07110138 CTTY OF CUPERTINO : < '
6'JILDING �IVISION PERMIT �������� ���������''
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BUILDING ADDRFSS: PERMIT NO.
10630 GLENVIEW AVE TBD - ��0 BE DETERMINED 07110138 .
YNER'S NAME: P�R�ITLS6UEDATE
PABON GUS C ET AL 11/26/2007
PHONE: SANITARY NO. CONTROL NO.
ARCHITECTlEWGINEER: BUILDING PERMffINFO
1/ 2 OSl3 3 0 LB FELT PRES TL, aLDC E�.ecr PLUMB MscH
0 0 0 �
� O p LICENSED CONTRACfOR'S DECLARATION � '
i� V I hcreby sflirm thal I am liccnscd umlcr provisiona of Chaptcr 9(commencing ^^-^^, .. ^ �-- �---- ---- -- --- Joh Bescuption
'� � wi�h Secdon 700U) of Division 3 of ihc Business �nd Protcssions Code, snd my liccnsc is
y in full focce and e t �,
�j ? Lice�ae asa Lic. M
n F � Da�c � — - Conusctnr �
ARCHRECi'S DECLARA770N
;� U 1 undcrsund my plans shall be used u public rccords
e.
i p y Liccnsed Prufcssional
n y � OWNER-BUILDER DECLARATION
� t� I hercby a[firm t�at I am excmpt Gum �hc Contrutors Licensc Law for �hc
i p O following rcason. (Scc6on 7031.5, Business and Profcssions Cafc: Any ciry ar rnun�y
K�� which requims a permit to conswct, altcr, impravc, dcmolish, ar m�mir any swctwc
y Z y prior �o i�s issuancc, alsc� rcquims �hc applicant for such permit to filc a signcd s�atcmcnt
x
< that he is licenscd pursuant lo thc p�ovisions af ihc Conuactor's Licensc [aw (CAapicr 9 5q. Ft. Floor Area Valuation
y I- �(commencing wiih Scction 7000) of Division 3 of ihe Busincss and Profcssions Codc) or
1 �.. that he is exempt the�efrom and Ne basia for the allcgcd exemption. Any vioiauon af
Section 7031.3 by azry applicant for a pecmit subjecu ihe applicant w a civil penaity of ppN Number Occupancy Type
not mme than tw dundred dollars (5500�
0[. u owner o[ the pmpccty. a my cmployces with wages u the'v sole compenaadoe,
will do ihe worlc. �nd ihe stcucwee is not imm�ded or ofteced for asle (Sa. 7044. Business Re uired Ins eetions
snd Rofessions Codc: The Conuacwr's Lianse L.aw does not apply ta m ow�r of Q P
property who builda or improves thereon, and who daes such work himult or theongh hia
own employccs, providcd ihat wch improvements are not imm�ded or otCered for sala If,
however, the building or impmvement ia sold within one yar oC compkuon, the owner-
builder will have the burden oC proving tAat he did irot build or improvc far purpox o(
saleJ.
❑ 1, u aaner oC 1he property. am exclusively conhacting wilh lianud conuactors W
consuuct the project (Sec. 7044, Husiness and Pra[usions Code:) The Coatracwr's Li-
ccnse Law docs not spply w an owrrer of propeny who 6uilds or improves Iheieon, snd ,
w6o conuscts for such projecis with a conuactor(s) licensed pursusnt to We Convactors
Licenae L.aw.
❑( am exempt under Sec. , B dc P C for this reasan
iner Da1e
WORKER'S COMPENSA'ITON DECLARA7'[ON
I hereby adimi under ponalty of pe�jury one o[ �he follawing dalarations:
❑ I have and will mainuin a Cenificate olConunt to self-insuce for Worlmrs Compen-
ution, as provided far by Secuon 3700 of the [abor Code, for the performancc o[ thc
wwk for which this permit is issucd.
❑ I havc and will mainlsin Wwkcr's Compensatian Insurana, as mquired by Scction
3700 of the Labar Cadc, for thc pcdormance of Ihe work for which this permi� is iuued.
