06120084 CITY OF CUPERTINO s -
BUILDING`DIVISION PERMIT C0�ITRtACTOR AN FORMA
BUILDING ADDRESS: PERMITNO.
OF
OWNER'S NAMP: A
5577 VASSAR DR. 12/18/2006
SANITARY NO. CONTROL NO.
NE:
, (408) 265-9270
ARCHITECT/ENGINEER: BUILDING PERMR INFO
BLDG ELECT PLUMB MECH
l� 0 0 0
C) LICENSED CONTRACTORS DECLARATION Job Description
w— I hereby alErm that an licxlved mice,provisionsof Chapu:r 9(cmnmertcing P
z,,, with Section 7001.f Division Sof the Business udP fe} �aw.cdm Rccnmis TEAR OFF EXISTING ROOF
H in full foot:and.f _ )
�yz Lic:Otc,(.Tazs=vlic.a INSTALL 3 PLY BUILT UP, HOT MOP ROOF
w Data
ARC HITECTSDECr AGN- WITH ALUMINIUM
i 1 understand my plans shall he used as public records
iyU
wo in Licensed Professional
OWNER-BUILDER DECLARATION
in
1 batehy aIBma Our I an u,mpt from duo Contractor's License Taw for the
:p o following mown.(Section 7031.5,Business and prnfectlou Care:Any city Or County
$ which regviru a Permit to construct,alar.imPmvc,dcmaliN,nr repair any rwctum
.Z e
Omura,is issuance,alw sequins tM applicant for such permit w fire a rigwd statement
that he is licensed pursuant to the provisiaMof the Contractor's Liao.Law pauper 9 Sq. Ft. Floor Area Valuation
eta (commencing with Section 7000)of Division 3 of the Business and Prefeuimns Cow)or $14500
!9F thu ho is exempt therefrom and the basis(a Be alleged asemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of yp Number Occupancy Type
set mole dun five hundred dollars(x M). 357170j8 ,
:tl L
❑1,u owner mf the proprny,a my employees with wage as Heir sole eompenuJon,
win do tbewow Cork,- he Co ers noes License a.cons
.1 apply to an owma of Required Inspections
and Prty who ns Calc improver
ver tntmfs Liana Law deo ret apply lf an owner of q P
property who s.provi ed that
such
improvements
and who dwsswh work hinuelfar though his
Ownemployees. Jut ruchIs semenuere Trot intended apitumed for muni,
builder,.due have
re or improvementproving
that
a did not year of completion.dicpre awncn
builder will have the burden of proving Nu he did not build a imprme for purpose of
sale.).
0 I,w Owner of she property,am uclasively contracting with licer and Contractors to
construct the project(Sec.7044,Business and propositions Cak:)The Com etors Li.
cone law does not apply to an owner of property who builds or impmvu theman.and.
who contacts for such projects with a conuewr(s)licensed pursuant in the contractors
License law.
0 1 am exempt under Sec. ,B&P C for this mason
Owner Dao
WORKERS COMPENSATION DECLARATION
1 hereby idnom under Nsulty of edur,ane of the following declarations:
I have and will maintain.Certificate of Cones an self-interest fm WeJets Compen.
sation,u provided for by Section 3700 of the tabor Code.for Ne performance of the
work(a,which Nu permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,as tric,uis:d by Section
37W of the Labs COd:,far the performance of the wart for which this Permit Is issued. '
CMayrtWieor. ow
7Z7Policy No'719U�tk 91 y
CERTIFl ATE OF EMPf10N FROM WORKERS'
COMPENSATION INSURANCE
(Thisicctian wed not he completed if Ne permit is forms,hundred Conan(SIM)
or less)
I terrify that in the pe formawc of the work for which this Permit is issues,1 shall not
employ any parson in any manner so u at become subject to the Workcn'Compensation
Laws Of Califomia.Data
Applicant
NOTICE TO APPLICANT:If.after making Nis Certificate of Exemption,you should
become subject to Ib:worker's compensation previsions or the Law Code,you must
JO forthwith comply with such provisions or this permit shall be deemed revoked.
