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06020062
CITY of cuPECOIVTR2,CTOR INFORMATION I BUILDING DIVISIONSION PERMIT BUII.DINGADDRESS: KEITH ROOFING CO INC P"""ND.06020062 20395 PACIFICA DR ER'S NAME: PERMIT ISSUE DATE WHITTAKER DENNIS S AND ELI ABE920 LINCOLN AVE 02/09/2006 PHONE: SANITARY NO. CONTROL NO. (408) 295-8616 ARCHITECT/ENGINEER: BUILDING PERMIT INFO ' BLDG ELECT PLUMB MECN RPc app LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm Nal I am licensed under provisions of Chapter 9(commencing with Section 7IXXp of Division Sof the Bulinus and Professiuu Code.eM mylicensu FINALED in funmrceandefr«L 25 �� TEAR OFF AND RE-ROOF T&C 0 q a Llccruc Class Lle.as - n p Date C ON JUN 4?, 2006 nECTI-SDESDEina— ARCHI Ry , I understand my plans shall W used as Public records IN r�s7yy�,sv p Licensed Professional pl 3 OWNER-BUILDER DECLARATION tlWry `Caapi I I hereby at Nat I am exempt form de Commences License Law for the p o following reason.(Sector.70315,Business and Prefesuom Code:Any city or county K.0C 9 which requires a Permit to conswct alar.improve.demolish,m MPur any swctma 319 7 2 YZ) prior to its issuance.also acquires the applicant for such permit in file a signed statement < ton W is licensed purfamal to On provisions;of due Contractor's Uccose Law chafmci 9 Sq. Ft. Floor Area Valuation y�nc (commencing with Section 70X)of Division 3 of the Business and Professions Cade)or y at he is exempt Ontario.and On basis for the alleged cm rplim.Any violation of Section 7031.5 by any applicant for a permit subject due apPlieam to a civil Penalty of r Occupancy Type not marc than,five hundred dollars(g500). ❑I,u owner of the pmpeny,m my employe.with wages u deir wle compenudon, will do dte work,end Nestmcmm limit intended oraBaed I.I.W.(See.7044,Business and Professions Cox:The Canoactoes License Law don wt apply in an comer of Required Inspections property who Wilds orim news thereon,and whodoessuch work himselfor through his Own employees,provided Nat such improvement am set inended ma@and fmsale.If. however,On building or improvement is sold within one year of eempledon,the owner. builder will have the burden of proving Nat he did not Wild or improve for purpose of sale.). 0 h as owner of the property,am exclusively contracting with licensed eomnnora nc convect on pmject(Sec.7044,Business and Profcssfou Cax:)The Contractor's Li. cane law does not apply in an owner of propeny.who Wilds or improver themon.W. who centimes far such projeeu with a comracmr(s)licensed .at in the Comractoes License Law. 0 1 am mmap'unxr Sec. .B&P C fm Nis moon or,, Date WORKER'S COMPENSATION DECLARATION 1 hereby afrmm under penalty of perjury one of the following decimations: I haw and will munuin aCutifiwe of Lament ro elf-imam fm WOatersCampcn- utian,Is provided for by S.ma 37X of the labor Code,fur the performance of the .it for which this permit is issued. 1 have and will maintain Worker's Compensation Insurance,as inquired by Section 37X of On labor Cade,for the performance of the wort for which this Permit is issued. My Workers Compensation Insurance carrier and Policy number art: carrier: 73TWrEPolicy NO.:ow 0771 S7-2L)O CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section ante not he camp le ted if that permit u foram hundred dollars(SIX) or less.) 1 cenlfy Nm in the perfnrmena of the work for which this Permit is issued.I shut not employ any person in any manner m as to become subject to dm Worke 'Compensation Laws of Califomm.Data Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject 10 the Worker's Compensation pmvisiou of the Labor Cax,you must .J Z foMwith comply with such prnvisiom or this permit shall be rimmed rewked. zCONSBUCTION LENDING AGENCY [—� I bemby armor Nat Vert is a connotation lending agency for the lerformana of a 7 the work fur which On permit u issued(Sec.3097,Civ,C.) QUnder.Name =z Lender's Address U 0 1 artily Nat 1 have mad this application and mute that the above infotmedun is u, F comecL I agate to comply with all city and county ordinances and state laws misting to 0 U building convection.and hereby amhodm mpmmmutives of this city to enter upon the F y .how-mentioned preperty for inspection putlmsea (We)agree to save,indemnify and keep humlm the City of Cupertino against res liabilides.judgmcnu,cmuend expersct which maY in enYwmy ucruc aguutsud City t.)z to coucgmmc of Ne graining of Nis paos it. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURC GU TIONS 2-5'010 Re-roofs Signalunca ApplicanuContractor Data HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will de applicant or future Wilding occupant eororehandle harardou material u xfimd by the Cupertino Municoi Cade.Clasper 9.13,and the Heahh sad Safety V.,m.seetiom 7ss32(.)7 All roofs shall be inspected prior to any roofing material being installed. C]Yes Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove omit hznadous air conumium u fined by the Bay Area Air Quality Management all new materials for inspection. District? P 0Ycs u I have mad the Woolens materials requirements unxr Chm acr695 of the Califor- nia HwlthkSafctyCodc,SaUom 25505.25533 and 25534.1 anxrsuM Natifthe Wilding does r�tort�"dy haw a tenant Nat ilu my respomihility b notify the occupant of the mqhich mu el pear in nonmetals Cambric.,of Occupancy. Signature of Applicant Date .�S/ ?--5-0(0 ner cur authorixcJ agent Data g All roof coverings to be Class "B"or better Ow CITY OF CUPERTINO Ism 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw COPY # 3 Sea: Twp: Rng: Sub: Blk: Lot: - APN . . . . . . . . : 36940025.00 DATE ISSUED. . . . . . . : 02/09/2006 RECEIPT #. . . . . . . . . : 33162 REFERENCE ID # . . . : 06020062 SITE ADDRESS . . . . . : 20395 PACIFICA DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : WHITTAKER DENNIS S AND ELIZABE ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014 RECEIVED FROM . . . . : ROGER BRIGHT CONTRACTOR . . . . . . . : BRIGHT, ROGER LIC # 21477 COMPANY . . . . . . . . . . : KEITH ROOFING CO INC ADDRESS . . . . . . . . . . : 920 LINCOLN AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95126 • TELEPHONE . . . . . . . . : (408) 295-8616 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 32, 000.00 384 .48 0.00 384.48 0.00 BSEISMICOM VALUATION 32, 000.00 6.72 0.00 6.72 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 391.20 0.00 391.20 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ --__--------___--_ OTHER 391.20 VISA TOTAL RECEIPT 391.20 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 305 FRAME 307 INSULATION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS S. Community Development �, 10300 Torre Avenue Cupertino CA 95014 Telephone(408) 777-3228 �PE(�TINO Fax(408)777-3333 Building Department JOB ADDRESS: PERMIT # 3 3- A . ©� -Z 00 6 2- OWNER'S OWNER'S NAME: -D-Py)r,� �eR PHONE # Z S=86 16 GENERAL CONTRACTOR: � �o FAX # - 7 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 Ti e Owner/Contractor Signature Date M�uwCity Community Development Department Building Division ! of Cupertino 10300 Torre Avenue • 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. • 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 " 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: �_Je. ,,,,5 tlG Job Site Address: Z03 9�_ ?0,6 94 !'_A TO. Roofing Company Name: Applicant's Signature: te. Greg Casteel Building Official Revised 11/2/04 .;Printed on Recycled Paper CITY OF CUPERTINO Woaoc UR_, REROOF Za WUPEkTINO PERMIT APPLICATION FORM APN # Date: 3A <tcc)- oas Building Address: Owner's Name: \\ 11// Phone#: l J �e — 3 S_'3 2 1 Z Contractor: Phone#: License #: SS- '7F'(o Contact: Phone#: Cupertino Business License#: a - Z5 s_8G 1 Type of Roof Covering: Existing Propos : Built-Up Roof e 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 Mfg.Installation Specs. Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ob Description: Residential Commercial Fire Zone: Yes ❑ No ®- Confirmed with Planning Dept. if there are any restrictions: LJ Cost of Project: Type of Construction: Occupancy oup: 31 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