08030130 3UILDING DIVISION PERNUT �CUl�3TRAG'I'OR�IN. 'OItMt� IqN� :
BUIL ANER
G ADDRESS: PMIT NO.
�17 OLD TOWN CT LOS GATOS ROOFING 08030130
ER'$NAME: PERMIT ISSUE DAIS
NATTIV MOSHE AND ESTHER P 0 BOX 1726 03/24/2008
PHONE SANITARY NO. CONTROL NO.
ARCHRECTIENGINEER: BURRING PERMITINFO
RE—ROOF, INSTL 7/16" . OSB&RF BLDa0 O O O
30p LICENSED CONTRACTOR'S DECLARATION
'rd I baby frum We 1 An 0¢ved man,providaes of Chapur 9(momoom il ob Description
wide Smmn 7Okr)or DMdon 3 ofNC Budoess s d Professions CedeanE my license e
a in full foae and effete 171,0 7
jn2 Licencea Lk.N
Dau 3�2 cmiranar y
3'- —T ARCHnECTS DECLARATION , J
1 understand my plans shall W used u public reenNr
�yU
yQ Licensed Preftui...I
^ OWNER-exempt fr DECLARATION
C 0 1 bunco Jnrm that 1 1. exempt Imre the fessions C,License Law for the
E D o rmlowing moon. pandaSee t 7 onium Business and ProImprove,
de ons Cham:Any shy or meat
$ pounty
ooch itsissuapermitm Ithe a@r.Improve,demultsh,erre a sig mymoment
Run IIIpoor 0 iuiensedpalm rego me theapplicantforthe suchCon permit he Lm
mLtwJnaumem
mm Wtbuislicensedpumuw7WofDivisioof 3ofComnnsslJmmelaw,Cod.)(Chapter 9 Sq.Ft.Floor Area Valuation
F 9
(commencingaIsxe pt Section7000)and M Division r of meBusiness
ex and professon.Anynn.Cudc)or
Nu bu u exempt Wrtfmm and the bsu for As alleged exemption.Any vitiation of ����
Section 7031.5 by any applicant for a permit subjects W applicant in a civil Penalty of APN Number Occupancy Type
act mart Nan five hundred d.11us($500).
0 1,s owner of W pmpmty,a my mpl0=wide wges u Wh mlecmpmsedon,
will Prfewade The
Co mmtIntendede Law
ddfor 1 a(See.70 an Bualrcof
Are arty wh bu Coon Tbu ves me em.Lkntse L.w don me Maty f rd on.gh Required Inspections
property who buuraerlmprow,chmmr,,na wbu dcu etuh wort n nfrader Nroogh his
man mploym,ping or Wteshimprovemmumtrot eadfc oroReral for sale.V.
budAtrhowever. R havbuile
As ord"of
u hath a did
ons old of comove forst.W ownsr-
builaQ N0 haw W bmdcn of pmHng We bu did rot Wild or improve far purpose of '
ubJ.
❑1.as owner or W propmy,am sclualvely contracting with 1lwnted mnvstms in
mmrues use project(Be-7014,Business and Professions Cade)The CmtmaY.Li-
cause law does not apply to an owner of property who builds or impnw dictum.ard,
wbu conertcu for such projeeu wide a mnuuwr(s)licensed mundane m the Comrsserr
Licam a law.
0lmem.,underSee ,B3PCrertburease.
Dam
WORKER'S COMPENSATION DECLARATION
1 hereby arBm under penalty of perjury,arm or W following aeaWedone
❑I tum anti WII malnuln a CWRnsm of Cansem m cell-iuum fm Wmkefa Compeer•
satien,as provided for by Section 3/00 of Re Labor Cade.for W perfomanm of the
work for which this permit is issued.
0 I have and will maintain Workers Compensation Insunna,u required by Section
3700 of the lather Code,for W Performance of W work or which this permit is house.
My WorI mpeuad..Wunne canner and Polity number m:
C4rciv: pvfv.'�"'OPoliry No.: I9S�—ZOOS
CERTIFICA OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This section steed not bocmpmed But Permit Is fororchundreddo tan(SIM)
or less)
I certify We In W Performance or sac work for which this permit is issued.I mull not
emptor any pence in my mamcrso u in become mbjcet to As Wad¢rs'Cmpenadm
Laws dCairmels.Due -
Appucme ..
NOTICE TO APPLICANT.IL after making NB CeniBwu of Emmpuon,you Amid
bemmt subject in W Wohm's CmpenYdW ProviJmle of W Iabm Cade you in=
.J O forthwith comply with such providom or this
pewit Nalrcm
l W dend ated.
