06060085 (2) CITY OF CUPERTINO ��+�♦'�':�✓' ' "' ' " �` ''3-`' "
Buamns DIVISION PERMIT �OI�FTRACTQR I1�IFORMAI(�PI
BUILDING ADDRESS: CONRAD ROOFING, SERVICE PERMTr'o,06060085
10642 LARRY WY
OWNER'S NAME: PERMIT ISSUE DATE
ROCHELLE HALL 332 PHELAN AVE 06/12/2006
E: SANITARY NO, CONTROL NO.
(408) 294-7,615
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
.
BLDG EUC PLUMS MO
o a LICENSED CONTRACTOR'S DECLARATION lob Description
bar F 1 heseby antro that 1 am licensed under provisions;of Chapter 9(commererng P
4 "` u 0aon7gg)a(Divbion3ofthcButinevantlProfeu/iomCode,arWmyliccnscu TEAR OFF SHAKES AND WOOD SHINGLES, INSTALL 7/16
y in full forte end eRaa e Z t NS'�—
:�
Lw. CI s G3 L _
H-u7i Ce- Canuaa OSB SHEATHING, 30 LB FELT AND 30 YEAR ELK SHING
Z ARCHITECTS�LdRAT10! '—
i y I undersmnd my plans shall W used as public maonls
Io,U
:wt;tLicensed Professional
y�
OW NER-BUILDER DECLARATION
I i I heathy alrim
that I am exempt form the Canhanors License Law In,we
p o following mason.(Section 71131.5,Business and Professions Code:Any city or county
:38! which required a Permit m errvmo m,alma borrow.demolish,or repair any stamuse
prior as its issuance,also rquiree Ne applicant for such permit he rile aligned mor mem
G war W is licensed pumen,to the provisions of the Contractor's LicumserLaw(Chap.9 Sq.FL Floor Area Valu iba'800
(commencing with Sweden 7000)of Division 3 of the Busmen and Professions Cods)or
`t that he is exempt thcefrmn and Ne basis for Na alicgel assumption.My sward on of
Secant 7031.5 by my appllant for a permit subjects the applicant ue a civil penalty of er Occupancy Type
not mom Nan flow hundred dollars(3300). 3 g . 00
❑Las owner arms property,or my croployces with wages u tharmlecompmuadon,
will Pr Ne wodr.and e: he Com ie nc intendedew LAwr ed does our
apply W an answer of �1.� as r-3®
and do dor rens Cade:The Commences 1,.1 U^"-law dao rot apply pan owner of Requi —" e s jM�y®(tgi$®t^r—
propenywhoWlldsorineproamanswer,mdwho dowsucb mak himselfwassurgh his
ownerployees,provided that reach improwmrnuam not intended oronered forsala B.
however.to building or improvement Is sold within was year orcrmp cdon,the owner,
builder
w er-
builder will have that burden of proving Nam he did nm Wild or improw for purpose of
"m' �/` 2006
❑1,u ownef of the property.m eaelusiwly contracting with licensed mnwcpm p JUN
construct the project(Sec.7044,Business and Professions Code:)The Commerce,U.
core law does r suhplymmowraofproperty who Wadamunproved thereon,md.
who ave.for such injects wiNatanuxbr(i)llmsued gosmtantmmW Cantraclofs
Cleemann law.
❑lam romp,under See .B@PCfm N4 mason
Own, Data
pIWORKER'S COMPENSATION DECLARATION
1 bemby arlrm under penalty of perjury am of the following declNdons:
Mw and veil maintain a Ce views of crown,anself-inwmfor waramescmnpen-
smion,as provided for by Section 3700 of the Labor Code,for the performance of Use
wart for which Nis permit is issued.
❑1 hew and will maintain Warkeh Compensation hoursnm,u required by Section
37M of Ne labor Core,for he performmce of Ne work for which was permit is issued. '
My Workers Compensation Insurance carrier and Policy number am:
'er: St'4aa.� F^Yn.a� Palms: �5'00a) OL
CERTIFICATE OFEXEMPI NFR WORKERS'
COMPENSATION INSURANCE '
Man seder seed not be completed If tun permit Isfaorc hundred doHm(5100)
or lass)
1 unify that In are performance of the work for which this permit Is Wood.I shall net
employ any person in any summer an u W become subject pace Workars'Compensation
Laws of Calif rmia Dam
App cin
NOTICE TO APPLICANT:If.after making this Cenrne a of Faemption.you should
become subject m Ne Warkefs Compensation provisions of dw Labe,Code you most
.J O foMwith comply with such provisions or this permit shall W deemed mocked.
