06040146 CITY OF CTIPERTINO
BulLomc DrvlsloNPERMIT y^�C0wRACTOR I1�fk�OIiMATIOAI
BUILDING ADDRESS: LE ROOFING PERMrr NO.06040146
22680 ALCALDE RD
OWNERS NAME: PER.3QI LSSUE DATE
KSAR MICHAEL Y AND RENEE 1910 DAY RD. 04/25/2006
ONE SANITARY NO. CONTROL NO.
ARCHITECTPENOINEER: BUIIDINO PERMIT INFO
BLDG EIECT PLUMB m1i
0 0
o o LICENSED CONTRACTORS DECLARATION Job Description
1 beeb,drm Wal 1 w Heard under P'°^norts a Charter 9(commencln{
+�
IWSudm70W)of MOsion3ofdo Bue.� Pmfcsana CO .".y rtmb nrallroa naerta REMOVE SHAKES, INSTALL SOLID OSB SHEETING, 30LB
ELT, 50 YEAR COMP CLASS A
ARCHrrECTS DECLARATION l'g�
fI undrraaW my p Ws+hall he used n peblk recares
LkcmcJ Prafcvnairal
3 the,e OWNER-BU wtI DECLARATION
I hertby alTirm Dar am Imo 1 Coaot Licenm Law
o po{ ralloving..(Section 7m I3.Bumev
and Profeak. w the
Cottle:Any city or eaunly
Sa. WI Iidrm a pClNll to Can9r1KL all�w.b11 PrPC.de0011ah.or Mink my AlaGarl:
ZA, xior b Es lltWKT.aLSa requires We apy.lO111 In,W6 l�t nilb file a signed autorneLl
Wu lc b licensed pmwa°In the,Movidon of We Canuuar's lam Lav(ChaPler9 Sq.Ft.Floor Area Valu 1
E=3 (commencing viWSsdW7W0)a Dividm J of Ne Budws and PraRulon Code)IX
5 _ dtx be b ewopt thee(rmn arta the bnla fear the alk{cd e>alptlan.My violation of
Solan 7031.5bya"applkaot for apumltmbjew We appBrant m a civil Pemhy Of 9erOccupancy Type
"mm Wm five kundrcd deBus SWA 37M4UQoo
L u ower or ttie proputy,IX my wploYea viW wv{a a Weir nLe cwepewdon.
vUl do We vert and Wewwme b ontbneeded IXoffecd fw Wc(S..7044.Bm41m Required Inspections
and Prweaaru Cade Tine C.tr .u¢me Lar dam not Wdy Ed avvor of q ns P
poperty vbo builtlt IXlmpmveaderica,and rbo doetarob work bbmelfor Wmu{b hu
ave empbyux•pvv d Wu such uoPrmemeWt art not intended woQeted far aaln�V. t /
Yvvcw v'ful aveOn{ oodken oaememumldvWio oreycm ofirn l W UM,EUche - J
buidw red have One buAm of pmvlag Wu k and ave bdW a impraO Iw Paupoae d
sale.),
❑L u avmcr a(the proRaY'•am rul®roly cmuacrin{rhh Bmivd mmuanran m i�
crosuian not pmjen(See 7044,ELEM.End Prafevlolu Coda':)The Cmmum's Ll' G
m Irvd eveyPlyWvovmcraKOpenyvbo Wti IXLop aomm,an't.
veto cawacu fa web paYm+vial acmaaemr(s)6wnsd Pmvau n We Geuavah '
Lkmm l,Uv.
❑laic mpluMer Sec .BdPC(w Wb ruwa
GumDau
is
WoRtio COMPENSATION DECLARATION
I bereby arrlrm under pevlty a(Pc'lwy arc of We folMain{dveliUnudowt
❑1 have and vW mainui°a Cudfnm of Comes n vR-Inure fa WIXkela Cwnpw
sadoe,n pamWcd fm by Smlmn 77110 0(do Mbar Cod,far We perfIXmant¢N the
nark for which tW pmmll Is ivucd.
(]1 baro and wiL automaton WO,I Cempcwden Iovvana.u rcydred by Sccdan
3l .fLoan
C`l�Abm_Coode,for
1N�eLvptrcnK«a�noa��ern
and fttv�y nu
of Ne vwk fa ahh,-kh.-atoo,pkwy milSS
MME u W6
ue
Mrk
Curkr?ea Comarentratom
n
POLL,No, / �L'L '
CERTIFlCATEOFEONFRAN WORKERS -.
