99080192 (2) PERMIT
APPLICATION FOR CITY OF CUPERTINO NUMBER
REROOF PERMIT INSPECTION DIVISION PERMR EXPIRATION
(408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED
• WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
• BUILDING ADDRESS
RESIDENTIAL COMMERCIAL OTHER
OWNER'S HAZARDOUS FIRE AREA
NAME D-V/UyJ�IZ� VES ❑ Il yes—Italderis end Mede ClassA
roof auerndy re required.
NO '❑ Initlel LC.B.O.p
ADDRESS 'e- - EXISTING ROOF COVERING
T PHONE — - NUMBER OF EXISTING COVERINGS
CONTRACTOR'S -- /
NAME CQs GAaf s /HLJ TO BE REMOVED.�L —TO BE RETAINED
TYPE QE ROOF
CITVRB ZIPd. Ir�fOX /, 4F& ,�(•? �505/ VERIN
��(y EXISTING
PHONErJ� 33 _ _ BUILT-UP ROOF
LICENSE
NUMBER ASPHALTSHINGLES
LICENSED CONTRACTORS DECLARATION _ /!
I hereby affirm that I am licensed under proylslons of Chapter B(commencing War Section .WOOD SHAKES
]000)of Division 3 of the Business and Pro108510 re Code,and my license is in full force and
ancon 3 g // WOOD SHINGLES El
LIcense ns CleLk.Number 7 15!&
5'fio
❑
Oahe contractor OTHER(SPECT
OWNER-meronBUILDERDECLARATION PROPOSED fGLES
I hereby ahrm in es 1 am exempt from Ne Contractors or coup Lew for the mess rg reason.(Sec.]0315•BImpro a end Profeolual or rep Code: Airy dry or ownry which requires a permit to j
coplicannor suh permitve,tbmola signed staeny mentrthate,prbrto hs Issuance,elsMeeproviathe BUILT-UPRof theant for cuch permit to file a signori r 9(co m nci he Ish Seced pursuant io the pro oftheof the Contractees LIcerree Lew(Chapter B(commenting with ohn and]000)of Division 3 of the V exemptio ern violati orof Cede)or that he lv exempt therefrom era the heals for Ne alleged ASPHALTS AUGU
exemption.Any f not violation of Section 7031.5 byarty epplicomfar a permit euotecns the applicant to
e chill penaly,of not more Nen INe hundred dollen
E]1,as owner of the property,or my employees with wages as their sole compensatlm,will do WCODSH
Me,work,and the structure la not Intended or offered for sale(Sec.]044,Business and Notes.
slam Code:The Contractoes LIcemse Lew does not appy to an owner of property who bulas or WOOD SHINGLES
Improvaa thereon,aro who does such work himself or through his own employees,proyided Nat
such impmomenm are not Intended or offered for vele.It,howeveq the building or Improvement
Is sold whhln one year of completion,the owner-builder will have the burden of provlag that he did OTHER (SPECIFY) El
build or improve for Purpose of sale.).
I,an owner of the property,am exclusively contmctlrg with licensed contractors to construct
the protect(Sec.7044,Business aro Pmfeei Code:The Contractors License taw dose net PROVIDE I.C.B.O. REPORT NO.-
apoy to an owner of property who builds or Improves,thereon,and who contracts for such projects
with a coniractor(e)licensed pursuant to Me Contractor's Ucense Lew, PROVIDE MFGR.INSTALLATION SPECS.
❑1 em exempt untler Sec. ,B 6 P.C.for MIs reason
Owner oma
WORKER'S COMPENSATION DECUBATION APPLICATION DATE VALUATION PERMIT FEE
I hereby allirm under penalty of perjury one of the following declaration:
1 have and will maintain a Cerdllcate of Consent to"114naure for Works/e Compensation,
as prwdetl for by Section 3700 of the Labor Code,or the performance of Me work lar which this Buildin
pemnit is issued.
--
-11 have and wil maintain Workers Compensation Insurance,as required by Section 3700 of oy Seismic
the Labor Code,for the pedomrence of the work kv which this What Is Issued.My Worker's G
Compen a � tante carder antl Policy number are: - " �' Total
Carrier �` �aQ�_CJ. i�n Policy N• 7 PERMIT AUTHORIZATION DATE
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE - N.CQ
(This section need not be completed If the permit Is for one hundred dollars($100)or tele.)
I comity that In Ne Performance of the work for which this permit a Issued,I shell not employ
arty person In any manner so as to become subject to the Workers'Compensation news of Call. All Toots shM be inspected prior to any roofing material being
fornix. 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: If,after making this CorBfleate of Exemption,you should become Applicant understands and will comply with all non point
submit to he Workers'Compensation provisions of the Labor Code,you moat fortrtmth comply P Y P
with such P"Iff loin or this permit shaftee doomed reyopad. Source regulations.
I comfy that I hews reed this epplicatIon and state Mat the above information Ie correct.I agree
to comply with all dry ant cwnty ordinances and state laws relating to building constructlon,and All roof c Brings to be class"C"or better.
hereby,authorize mi,reaenlatlyss of his city to enter upon the aboya-mentioned property for In-specton purposes.
Xz^^wr-te�
(We)agree to esus,Indemnify and keep hermlaes the Clry of Cupertino egeirel Ilebdltiea,
lodgments,coats and expenses which may In any way accrue against said OrrIn consequence
of he gmndag of this pe m . SIGNATURE OF A PLICA 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
• 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.
i. 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 cheating and a building inspector will inspect all sheating 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 TIM ABOVE POLICY ON RE-ROOFING AND WILL COMPLY
WITH THE POLICY.
HOMEOWNER'S NAME: Z,� t, 1'5 6 //i§vti �N
ADDRESS:
RE-ROOFING COMPNAY NAME: LAS Ci¢rrs /�eglvFj
APPLICANT'S SIGNATURE:
• CITY OF CUPERTINO
BUILDING DEPARTMENT
Re-roof7winword
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE .INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: yvonnek
Sec: Twp: Rng: Sub: Elk: LOC:31621086.00
INVOICE DATE. . ....: 08/26/1999
REFERENCE ID k ...: 99080192
SITE ADDRESS .. ...: 19854 WHEATON DR
SUBDIVISION . . ....:
CITY ... . . . . . . . ...: CUPERTINO
IMPACT AREA . . ..... '
,( OWNER ... . . . . . ....: HUGUNIN EDWARD T AND LOUISE M
' ADDRESS . . . . . .....: 19854 WHEATON DR
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-2338
CONTRACTOR ....... : RADONICH, GARY LIC # 17814
COMPANY .......... : LOS GATOS ROOFING
ADDRESS .......... : 1771 SMITH AVE
CITY/STATE/ZIP .. . : IAS GATOS, CA 95030
TELEPHONE ... .... . : (408)358-1233
NOTE: THE FEES LISTED ARE ONLY THOSE DUE BEFORE PERMIT PRINTING
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DOE
_______________ ___ _________ ____________ __________-
BPERMF EE P 157.00 0.00 157.00
ESEISMICRE P 1.00 0.00 1.00
_________ ____________ ___________
158.00 0.00 158.00
Ve 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• 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: yvonnek
COPY k 1
Sec: Twp: Rng: Sub: Hlk: Loe:32608068.00
DATE ISSUED....... : 08/26/1999
RECEIPT q.... .... . : 9901
REFERENCE ID H . . . : 99080193
SITE ADDRESS .... . : 10653 GARDENA CT
SUBDIVISION ... ... .
CITY ........... . . : CUPERTINO
IMPACT AREA . . . . . . .
i
OWNER . ....... . . . . : PEAKE
ADDRESS .... . . . . . . : 10653
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1614
RECEIVED FROM ....: DAVE
CONTRACTOR ....... : RADONICH, GARY LIC # 17814
COMPANY .......... : LOS GATOS ROOFING
ADDRESS .......... : 1771 SMITH AVE
CITY/STATE/ZIP ... : LOS GATOS, CA 95030
TELEPHONE ....... . : (408)358-1233
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- --- _____ _--------- ---------- ----------
BPERMFEE VALUATION 12,000.00 177.00 0.00 177.00 0.00
BSEISMICRE VALUATION 12,000.00 1.20 0.00 1.20 0.00
7•PERMIT : 17B.20 0.00 178.20 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 178.20 6160
---••
TOTAL RECEIPT 178.20
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
•