'Z' CONSTRUCTION LENDING AGENCY
[—i4 thereby M.Out aim id a construction lending agency for the perfurmence,of
CYi Ne work for which was Pont,is Wted(See 3097,Civ.Q
Lp Landers Name
M Z fellers Address
U C) 1 metify that 1 have mad Ws application anal Nat the Own ofomatiun u
tL t— correct.)agree to comply with all city and county ordinances and sum laws remdng In
OU building convection,and hereby authorise representatives o(Nis city to enter upon the
J'a above mentioned property for inspection purposes.
(We)agree he saw,indemnify rod keep harmless the City of Cupedna aswgi
F,pn liabilitles,judgments.com and expenses which may In any way accrue agWnsrsSW City
U 2 in consequence or the g,mNvg of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POlyn' Issued by: Date 2-�
SOUR ONS.
6-I 06 Re-roofs
Signmum of ApplicuntrContramor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will an applicant aro forum Wilding ammpunlsmm m handle hsardaas mamrul
u defined by the Cuperd Municipal Cade.Chapter 9.13.and the HeWN and Safety
Code.Surma 19532407�� All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will Na applicant or future Wilding occupant use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
:mit h0molsw air contaminants as deneed by(he Bay Area Air Dually Management all new materials for inspection.
DiwktT �/
❑Yes rLMNu .
Iban mal the ha»rdtres, riau requirentunu under ClunerG95 ofde Caliror- / ^ '•L—OI
terHealth@Safmyeode Sed=255M.35533uWu534.IwWcrnond [fL a Wilding b O
does not currently haw a mnam,Nat It u my rearponsihiliy an vodry dor nutriment of the
requirements u most be met prior be issuance of a Ccrr of Occupancy. Signature of Applicant Date
�� 6-1L-ol
ownr,or auNmised.ens Dam All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
r ' I '. �• t Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
f UPEkTINO
Building Department
JOB ADDRESS: /OG42. L4ccy W q7 PERMIT #
6a6aa -
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: Co cod ?-�C' ,,S.rte _ FAX # 29 - (,6
I am not using any subcontractors: -
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
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 Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
am 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 31602032 . 00
DATE ISSUED. . . . . . . : 06/12/2006
RECEIPT # • • • • . . . . . : 34796
REFERENCE ID # . . . : 06060085
SITE ADDRESS . . . . . : 10642 LARRY WY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ROCHELLE HALL
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : CONRAD ROOFING SVC.
CONTRACTOR . . . . . . . : KEITH CARNAHAN LIC # 22297
COMPANY . . . . . . . . . . : CONRAD ROOFING SERVICE
ADDRESS . . . . . . . . . . : 332 PHELAN AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 294-7615
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 13 , 000 . 00 201. 96 0 . 00 201 . 96 0 . 00
BSEISMICRE VALUATION 13 , 000 . 00 1. 30 0 . 00 1 . 30 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 203 . 26 0 . 00 203 . 2.6 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------=-----------
CHECK 203 .26 11261
TOTAL RECEIPT 203 . 26
•
CITY OF CUPERTINO
0REROOF
• CUPERTINO PERMIT APPLICATION FORM
APN# 31 �Q_ N__6312- I
Date:
Building Address: to64Z L9`Cy
Owner's Name: go CPhone#:
CL)k.� 11--t�1
Contractor: �v�•Ga a �� � License#:
2.11 (�S2
Contact: ` '' Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 2�Asphalt Shingles
21' Wood Shakes ❑ Wood Shakes
Sir' Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings Z— ❑ Provide I.C.B.O. Report#
Er To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read,Understand and Will
—GF s m1WthsCino',s TaNOfPolicy:
c
. ,se '
oSu tJob Description: T. X'
"I y , 3olG F.It
-So � Elk
Residential [' Commercial ❑
Fre Zone: Yes ❑ No Confirmed with Planning Deft. if
there are any restrictions: LJ
Cost of Project: pr I L,80 o Type of(;Qwtruction: OccupaTj_ up:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg 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: )eOJ j11 poo
Job Site Address: 0(.4 Z L a<cy W 4y
Roofing Company Name: 60 v..cS-atuL,
v d �a+� �y
Applicant's Signature: X7 / � Date:
. Greg Casteel
Building Official
Revised 11/2/04