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99080049 3 7 5 cP O 0( 01,0 goo 4 PERMIT APPLICATION FOR CITY OF CUPERTINO NUMBER INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408)m-3228 PERMIT EXPIRES IF WOW IS NOT STARTED _ WITHIN ISD DAYS OF PERMIT ISSUANCE OR 1B0 MY$FROM LAST CALLED INSPECTION. BUILDING ADDRESS , 'l/,� 0 IYZV ` L��-+�� I� PIG• RESIDENTIAL COMMERCIAL OTHER OWNER'S - HAZARDOUS FIRE AREA (y� YES ElIf I understand Mat a Class A NAME �l I� ( C� T�Q'L� �jt \ �S ��' `A"� l d semby isregWred. NO ❑ InWel I.C.B.O.N ADDRESS 10(02'0 [�I �S�l PIC'• EXISTING ROOF COVERING PHONE / NUMBER OF EXISTING COVERINGS CONTRACTOR ,/�I � C_t P GU P I 70 BE REMOVED ( TO BE RETAINED NAME 1_lv ADDRESS (O mA-0�.� l TYPE OF ROOF COVERING CITY a ZIP q 2 EXISTING G1 PHONE / J ' � 16 D BUILT-UP ROOF LICENSE Q /J / !n NUMBER _( (� SE CO ASPHALT SHINGLES ' _ �] LICENSED under proxii DECLARATION O/ � hereby inion that em I Business under pmssbre of Chapter 0(commencing in with Sectionand WOOD SHAKES O 70001 0l DWlsbn 3 0l the Buslnev end Pretensions Cotle,and nYf Ikenea b In lull force entl amen. �Z / Z(� WOOD SHINGLES License Cleve Lk.Number / Into — Conireclar OTHER(SPECIFY) /� OWNER-BUILDER DECLARATION PROPOSED D Q hereby affirm that em exempt from the e: Any ors License Lew for the following a reason. (Sec.7ct,alt Business and Professions it an Argy dry or county which requires a permit to D construct,alter,improve,demolishigned statement Math [prioralit lo Itsnse Insurance,pursnt alsoreprovis the BUILT-UP ROOF AUG g of the for etch parmb to 018 a signed statement that g it licensed 7WO)o to the n 3 of one 1999 of the ss can nPr'sro L Professions Lew(Chapter 0 o Is ex a pt t with therefrom and the b s for the 3 of rhe kk��t� Business end Pro lotion f Code)or that fe le exempt therefrom entl the bests for the alleged to ASPHALT SH NGL exemption,Any violationofhan five 70.31.5 tryany applicanttoapermit eublecta the applicant to e cWll penalty of not more then flue hurrtlretl dollars(5500).): [� ❑1,as owner of the property,or my employees with wages as their sale compensator,will do WOOD SHAKES Ey ❑ the work,and the structure ts at fitencetl or offered for sale(Sec.7044,Business end Profes- sionsCode:The Contractor's License Law,does mt apply to an owner of properly who builds or WOOD SHINGLES Improves thereon,and who rices such work mrasefi or through his own employed provided that ❑ ouch Improvements are not intended or offered for sale.It,however,the balding or Improvement Is sold witNn one year of comf>letion,the owner-bullcor will have the Wrden of proving Net he did OTHER (SPECIFY) ❑ not build or Improve for purPase of sale.). 01,as owner of the property,em exclusively oxniraceng with licensed contractors to const/W the project(Sec:7044,Business and Professions Code:The Contratorb License Law does not PROVIDE I.C.B.O.REPORT NO. apply to an owner of property who Wilds or improves therein,and who contracts for such projects with a contmctorle)llceneed pursuant to the ConITWors Lodi Law. PROVIDE MFGR. INSTALLATION SPECS. 01 errs exempt under Sec. ,B 8 P.C.for this reason Owner Dare WORKER'S COMPENSATION DECLARATION APPLICATION DATE VALUATION PERMIT FEE I hereby affirm under penalty of perjury one of the following declension: -11 have and will maintain a Certificate of Consent to sell insure for workers Compensation, - D�" 00 as provided for by Section 37DO of the Labor Code,for the performance of the work for which this Building permit is hued. J/ �� $ells I 01 have aM will maintain Worker's Compernamon Insurance,as required by Section 371X7 of bO�r� the Labor Code,for the performance of Me work for which this permit Is Issued.My Workers T tel Compensation/Insuurr'ance comer and Policy number are: Carrier 1/46 r/t`7/!f(� 1/1S' wlicy No. W0(�4 PERMIT AUTHORIZATION CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE N.CQ (This section reed nal ber campleted N the What is for one hundred tldlars($100)or lay.) I certNy that In the performat of the work for which this permit is Issued, shell not employ any parson In arty manner est m to become subie m t Wer m Compenaauoo Lawn of car- All roofs shall be Inspected prior to any roofing material being fomla. installed. If a roof is installed without first obtaining an Data Applicant inspection,I agree to remove all new materials for inspection. . NOTICE TO APPLICANT: If,rater making this Cerdficaleof Exemption,you should beconro Applicant understands and will comply with all non int subject to the Workers'Canpeasadon provislins of the Labor Cade,you must forthwith comply pP p y PO with such provisims or this permit shot be deemed revolted. SOU regulations. I cerlity Vial l have read this a allcauon and state that the above Information Is coeacl.I agree to coney who all city and county ordinances ants state laws rela0ng to building corkstmctlon,end All fcoveig It be class"C"or better. hereby authorize representatives N this city to enter upon the above�menfioned property for in- 1 y _ spection purposes. J (We)agree to save,Indemnity and keep hamless Ne City of Cupertlero against Ilebllltles, judgments,coats two expenses which may in any way accrue against end City In consequence $IG RE OF P I NT DATE of the granting of This pennll. 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 a • 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. 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. I_ HOMEOWNER'S NAME: I\yll l 17i kW' CAe_,,- F4 An ADDRESS: RE-ROOFING COMPNAY NAME: V APPLICANT'S SIGNATURE: • CITY OF CUPERTINO BUILDING DEPARTMENT Re-roo(/winword INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO . BUILDING PERMIT INVOICE OPERATOR: karenb Sec: Twp: Rng: Sub: Blk: L t:37534069.00 INVOICE DATE. .. . . . : 08/06/1999 REFERENCE ID N . . .: 99080049 SITE ADDRESS .... . : 10620 TUGGLE PLACE SUBDIVISION .... . . . CITY . . ....... . . . . . CUPERTINO IMPACT AREA ... . . . . OWNER . . ........ . . : KAMBIZ KOUCHES FAHANI ADDRESS . ....... . . : CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 CONTRACTOR ..... . . : STEFFENSON JR, JIM LIC 4 19668 COMPANY ........ . . : HOMEGUARD INC ADDRESS ....... .. . : 510 MADERA AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95112 TELEPHONE .. . . . . . . : (408)993-1900 / FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DOE --------------- --- --------- ------------ ----------- BPERMFEE P 107.00 0.00 107.00 BSEISMICRE P 0.50 0.00 0.50 --------- ------------ ----------- 107.50 0.00 107.50 ID ......--DESCRIPTION ......... VOICE ID -----__DESCRIPTION --- ..... ........ .............. 305 FRAME 307 INSULATION 601 HOOF TEAR OFF 602 ROOF PLYWOOD NAIL - 603 ROOF BATTENS 604 ROOF IN-PROGRESS • CITY OF CUPERTINO I 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: karenb COPY N 1 Sec: Twp: Rng: Sub: Blk: Loc:37534069.00 DATE ISSUED..... . 08/06/1999 RECEIPT q....... . . : 9756 REFERENCE ID p . . . : 99080049 SITE ADDRESS . . . . . : 10620 TUGGLE PLACE SUBDIVISION . . . . . . . CITY . . ...... . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER .. ..... . . . . . : KAMBIZ KOUCHES FAHANI ADDRESS ..... . . . . . : CITY/STATE/ZIP . . .: CUPERTINO, CA 95014 RECEIVED FROM ....: TIM CONTRACTOR . . . ....: STEFFENSON JR, JIM LIC M 19668 COMPANY .. . . . . ....: HOMEGUARD INC ADDRESS . . . . . .....: 510 MADERA AVE CITY/STATE/ZIP ... : SAN JOSE, CA 95112 TELEPHONE . .. ..... : (408)993-1900 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 MICRE VALUATION 5,000.00 0.50 0.00 0.50 0.00 es PERMIT ----107 50 D.DO 107.50 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 107.50 24669 ------------ TOTAL RECEIPT 107.50 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 •