99100124 3z - o � -- 0 3z C1 10
PERMIT
APPLICATION FOR CITY OF CUPERTINO NUMBER
INSPECTION DIVISION PERMIT EXPIRATION
REROOF PERMIT - (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
_�Mfid bp zoo RESIDENTIAL - COMMERCIAL ✓ OTHER
OWNER'S HAZARDOUS FIRE AREA
YES ❑ H yes—I understand that a Class A
NAME �()I til '1—TQ I 1 q root assernby Is required.
NO ❑ Irvfial I.C.B.O.tl
ADDRESS ZIOlO H-eme�-}.��C�1 .�te.• Z�O EXISTING ROOF COVERING
PHONE —� NUMBER OF EXISTING COVERINGS
CONTRACTO
RS ��77�,�,,,,L
NAME� 'Ins ale CZ(_Xl I I Y-)q TO BE REMOVED TO BE RETAINED
ADDRESS 1
y I LW TYPE F O OVE IN
GITY 87JP 4Ig)—I: 7 f l {ZPv�Stc�r�fAve. HcIun 1 xl TIN
PHONEIU-5GJ qto`I(- 5101 BUILT-UP ROOF
LICENSE
NUMBER ASPHALT SHINGLES
LICENSED CONTRACTORS DECLARATION
I hereby efflrm Mat I ern licensed under provisions of Chapter g(comnnncl g Mth Section WOOD SHAKES ❑
7000)of Dldnlon 3 of the Business and Professions Cade,and my films,is In lull tome and
effect.
A�••� O WOOD SHINGLES E]' License Claes c% �-1 Llc.Number
(0/Ia MCA 2 '� OTHER(SPECIFIC
Date Contractor
OWNER-BUILDER DECLARA ION PROPOSED
I hereby aHlrm that I em exemptth
from the Contractor's License Lew for e following resew.
(Sec.7031.6,Business and Professions Code: Any ch y or county which requires a permit to
cco,tmct after.Improve,demolor demolish, repair any structure,prior to Its Issuance,also requires the BUILT-UP ROOF /IN /\❑
applicant for such permit to file a signed statement Met he Is ficenwed pursuant to Me Prwlslons rl'I
of the Correctors License Law(Chapter 8(Commenclwith Sector 7000)d DNlalon 3 of the
re
Business and ProfeesioCade)or that he Is exempt therefrom and the basis for the alleged ASPHALT SHINGLcI D
exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to . ❑
e civil penalty al not more than five hundred dollars($600).): �11 OCT 5 0
01,As owner of the property,on my employees with wages as their sole compensation,will co WOOD SHAKES 1 1999
the work,AM the structure Is not InteMM or offered for pale(Sec.7064.Business and Profm-
afons CMe:The Contractors LI<umse Law does not apply to an owner of property who build,or WOOD SHINGLES
Improves thereon,and who does each work himself or through his own employees,provided Het 13Y
❑
such Improvements are not Intended or offered for Bele.It,however,the bullong or Improvement
is ear within one year of completion,the owner-tullder will hese the bunden of proving Net he did OTHER(SPECIFY)
not talo or Improve for purpose of sale.).
❑I,as owner of the property,am exclusivity contracting with licensed contractors to conaWct
Me project(Sea 704.Buslnem and Professions Code:The Contractors License Law does not PROVIDE I.C.B.O.REPORT NO.
apply to an owner of property who oullds or Improves thereon,and who contracts for such projects
wIM a comm ictor(s)licensed pursuant to the Contractors Ucense law. PROVIDE MFGR.INSTALLATION SPECS.
F7 em exempt under Sec. ,B a P.C.for thio reason
owner Data APPLICATION DATE VALUATION PERMIT FEE
WORKER'S COMPENSATION DECLARATION K'1
I hereby affirm under penalty of perjury we of the following dodaramn
r-) : Q V 1 have end will Mormon a Certificate of Consent to,elf-insure for Workers Comensatlon, Building V
m provR ad for by Section 3700 of the Labor Code,for the performance of the work for which this n qq �{ /�
permit ie issued. 10118 /1- 4 11,S I/ �� Seismic i,
❑ have and will the performance
Workers f the w Compensation Insurance,m required by d.My 3700 of
the Labor Cade,for the pedmmand of the number
for which this permit is Issued.My Workers
Compensation insurance Corder entl Policy number are: Total (-11.01.11)
Carrier =1'15L1faix-e 6pazy No. I1 1072—(117$ PERMIT AUTHORIZATION DATE
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE 100)o
(This settlor need not be completed If the Permit B for we hundred dollars($100) r tem.)
I certify that In the performance of the work for which this permit Is Issued,I shell not employ -
any person In any manner so As to became subject to the Workers'Compensation Laws of Cell- All roofs shall be inspected prior to any roofing material being
fornix. installed. If a roof is installed without first obtaining an
Data f O ApplKant ��Oa !Jm{ "wA inspection,I agree to remove all new materials for inspection.
NOTICE TO APPLICANT: If,offer makirtgHie Ce 112m.of Exemption,you Applicant understands and will comply with all non point
sublem to the Workers'Canponnatlon provinlons of Ne Labor Code.you must forthwith Comply
with such prwlelons or this permit shall M deemed revoked. Source regulations. -
I Certify that I have read this application and state that Ne above Information Is correct.I agree
to comply with all city and county ordlmrrces and state laws relating to building construction,and All roof Coverings to be classG or better.
hereby Authorize representethea of this city to enter upon the aowa-mentioned property for In-
spection purposes.
(We)agree to neve.Indemnity and lay I harmless the City ai Cuperflnoid C apemen liabllance
j menta toes end expensm winch may In em way accrue epelrret mlo Ctry n coneequerce SIGNAI RE OF APPLICANT DATE
of the prentirg of His pemil.
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 ACCESSTO ROOF SHALL BE PROVIDED FOR INSPECTION
OFFICE COPY
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: karenb
Ser Twp: Rng: Sub: Blk: Lot:32607032.00
INVOICE DATE. . . . . . : 10/25/1999
REFERENCE ID # . . . : 99100124
SITE ADDRESS .... . : 21070 HOMESTEAD RD
SUBDIVISION ...... .
CITY . . . . . . ...... . : CUPERTINO
IMPACT AREA ..... . .
OWNER . . . . ....... . : SEUIG HAHN
ADDRESS ........ . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4823
CONTRACTOR ...... . : ELMORE, PAUL M. LIC # 105
COMPANY .......... : RESPONSIBLE ROOFING INC
ADDRESS . ......... : 918 N RENGSTORFF
CITY/STATE/ZIP ... : MOUNTAIN VIEW, CA 94043
TELEPHONE ........ : (650)969-6151
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE CUE
--------------- --- --------- ------------ -----------
BPERMFEE P 177.00 0.00 177.00
BSEISMICRE P 1.20 0.00 1.20
--------- ------------ -"'"'-----
178.20 0.00 178.20
ID __-----DESCRIPTION
-__-__--- VOICE ID ._-.....DESCRIPTION
... ..... ........ .................
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•
Plan Check Division
10300 Torre Avenue
Cupertino CA 95014
Telephone(403)777-3223
Fax(408) 777-3333
City of
Cupertino
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance, you must agree to comply with 1994 UBC Standards and
manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 that the proper City inspection
can be performed.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: `�e l ii G H,{ , l
Address: 210.10 H(MpP-) -e-nd 5h' . 260
Reroofing Company Nam��enq�(X�' S/bje P-ry) 9
/,tx
Applicants Signature: MW44 6&z±z, -
Joe Antonucci
• (Chief Building Official)