06070105 CITY OF CUPERTINO
9UILDINGOIVISION PERMIT -> (�N,.TRACTORJNF�ORMr� I(.N:•
BUILDING ADDRESS' MBROWN CONSTRUCTION, INC PERMIT NOO 6070105
1097 KENTWOOD AV
OWNER'S NAME: PERMIT ISSUE DATE
SCHATZ NANCY H 702 S. DANIEL WAY 07/17/2006
NE: SANITARY NO. CONTROL NO.
(408) 260-1260
ARCHITECT/ENGINEER: BUILDING PERMIT.
ER INFO
PL
BLDG ELECT PLUMB MECH
Q C=
lgg LICENSED CONTRACTOR'S DECLARATION IOb Description
i u FjI Amery affirm dol 1 Am B¢med under pmvis as of Clupur 9(commencing Job
GW with Sued.7010)of Division 3afdro Business and Profeari and my lice.is
+� mmnfot«andeir . SCO REMOVE 1 LAYER OF OLD ROOF AND INSTALL APPROX.
;qz umnmC] Lm." 21 SQ. OF COMP CLASS A
= Dau Camrana�
I4 As shall ECr3 DELLA ATIO _ _/L ,_ (I _
i 2� 1 understand my plans shall be uxtl u public nxordWM•DY/L^�i JI•61
iy
n G Licensed Professional
'a5 OWNER-BUILDER DECLARATION
I hereby airum that 1 am exempt from du Conuaatofs License law for the
D O following mason.(Swoon 7011.5,Business and Profession Cade:Any city or county
5$ which mquius A permit in..nRrAL Abu,improve,d.Aelbh.Or upon any somcluu
prior At its issuance.also,requires the applicator for such permit u file a signed statement
`e 'hub is licensed pursuant on the pmvisionsofthe Commerce,Lice=Law(Chapt,9 Sq.Ft.Floor Area Valua 000
s�$ (commencing with Socoon TODD)of Division 3 or the Business and Profession Code)or
e the he u Axempt themfmm and Ne bub for Ase Alleged exemption.Any violadm of
Section 7031.7 by arty Applicant for a permit Objects the applicant e a civil PAWry of 3 A ySS Tber0 0 Occupancy type
not more Nan Ove hooded dollars(5500). 5 9 3 7
❑1,As owner of the irmpeny,or my employees with"tea As their seb compomtlon,
will do the work,and the swnuu is not rounded ar afferei for tale(Sm.706/.Business
And Plafeadme,Cade The Com oscral,License Law does N Required Inspections
a l apply to Owner a( q red Y .
pmpemywyOb,poeIXrmlpmWalh Improvements
prve wits Amnotcb work bYnCaOr for We his N ��yyta� a
hwnemploybuildiingormatamhent is to within
not roundedmpRemd farsele,IL , .li{�fy((9 M'ppP)PLwpY^
balder.the e"the
burden
Of p ul.g so,An Aides ar year Ari mprove f r vans.Of 's/"��CC
builder will have Ne burden of proving Nat lo,did rot build or impels far purpose of
nW.), a
i,As Amur of the property.am exclusively conaacdng with licensed Amassers so
cube La the es not (Sea 7014,Business ro and Py who ho Code:i The CDnuactar,a and. CU
come law dada not apply u A ore of esc ery who Wilds s improves Asesmn,rod. ��
whosse Lace for such prokcu with a AntractoRO licensed puruunt m die Contracmfa fjf�j�/t
Owner las. y „ q� ,y
❑I Am exempt under Sea ,B&PC far this mann I� plttVj)/
Owner Data /�
WORKERS COMPENSATION DECLARATION
1 hereby&IT=under penalty of perjury one of the following declarations
1 hues and wia marnW n a CWOmeaf Consent In self-mmol for WorkehCompen-
ution,As provided for by Senium 3700 of the Labor Cade.for the performance of du
swrk for which this permit is issued.
klov,and will msinuin Worker,.Compe ablon InsurOce,u required by Section
L7OTof the labor Cada for du performance of the work for which this permit is issued
y worker, om euwm imr curie and Polity number art:
Carrier.— Imp,
Polity OM ( RK tS'(��
C RfIFlCCOMPE COMPENSATION
NFROM WORKERS
COMPENSATION INSURANCE
Cihissection seed Amite completed ifft permit Is forme hunduddoBars($100)
or bis)
1 UNry that N on,po fernAwA of Ibe wafb for which this Permit Is bend,I.hall Ar
employ any person in any mmur An As m become wbkct to the Worwri Compensation
Laws of California.Dau
APORWIL
NOTICE TO APPLICANT:IC slur making this GAN@au of Exemption,ym.hmW
become ObJrt M du Worker's Compensedan provisions of the labor Code.you Atm
.,ZfoMwith comply with such provisions At this permit that he owned mucked.
z Oy CONSTRUCTION LENDING AGENCY
[—i 1herebyaffinardw Neu Is.couvucdnn bulf.j.pay,for the performance of
C> the work for which do.permit bbased(Sec.3D97.Civ.C.) '
W n~. lender,$Name
Z Iendces Address
U 0 1 cunify that 1 have mad Asia Vquicadan,nd suss the ds above inforeudcn I-
P
P coronet.I agree a comply with all city no county ordinances and s m:laws relating to
DU building coneuunian,and hereby authono,mprctentstiva O(one city to enter upon see
Ls) movo-mentiuned property for Inspection purposes.