My Worke�'s C mpensation Inwrance cartier and Poliry number am:
CaRier: Poliry Na.:
CERITFIC� lE OF EXEMPITON FROM WORKERS'
COMPENSATION INSURANCE •
(This section necd not be completeJ if ihe permit is far onc hundred dodua (5100)
or Icss.) •
I cenify Ihas in thc perfarmancc of t6c work for which �his pcm�it u isauc4 [ shall not
e:nploy any person in any manner so u w become subject io the Worlcen' Compensation
Laws of Califomia. Da�c
AppGcanl
NOTICE TO APPLICANT: If, allcr making this Ccrtificate of Excmption, you should
become subject to thc Worker'e Compcnsadon provisions of U�c Labor Codc, you muu
. O fonhwith comply with such provisions or this pecmit shall6c dccmed revokcd.
'� "" CONSIRUCflON LENDING AGENCY
[- �- I hcroby slTirm Uut then ia p consuuctian knding agcncy (or thc perCurtnancc uC
�� thc work for which ihis pertnit is issucd (Scc. 3097. Civ. C.)
W� Q Lendc�s Namc •
� z Lcnde�s Add�cts
V 0 I certi[y that 1 have read this applicuion and s�a� ihu ihc above informadun is
w�"� cortcc� 1 agex to comply wi�h all city and counry oniinsnces and su�e laws relaGng w
� U building conswcuon, and hereby suWori�t mpresentauves of this cily to cnicr upon tMc
� a abovc-mcntioned propcny (or inspec�ion purposea
(Wc) agree to save, indcmnify and keep ham�less �he City of Cupertino against
�� liabilities,judgmcnts, casts and expenscs which may in any way uccuc agtinsl said City
V;� in consequence oC U�c granting aC U�is permi� /
�"� APPLICANT UNDER NDS AND W1LL COMPLY WITH ALL NON-POINT Issued by: Date //i Z U'��
SO E REGULATI
� � ` Re-roofs
Signuuro of Applicant/Conuac Da�c ��/ A `
H S MATERIALS DISCLOSURE Type of R � )Of ��/
wll lhc applicant w Cuturc building occupant sarc or handle haiardous matcrial
defincd by 1he Cupertino Municipal Cade. Chapmr 9.12, and thc Heal�h and SaCety
k. Section 25532(a)? All roofs : hall be inspected pcior to any roofing material being installed.
❑ Ycs � No
Will Wc applicant or fulurc building occupant usc cquipmrnt or dcviccs which If a roof i: installed without first obtaining an inspection, I agree to remove
emit har.azdous air conwninanis at dcfincd by �hc Bay Area Air Quslity Managcmcn� all new m; �terials for inspection.
District?