Zy'--' CONS ucnON LENDING AGENCY
(-. I Iromby afOm the Wer is.consuuetinn mmmns agency for W perfmm.nm of
aW wart fm which this permit m iudedee.(S3091,en.Q
UJCa Landers Name
o z Lenders Address
U O 1 certify that I have read this application aM sum des Ne above informadun is
5L com i-I ague m comply wit JI city Ad county an inu¢es and sues Isere reining m
.r� building construction.and hereby suWdR repmmnntives or this city in cnW uponW
4T7abuve-Ifto mad property for Inspersion purposes
y (We)agree to sew,indemnify and loop humles ft City of Cupertino aatiom
W IiAilides,judgmenuu.co, and expenses which may In my way atom against said City
U Z In consequence of the gaming of this permit.
ti APPLICAtyyyITTTTTT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE
:411 meIO �
3 Z4 Ag Re-roofs
Sign nal ApplluDam
HAZARDOUS
US MATERIALS DISCLOSURE Type of Roof
Will ftaCupenem fuuniipalre ode,it ChaptuortncA m HIAA aammriJ
MOned by W CupeNno Municipal Code.Chapter 9.11.and W HcJN and Safety
Becdae 255324)+ All roofs shall be inspected prior to any roofing material being installed.
❑yet bir
Will Ne applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit huumous air conuminanu u danwd by W Bay Ama Air Quality Management all new materials for inspection.
Roomer(
D Ycm N
I have mad W hanNau numd.0 requirements under Chapter 6.95 of W culler. _
nia)reside&S.rnycade.Seca=25505.25533and 53e.Im&tvwd WEW bolding
don ret a dr new.mnsne deo u ts err mpanuMuty m mdrr dee artdPmt err saw
rtgdirtme wnKMmdR mupriormconsumers eertirou r Sign [ureofApplieant Date
"u ed a 3�Z¢ o m All roof coverings to be Class'%¢"or better
t or mNodsd agent Dam' '
• CITY OF CUPERTINO
2 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35611034 . 00
DATE ISSUED. . . . . . .: 03/24/2008-
.
RECEIPT #. . . . . . . . . : BS000004242
REFERENCE ID # . . . : 08030130
SITE ADDRESS . . . . . : 917 OLD TOWN CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : NATTIV MOSHE AND ESTHER
ADDRESS . . . . . . . . . . : 917 OLD TOWN CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4024
RECEIVED FROM . . . . : LOS GATOS ROOFING
CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481
COMPANY . . . . . . . . . . : LOS GATOS ROOFING
ADDRESS . . . . . . . . . . : P 0 BOX 1726
CITY/STATE/ZIP . . . : LOS GATOS, CA 95031
• TELEPHONE . . . . . . . . : (408) 298-9399
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC . NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 7, 164 . 00 0.80 0. 00 0. 80 0. 00
1REROOFRES SQ FEET 24 .50 318.:50 0. 00 318 . 50 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 319 .30 0. 00 319. 30 0. 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
()3
CITY
O
CITY OF.CUPERTINO
REROOF
T
OF
+CUPERINO PERMIT APPLICATION
APN# -56^ / / — 63`T .. 6Q Date:
Building Address:
9/ 2
Owner's Name: Phone #:
Contractor: L o S 2 0 o y- ►r? t{ Phone #: 1�o 8 „2 C) g'_ 9_3 ,9 9
Fax #: YOF - 93
Cupertino Business License #: � '7/ / Contractor License #:
3oo ,707
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles >� Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) if Other (Specify) 7 /1, GS 3
Number of existing coverings ❑ Provide I.C.B.O. Report #
To be Removed ► �f Prove. Installation Specs.
S S
S s .� an !lq ss
Jo Description:
Residenti Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: ❑
Valuation: i-
I Have Read, Understand and Will
Comply with Cupertino's Tear-Off Policy:
Signatur
CITY OF CUPERTINO
G Q� REROOF
OCUPEkTINO FEE SCHEDULE
Number.of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1C0M1VLR00F
1BSEISMICO Seismic Commercial B
1RER00FRES Re-roof Residential B 1SFDWLROOF
1BSEISMICRE Seismic Residential B
1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
IBUSLIC Business License B
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 wit the above tated policy on re-roofing.
Homeowner's Name:
Job Site Address:
Roofing Company Name: yy 1
Applicant's Signature: L
�l�ll )Z/ /� Date: d) 0-8'
Greg Casteel
Building Official
Revised 11/2/04
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
�UPEf�TINO Fax(408)777-3333
Building De artment
JOB ADDRESS: PERMIT #
917 olal Tow ^ G--, 0 �-o 3 e
OWNER'S NAME: E e r .aTJ v PHONE # ¢o g_ 9 B — 9
GENERAL CONTRACTOR L,,.s a FAX # ¢cg
I am not using any subcontractors: 31 z o
Signature Date
Please check applicable subcontractors and complete the following information:
60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
iLinoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
'I Sheet Rock
Tile
3)Z jo S
6wner/ Signature Date