(We)agree to uvea indemnify and keep harmless thc City of Cupertino alisms'
(,y y Irabiirdr,Judgments.cru and espwu which may In any way see=kgainst said City
(„)�[, in con quj'�
gemming of N' It.
APPLI AERSfAN ND WILL COMPLY WITH ALL NO Issued by: Date
SOUR EION
Re-roofs
Si{nuts a Applicen ue<ur Dau
H RDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future bulkims owupasr lam round].hayallon mauri,l
as de0ned by the Cupertino Municipal Code,Chapter 9.13,and the Ha1As and Safety
Code.. don 25532(,)+ All roofs shall be inspected prior to any roofing material being installed.
❑Yns a
Will the Applicmt or tum building Occupant use equipment or devices which If a rOOI IS installed without first obtaining 8n 1n5peC[lOnr I agree to remove
emit hayardnns air Anuminanu u defined by the Bay Area All Quality Management all new materials for inspection.
DisWct7
❑Ya 17116.
l he.mad the haeardoul,matcrlvls equimmenuunder Chapter 6.95 ofthe Ca]ifor. _
ria Health&Safety Code,Suctions 25705.25733 and 25534.1 understand Udrive building
dao not candy A.A tenm4 Nat it b my responihi]ity u notify the oupanm o(thc
mquiumets ichmuubenur its uuscofaCmiOceco mwmm)' Signature of Applicant Date
Owner or w oris ege Date' Ail roof coverings to be Class"B"or better -_�
Community Development Department
Building Division
yr City of Cupertino
sof4 10300 Torre Avenue
4ki�3r
• Telephone: (408)777-3228
CITY OF Fax (408)777-3333
CUPEkTINO
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.
• S. 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 Raid 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: ) � ''I � r Cv tx,if) CA-
Roofing Company Name: gbrollon
17_GrApplicant's Signature: Date: 71-7-
Greg
eg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
Community Development
10300 Torre Avenue
SfITYOF
CupertinoC95014
Telephone(408)777-3228
11 Fax(408)777-3333
4JUPEkTINO
Building Department
JOB ADDRESS:-j S Y,� w�� �e I C o PERMIT #
n c5olt}
OWNER'S NAME: QnCY PHONE # 8. 2S 3 X931
GENERAL CONTRACTOR: RW U THC FAX# Y, Zlob 12(., C)
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
-l. 11. 0&
Own r/ ontractor ignature Date
CITY OF CUPERTINO
!m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35930017 . 00
DATE ISSUED. . . . . . . : 07/17/2006
RECEIPT # . . . . . . . . . : 35289
REFERENCE ID # . . . : 06070105
SITE ADDRESS . . . . . : 1097 KENTWOOD AV
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SCHATZ NANCY H
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : MBROWN CONSTRUCTION
CONTRACTOR . . . . . . . : CHRIS BROWN LIC # 25108
COMPANY . . . . . . . . . . : MBROWN CONSTRUCTION, INC
ADDRESS . . . . . . . . . . : 702 S . DANIEL WAY
CITY/STATE/ZIP . . . : SAN JOSE, CA 95128
TELEPHONE . . . . . . . . : (408) 260-1260
SEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 4 , 000 . 00 104 . 76 0 . 00 104 . 76 0 . 00
BSEISMICRE VALUATION 4 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 105 . 26 0 . 00 105 . 26 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 105 . 26 AMEX
TOTAL RECEIPT 105 . 26
•
CITY OF CUPERTINOO�O
REROOF
W-UPEkTINO PERMIT APPLICATION FORM
APN # Date: 0(0
Building Address: e� �j rho j ck q 5b 1q
I o9rioc� fes. lP
Ow ne 's Name: S Phone �Icf31
C tractor: Phone#:. License M
Co>�3ncN� 4b b- "0 . 1260
Co act: Phone#*,,,
Cupertino Business License#:
2cn0- 12(od 2S1
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof �y Built-Up roof
X Asphalt Shingles J^ 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 Com 1 With Cu ertino's Tear Off Polic
Job Description: �ci ot— �7°� 1hSaU apP�k. 5�• o F
DS} vn d Lass A.
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dt. if
there are any restrictions: LeJ
Cost of Project: 1, Type of Construction: Occupancy group:
/0DD t QUDT Slh �G Y✓1
Qty. if
Applicable Fee ID Fee Description Fee Grou
BPERMFEE Bldg Permit Fees BUILDING
BENERGY EnergyBUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
•