COMPENSSATIONArON INSURANCE
mid aeelm need not no empleted B the permd la foram huMmd dolls(SIM)
orle )
I cedfy di to We perfurmawu of the,vark for vbich Wb pemil b Imsd.I ahaR not
empty WY person in my numorw u In be"),"Ue Subject n the Worte".cornianEezoon
Inn a!Caifamia.Dam
NObow
TICE TO APPLICANT:If,after matin{WIa Color.N EtcnPliwt,you aboard
OaOrne aoi to We Workefa CIXnpe.tlnn poriaion a the LAbw Cod,yo t mm
.,O ranhriW comply vilk awl,prOvidau IX LOU,pane,k sball be d¢mcd revoked.
z CONSMUmON LENDING AGENCY
t^i I bereby affrm WU Wert It a ccatvaNmt Lending agency rar one perfmmane of
a do rock I.which Wit porno b Ltstmd(S c 3097.Civ.C)
a0 Isldes Num
Z:) z Lender's Addran _
U0 1 mrifY Wu 1 hate rtad WIa tepplkadoe art fun drat We above iofarmadun ta
D. E Correa l ague nom ply with all city and.1y aoli.art dun lava relating ED
Obodding muweion,and hereby wWwbe tepnwaudros or Wisehy m cnur-pm We
6UU above-mentioned propeEty for i.Mluon Purpaex
(Wer)agrte to oro,4dcmn fy and keep barmles do C'Iy of CuPerdm a{allm
Ibbuidm,Jnd{meou.eoptWeapemu vhkhmry Many nyaewe againtl,WCty /
Uz to en^n' "oftne {of dds perm) N ZS GL
'-' APPLICANT UNDO ANDS D L CC����PML..Y WnH All NON-POINT Issued by: Date
SOURCE RFL ONSn
�/✓ Re-roofs
Sig'unoe ofA°°�HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIOytnco,kriwfmwe we c-atop mew andhha,adsatrwwial
u defined by the CupeNm Muni ipal Cede.Chapur 9.11 and do Health dad Wcry
Code.Srmvon 1573${)7 All roofs shall be inspected prior to any roofing material being installed.
C]Y. ,�Na
Will theawlkam"rnlm<baumatawpantumegmpammorde-im.bich If a roof is installed without first obtaining an inspection,I agree to remove
I coil hue air cwnao i ru a&fund by We Bay Arta Alr Quality IAana{emea all new materials for inspection.
Dituin7 /
❑Yee '—r .Bttu _
IhmelnddoduSa snmvlalsrequkemewr34,1 Chspnr6 it WebWl ng
Na Ninthtt Safely Cao.tectiwohAt it Myrart21511.1 wdemmtle if We Eorton
Joey not G Y have a ICraOL It b my nmpe®bilily b nalfy do asupml or do
gwp4�m n o^cwmmarG sums Signature of Applicant Date
All roof coverings to be Class"B"or better
OwncrwauNarveda I .. Dam.
CITY OF CUPERTINO
m 1 of 1 PERMIT RECEIPT - OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 34244019 . 00
DATE ISSUED. . . . . . . : 04/25/2006
RECEIPT # . . . . . . . . . : 34116
REFERENCE ID # . . . : 06040146
SITE ADDRESS . . . . . : 22680 ALCALDE RD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . .
OWNER . . . . . . . . . . . . : KSAR MICHAEL Y AND RENEE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3977
RECEIVED FROM . . . . : RICHARD GARCIA
CONTRACTOR . . . . . . . : RICHARD GARCIA LIC # 24428
COMPANY . . . . . . . . . . : AFFORDABLE ROOFING
ADDRESS . . . . . . . . . . : 1910 DAY RD.
CITY/STATE/ZIP . . . : GILROY, CA 95020
TELEPHONE . . . . . . . . :
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- - ---- - --- ------------- ---------- - --------- ---------- - - --------- -
BPERMFEE VALUATION 14 , 000 . 00 212 . 76 0 . 00 212 . 76 0 . 00
BSEISMICRE VALUATION 14 , 000 . 00 1 .40 0 . 00 1 .40 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
------------ ---------- ---------- ----------
TOTAL PERMIT 319 . 16 0 . 00 319 . 16 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----- -- -------- - - ------------ ------------
OTHER 319 . 16 AMEX
TOTAL RECEIPT 319 . 16
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CITY Off' CUPERTINO
REROOF�
CUPE(t INO PERMIT APPLICATION FORM
Building Address: Ca
owner's Name: P ne#
u
Co tractor:Phone#' License#:
r t'" —�
Contact: '
one# Cupertint�usiness License#;
Type o 00 Cov ring:
b/o S
T.xisting: Proposed:
❑ Built•Up Roof ❑ Built-up roof
p Asphalt Shingles �f�+phalt Shiag!es
Wood Shakes /❑ Wood Shales
Wood Shingles Cl Wood Shingles
❑ WooOthe (Specify) ❑ Other(Specify)
Number of existin8 coverings ❑ Provide 1-C.B.O.Report N
Q To O Removed ❑ Provide Mfgr.Ltstolatien Spt,=.
. I Have Read Understand and Will Cam!)IV with Cupertino's Tear Off Policy! I�� Q�
Job Desuription: �/ Dl
Residential Cottvnercial ❑ j�[ C(�t�Q �!CR�S
Fire Zone: Y53� 1`1oi0� / Confirmed with Planning Ipt• if
there are an restrictions: u
Cost of Project: Typo o� ns tion: Occupancy group:
9 C�
?iy
Qty. if Fee Desch tion Fee Group
A licable Fee IA BUILDLNG I
BPSRMFEE Bid Permit Foes BUILD
BENERCrY Ene BUILDING
BSEISMICRE SeismBU
ic Fee Res BUILDING
BSBISMICOM SCt51Ine CommercialBUILDING
BPLANCHK Plan Check Fee B DING
BUSLIC Business License
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