for sale.If,however,the building or improvement
is I within ane year of completion,the owner-bulltler will have the burden of proving that he did OTHER(SPECIFY) El
build or Improve for purpose of agile.).
0I,as owner of the property,am exclusivity contacting with licensed contractors to construct
the project(Sac.7044,Business and Professions Code:The Coniragor'li Licanso Law does not PROVIDE I.C.B.O.REPORT NO.
apply to an owner of property who bullds or Improves thereon,and who contacts for such projects
with a contractor(s)Ikensed pursuant to the contractors License Lew.
❑1 em exempt under Sec. ,B a P.C.for thio reason PROV
MIA
Owner DateAP U ION MIT FEE
WORKER'S COMPENSATION DECLARATION
1 hereby road under penally of perjury one of the following declaration:
Wo - 1C
❑ have for
Mil maln 37a Cerlfficaa of Convent to perfosurefar Workers Coon wtchi Compensation, Ildl Ib
u proWtlnd for q'Sectim 3700 01 IM19 Lobar Cade,for Me pedormence of the work br whkr Mlv
N
r issued. h
1 have end will maintain Workers Compensation Insuance,as required by Section 37DD of
M L bor Carlo,for the performance of the work for which MIs Per a Issued.My Worker's O
Compensation n911lanC RIB! n 9: S S' - }
Comer Policy No� 12 I DATE
CERTIFICATE OF EXEMPTION FROM WORKERS' ZOW
COMPENSATION INSURANCE N.C.0
(This section need not m completed If he permit Is for one hundred dollars($100)or.less.)
I certify that in the performance of he vvork for which this pamnit Is Issued,I shall not employ
rem,person Inany manner so aro m become Subject to Me Warkers'Compenaation Laws of call- All roofs shall be inspected prior to any roofing material being
onal installed. It a roof is installed without first obtaining an
Data r___ZO "5 y Applicant inspection,I agree to remove all new materials for inspection.
NOTICE TO APPLICANT: If,after making thinCertiilcM -.a.�wtw,a,you should ow�rna Applicant understands and will comply with all non int
subject to the Workers'Compensation provisions of Me Labor Code,you must forthwith comply PP p.Y Po
with such provlsbns or MIs permit shall be deemed revoked, source regulations.
I cerllty that I have read this applitaticn and state that the above Informalion is correct.I epee
to comply with ell dry call county ordinances and MatelBwv relating to building coastacibn,and All roof coverings to be class"C"or better
hereby authorize representatives of this cry to enter upon the above-mentioned property for in.
stop purposes. �s ��
(We)agree to save,Indemnify and keep harmless Me City of Cupertfm agaMst Ilebilhles, 9 Lv
of M g e tingsof flit pand erMt which may In any way,a<srue against said city Inconsequence C 16NATURE-01:APPLICANT DATE I
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
OFFICECOPY
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.
MPORTAiNT:
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:
ADDRESS:
RE-ROOFING COMPNAYNAME: /�✓lj//t�O���L�7/ /rU�Tp/Ci
APPLICANT'S SIGNATURE:
CITY OF CUPERTNO
• BUILDING DEPARTMENT
Re-rmf7winword
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: karenb
l
Sec: Twp: Rng: Sub: Blk: Lot:37523034.00
INVOICE DATE. .....: 09/21/1999 _
REFERENCE ID h ...: 99090127
SITE ADDRESS . ....: 10526 STERLING
SUBDIVISION . ......
CITY ..... . . ......: CUPERTINO
IMPACT AREA ...... .
OWNER .. . . . . . ..... : LOB CONSTRUCTION
ADDRESS . . . . . ..... :
CITY/STATE/ZIP ... : CUPERTINO, CA 95014
CONTRACTOR ...... . : LIC N
COMPANY . . ........ :
ADDRESS . . . ....... :
CITY/STATE/ZIP ... . ,
TELEPHONE ........ :
FEE DESCRIPTION CHK 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
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
FRAME 307 INSULATION
ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
3 ROOF BATTENS 604 ROOF IN-PROGRESS
•
CITY OF CUPERTINO
Item 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: karenb
COPY q 1
Adsk
Sec: Twp: RnS: Sub: Blk: Lot:37523034.00
DATE ISSUED.... . . . : 09/21/1999
RECEIPT #....... . . : 10119
REFERENCE ID # ... : 99090127
SITE ADDRESS ..... : 10526 STERLING
SUBDIVISION ...... .
CITY ... . . ... ..... : CUPERTINO
IMPACT AREA . ..... .
OWNER ... . . ....... : LOB CONSTRUCTION
ADDRESS . ......... :
CITY/STATE/ZIP ... : CUPERTINO, CA 95014
RECEIVED FROM .... : TIM
CONTRACTOR ....... . LIC #
COMPANY . .. ....... :
ADDRESS . . ....... . :
CITY/STATE/ZIP ... ,
TELEPHONE ........ :
FEE ID UNIT QUANTITY AMD= PD-TO-DT THIS RED NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 5,000.00 107.00 0.00 107.00 0.00
BSEISMICRE VALUATION 4,800.00 0.50 0.00 0.20 0.30
---------- ---------- ---------- ----------
TOTAL PERMIT 107.50 0.00 107.20 0.30
OF PAYMENT AMOUNT NUMBER
-- -------- ---- ------
CHECK 107.20 1135
------------
TOTAL RECEIPT 107 20
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ ............................ ........ ............................
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•
CITY OF CUPERTINO '
1 of 1 BUILDING PERMIT RECEIPT OPERATOR: nancyc
COPY q 1
Sec: Twp: Rug: Sub: Blk: Lot:37523034.00
DATE ISSUED. . . .... : 09/21/1999
RECEIPT q. .. . .....: 11216
REFERENCE ID q ... : 99090127
SITE ADDRESS . . . . . : 10526 STERLING
SUBDIVISION . . . .. .:
CITY ..... . . . . . . ..:.CUPERTINO
IMPACT AREA . . . ...:
OWNER ... . . . . . . ... : LDB CONSTRUCTION
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . .: CUPERTINO, CA 95014
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 51000.00 107.00 107.00 0.00 O.OD
BSEISMICRE VALUATION 4,800.00 0.50 0.20 0.30 0.00
PERMIT 107.50 107.20 0.30 0.00
MEi�.JD OF PAYMENT AMOUNT NUMBER
__________ ____________
CHECK 0.30 1135
------------
TOTAL RECEIPT 0.30
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS