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06070149 CITY OF CUPERTINO �' ''� " + , BUILDING DIVISION PERMITcciR:�.C�ra,R YrrRmmro • BUILDING ADDRESS: v GROMO ROOFING INC 1ERMITN0.06070149 10883 LEAVESLEY PL OWNER'S NAME: PERMIT ISSUE DAM TREFZ DELOMA 121 W WASHINGTON 2006 ONE: SANITARY NO. CONTROL NO. (408) 746-2075 ARCHITECUENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMS MECH O 0p LICENSED CONTRACIORS DECLARATION - Job DeSCTI eros 1 hereby&M.that 1 am licensed under pmmvis s of Chapter 9(commeacing P with Section 700M of Divem.S ofdte Bud.and Prefeadou Code.ab my tkomwI. in fullInrauWeg TEAR OFF EXISTING ROOF AND INSTALL 1/2" OSB ua.Cm "Z_ 9 p c.g r A-13s +iG L 9 m 30 YEAR SHINGLES CLASS A- t- Date COntrac ARCHITECTS DECLARATION V I understand my pWia shall W used u Paul.records tyU LL Licensed Pmfeasinnai th OWNER-BUILDER DECLARATION y I hereby signs that I am scamp,from the Com memes License Law for Ne :cc following mason.(Sado.703 1.5,Business and Prefeuiou Cade:Any city fir county $(Vi which requires a permit to cortume4 ahm,,W prove,demolish,or minor any sanctum -z y prim to its issuance,also requires the applicant for such permit to file a signed staumat C that u uato at Ilicensed pursnt tie provisions of the COmraclnrl UwMM law(Chapter 9 Sq.Ft. Floor Area Valuat Q 5(]Q l� (commencing with Section 7000)of Division 3 of we Bud.and Prefesairas Coca)Or 9 Nu he Is whmpt Ncmfmm and the bask for the alleged eamption.Any violation of Section 703 1.5 by airy applicant far a permit subjects the applicant to a civil penalty or3 pith N�I Iber 0 0 Occupancy Type not moman Nraw hundred dolWa(S5W). 5615 5 ❑I,as owner of the Property,or my emPloyces with wages at their ask compeasadon, will do the work.and the swmue Is not mucled or o&red for Sale(Sec.7044,Bud. Required Inspections sal preresslona Code:The Commutes Llc mic Law doer an[apply In an owneer of q P property who bagels w Int proves theman,std who does such work h(mzelf or through his Own employee,provided shommich improvements are not intended orOgered for oak.If. howevTI Wilm .Nn:avetebding rlmpmwmentkmt he year of rnmove on.for the rose n.of builder wig have the burden of proving Nu W did rot build Or Improve for Purina of ❑1.Or Owner of the property,am eacludvely contracting with licensed..=in.to coatnmt the pmjm(See.7044,Bekaa and Pmfeulons Code:)The Cn acurce.U- coase Taw dos no,apply to an Owner of property who Wilda or improves demon.and. who contracts for such prejeets with a eommunter(G licensed pan.nt in the Contractors Lt.'.law. ❑Iomscemptumdea See .B&PCfordusreuom Owner Dau WORKER'S COMPENSATION DECLARATION I hereby again under penalty of penury new of tW following dcumailoe: Ias.and will maintain a Cenificata of Consent in self-Insure fm Workers Caspeo- radon,se provided fm by Section 3700 of the labor Code.fm Ne performance Of the work for which this permit Is issued. ❑1 have and will maintain Wortrh CompenaWon Iuuranoe,all required by Suction 3700 Of Ne Labor COM,for$a pefomana of the work for which this permit is"-d - My Workda Compensation Wwnbee aria aha Policy number are: Carrier r;7, 7-4 uraA_g>policy No.: 2Ysr— )/r3 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE rihk and.tmed rot W canpkted gave permit is(oras.Winded dollars(SIM) or lea) 1 certify Net In the performance of 144 work for which his permit is Wued.l"I Out employ any person In my memberse,W Of Wcome subject to the Workers Compensation Laws of California.Dau Applicant NOTICE TO APPLICANT,If,aur making,his Ocninau of Esemp,ion,you ahauu become subject in 144 Wormes Compensation provisions of 144 Lime,Cade,you muss .J O forthwith comply with such pravlsk.or this permit Nall W decmcd revoked. „zvIn CONSTRUCTION LENDING AGENCY [••� I Wreby eRrm that Nam is a canurunirn lending agency for the performance of ai> the work for which this permit Is hand(Sec.3097,Civ.C.) GQ Lenders Name 7 Lendeh Address U Q i certify that I have mad this application and mm that the eWw information is fL P correct.I agree to comply with all city and county ordinances and state lave relating u C U building construction,and hereby authorize representative of this city to enter upon the above-mentioned property for impaction purposes. (We)agree to save,indemnify and kap harmless he City of Cupenmo agdrst `VV)j Ilabilldes,judgments,coats and eaperos which may in any ray scone against said City in U s'+ APPLICANT UNDERSTof the IANDS Aof iND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. 7/2//D i� �'� Re-roofs Signuurt of Appll mUCcustractur HAZARDOUS MATERIALS DISCLOSURE Date Type of Roof WIII the applicant or future Wilding compantmre or handle ha aline,maurW as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety Code.section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yes ON. 40 Will the.pplicant or fuwm Wilding o p.at esu equipmat or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit banner.air c rournirwtu as dedted by the Bay Ams Air Quality Management all new materials for inspection. Manor? Oyu 0 N I have real the huauous materials requirements under Chapter 6.95 of weCollror- nkHulett&S.fetyCode,Ssdw 25505.25533 and 25534.1 undmwW that ifthe Wilding dao rat currendy haw a un.nt,du it is my responsibility in amity the occupant of etc require=:: equire= which ntet prior issuance of a certificate Of Occupancy. Of Applicant Date 70 7/=do G All roof coverings to be Class"B"or better Owner or arwhomad agent Date" CITY OF CUPERTINO am 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35615025 . 00 DATE ISSUED. . . . . . . : 07/21/2006 RECEIPT # . . . . . . . . . : 35340 REFERENCE ID # . . . : 06070149 SITE ADDRESS . . . . . : 10883 LEAVESLEY PL SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : TREFZ DELOMA ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : FRANCISCO GONZALEZ CONTRACTOR . . . . . . . : GONZALEZ, FRANCISCO LIC # 22795 COMPANY . . . . . . . . . . : GROMO ROOFING INC ADDRESS . . . . . . . . . . : 121 W WASHINGTON AVE CITY/STATE/ZIP . . . : SUNNYVALE, CA 94086 TELEPHONE . . . . . . . . : (408) 746-2075 •FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- --- ---------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 10, 000 . 00 169 . 56 0 . 00 169 . 56 0 . 00 BSEISMICRE VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 170 . 56 0 . 00 170 . 56 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 170 . 56 MASTERCARD TOTAL RECEIPT 170 . 56 • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 16UPERTINO Building De artment JOB ADDRESS: PERMIT # log-,P3 /O)607a� � y OWNER'S NAME: E o h /1./F K z PHONE #fVoP9 2 SZ - GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets &Millwork r� 20 n 61 /G pd F gni /, f` 516 2- Cement Cement Finishing Electrical Excavation Fencing, Flooring. Carpeting Linoleum/ Wood Glass/ Glazing Heating Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Ruck Tile 7/2 Owner/Contractor Signature Date O��IUI� CITY OF CUPERTINO ' REROOF • CUPERTINO PERMIT APPLICATION FORM APN# 35(s-- Building 5,^--Building Address: V Owner's Name: one#: " Kif Z of, 2 Contractor: License#: o S 716 Z / G D ® O©C/ C N Contact: Cupertino Business License #: ,eeo Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof IL Asphalt Shingles V Asphalt Shingles ). Wood Shakes ❑ Wood Shakes ' ❑ Wood Shingles ❑ Wood Shingles F Other(Specify) T/L K : kk ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. • I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: - P<.4 xl/ 7-140' e- &Jrf-F •-r 7W Llra �11y lB >,rvi c/Cf Residential Commercial ❑ Fire Zone: Yes ❑ No Confirmed with Planting Dot. if there are any restrictions: LJ Cost of Project: Type of Construction: Occupancy 9 r1 : Qty.if Applicable Fee ID Fee Description Fee Group BPERMFEE Bidiz Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING • Community Development Department Building Division City of Cupertino 10300 Torre Avenue • Telephone: (408)777-3228 Fax: (408)777-3333 Building Department Subject: Re-roofing policy for the City of Cupertino 1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards and manufacturers specifications on re-roofing. 2. New roof coverings shall not be applied without first obtaining all inspection 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 roofs shall be inspected prior to any roofing installation. 4. To receive a final sign off from the City, the following steps are required: 1) Pre-inspection and/or tear off approval. 2) In-progress inspection approval. 3) Final inspection approval. a) Spark arrester installation. 5. If plywood is installed,a plywood nail inspection is required. • 6. Any roofing which is applied without first obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be performed. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re-inspection fee of$176.18. The re-inspection fee must be paid before another inspection can be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of 1/4"per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be on the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: 7) & r o /`9� /Z& G Z job Site Address: /(�� ��? L <i V6rl y Roofing Company Name: 4/1 r� �O /Zdf>/� /Y �'✓ _ Applicant's Signature: „��� i — Date: 7 r//O (p • Greg Casteel Building Official Revised 11/2/04 _