Q Ycs No
1 havc macl �he hvard ma�crials requiremcn�s undcr Chap�cr 6.95 of thc Glifor-
nia Hcalih & SafcryCodc, Sectiatt 25505. 25533 aru125534. [ un�rs�v�d that if ihc 6uiWing
docs not cwicn�y havc an�, �hat it is my nsibiliry to noufy �hc occupant nf ihe
rc i mcnls which be met prior w iu of a Ccrtificaic o( Occu �r. S ignature �f Appl icant Date
�� °" d All roof coverings to be Class "B" or better
Owner or author'vtd agcnt D��
CITY OF CUPERTINO
� ' ' � REROOF
CuP��T�NO PERMIT APPLICATION �
l� /3
APN # Date:
3 Qa�ooa.ao � - � - � �-
Building Address:
� G G 3 � G � �� - �-�, E, , .� ��
Owner's Name: Phone #:
�� �, ('a b c� �--` . 'fi0�s � �� S' -- 333 S
Contractor: Phone #: !��'b -- N G a - / (c � �
c
(�t�..e � o c� a�r c�` - Fax #: G 5 0� l-- a 3 0 3
Cupertino Business License #: Contractor License #:
� � �- ,
Type of R.00f Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
'� Asphalt Shingles � Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings � ❑ Provide I.C.B.O. Report #
� To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: ,. ,�
%`�os �6 a 3� (� �� � ���s i �-- . ��-s � ` �- � l�sS
d
Residential Commercial ❑
Fire Zone: Yes ❑ No ' Confirmed with Planning Dept. if
there are any restrictions: L�
Valuation: _--
ll� ddC� �-
I Have Read, Understand and Will Co y with Cup�;rtino's Tear-Off Policy:
/
Signature
CITY OF CUPERTINO �
REROOF
CuP�r�TiNO FEE SCl3EDULE
Number of ''
S uares Fee ID Fee Description Fee Group Permit T e
REROOFCOM Re-roof Commerci al B COMML-ROOF
BSEISMICOM Seismic Commerci al B
� REROOFRES Re-roof Residential B SFDWL-ROOF
/ BSEISMICRE Seismic Residential B
REROOFMRES Re-roof Multi-Fam: ly B MFDWL-ROOF
BUSLIC Business License B
Community Development Departrnent
Building Division
City of Cupertino
10300 Tone Avenue
Telephone: (408) 777-3228
Fax: (408) 777-3333
Building �Department
Subject: Re-roofing policy for the (:ity of Cupertino
1. Prior to permit issuance, you must agr��e to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be applie 3 without first obtaining all inspection
and written approval from the buildin;; 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 an�� roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre-inspection and/or tear off appr��val.
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 ','irst obtaining an inspection,
will require the removal of all new mai erial down to the sheathing,
so a proper City inspection can be perf �rmed.
7. NOTE: If you call for a plywood nail i:ispection 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: �s U 5 �4 I� q� �'
Job Site Address: l0 �t 3 G �r �-e •r� 1r' t,-e �
Roofing Company Name: (9>.9 Ce �� �) v'
Applicant's Signature: Date: l�' aG �O �
�
Greg Casteel
Building Official
RevisE�d 11/2/04
CITY OF �UPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPER.ATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 36925002.00
DATE ISSUED.......: 11/26/2007
REC�IPT #.........: BS000003317
REFERENCE ID # ...: 07110138
SITE ADDRESS .....: 10630 GLENVIEW AVE
SUBDIVISION .......
CITY .............. CUFERTINO
IMPACT AREA .......
OWNER ............: PAEON GUS C ET AL
ADDRESS ........... 10630 GLENVIEW
CITY/STATE/ZIP ...: CUFERTINO CA, CA 95014-4568
RECEIVED FROM ....: HO�ARD M WAUGH
CONTRACTOR .......: TBL - TO BE DETERMINED LIC # 00096
COMPANY ..........: TBL - TO BE DETERMINED
ADDRESS ...........
CITY/STATE/ZIP ...: ,
TELEPHONE .........
FEE ID UNIT QUANTITY FMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1REROOFRES SQ FEET 24.00 312.00 0.00 312.00 0.00
BSEISMICRE VALUATION 10,000.00 1.00 0.00 1.00 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT : 313.00 0.00 313.00 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 313.00 #4315
---------------
TOTAL RECEIPT : 313.00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
605 FINAL REROOF
�: . ; �
Community Development
10300 Torre Avenue
,� �;�;: :: Cupertino CA 95014
:�. ' Telephone (408) 777-3228
CITY OF Fax (408) 777-3333
CUPEI�TINO ��� `���
Buildi�n De artment
JOB ADDRESS: . PERMIT #
,� G � I �e r, r -� �.c.9 � / � ,
OWNER'S NAME: U c, —' ' PHONE #(So �
GENERAL CONTRACTOR: �;ef �r � ��� FAX # �. --O 3
I am not using any subcontractors:
Si�;nature Date
Please check a licable subcontractors and com �lete the followin information:
SUBCONTRACTOR BUSIrfESS N�ME 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
/� o � � o� �u�
Owne - ntractor Signature Date