Z� CONSTRUCTION LENDING AGENCY
[-� Ih,mhyaffirm that IM.isaconsuvctinn lendiagag:m:y,ror the performance.(
C the work fur which this permit u issued(Sec.7097,Civ.C.)
W�Q LendeYs Name
Z Lender's Add.
U O I certify that I hoc mad this application and state that the above information is
Correct.1 agree to comply with all city and county ordinances and rule laws relating to
0U building construction...itw.1r,amhame re,merstises or this city,.Cott,upon the
l'W ahovc mentioned pmperty for inspection purposes.
(We)agree to save,indmod fy and kap harmless the City o(Cuper inm against
liabilities.judgments.costs and expenses which may in any way accme against said City
U Z in consequence of dm grunting Of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REOU
9 0 10' Re-roofs
Signature of ApplicanJConuactor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant core orhandlc meadow material
as deflied by the Cupertino Municipal Code.Chapter 9A2.and the Health and Safety
Cock,Section 25532(4)7 All roofs shall be inspected nor to an roofing material being
❑Y. . .pale P prior Y g ginstalled.
will to applicant or rutum Wilding Occupant ase:yuipmentordavias which If a roof is installed without first obtaining an inspection,I agree to remove
mit ha Moor air contaminants as defined by Ne Bay Area Air Quality Management all new materials for inspection
District
DYu Nu
Ihavcreul thehvaNwsmau05.253immeass 5534.I rChawr ord hatifthe Wilding ��`
far-
iia HwlIhave ma the ow-rdets
Sttdom 2550&25533 anJ25s an&,Jhrsser6.95 fth building ` V
data not tome. h.ve.tenant that in' ruporsibility to notify the uaupent Of the
rtynimmens whreh t rssmawc cur,cenireae or p.n )gra lure o Applicant Dale
Owner or ammorisd 4)g D,ro All roof coverings to be Class "B"or better
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35717018 . 00
DATE ISSUED. . . . . . . : 12/18/2006
RECEIPT # . . . . . . . . . : BS000000020
REFERENCE ID # . . . : 06120084
SITE ADDRESS . . . . . : 10121 IMPERIAL AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MIKUL MICHAEL
ADDRESS
CITY/STATE/ZIP . . . : HILO HI, 96720
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR . . . . . . . : HANK OLOCKI LIC # 26739
COMPANY . . . . . . . . . . : ROOF ROOFING
ADDRESS . . . . . . . . . . : 5577 VASSAR DR.
CITY/STATE/ZIP . . . : SAN JOSE, CA 95118
TELEPHONE . . . . . . . . : (408) 265-9270
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 14, 500. 00 223 .56 0. 00 223 . 56 0. 00
BSEISMICRE VALUATION 14, 500. 00 1. 50 0. 00 1 .50 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 225 . 06 0. 00 225 . 06 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
OTHER 225 . 06 VISA
--------------
TOTAL RECEIPT 225 . 06
•
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:
Job Site Address:
Roofing Company Name:
Applicant's Signatur . Date:
• Greg Casteel
Building Official
Revised 11/2/04
Community Development
10300 Torre Avenue
1�SO Cupertino CA 9 014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
WUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
i 0 i a l 1 M%-i ft-- M)5 1 L)(-p i s
OWNER'S NAME: / PHONE # 3 Z
GENERAL CONTRACTOR'/ FAX #
I am not using any subcontractors- Z Z;
tgnature Date
Please check applicable subcon tors and complete the following information:
SUBCONTRA OR 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
er/Contractor Signature Date
j
CITY OF CUPERTINO /a op8�
REROOF &�
• CUPERTINO PERMIT APPLICATION FORM 0&4A000
APN# 3S'�' 1O Date:
Buildin Address:
MB
wne 's ame: Phone#:
Of,32>-Z
ontractor: Licen e#:
Contact: Cupertino Bu i ss License #:
Type of Roof Covering: Ab-731
Exiting: Pr ed:
Built-Up Roof �y 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.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: eaf- O' pc� /vS-IL W 2 �u
Re dential ❑ Commercial,//M
Fire Zone: Yes ❑ No Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: Type of Const ction: Occupancy group:
B D13
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
•