08040078 (2) CITY OF CUPERTINO +qi
BUILDINGD[AWSION 'a PERMIT ;mCO3NTRACTOVEA NI�URMyA'C
BDa.grlbt'sAp1y1RE5(9�ICKSBURG DR CUPERTINO ROOF, INC 08040078
OWNER'S LNA�ME: FEMOT ISUEDATS
1052 KELLY DR 04/11/2008
IrNE (408) 973-9427 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG O POLUMB MECH
O
has LICENSED CON1RACfOR'SDECLARATION Job Descil on
U 1 oreby affirm Nat 1 am Hammed ands add
Proem of Chopin 9(commencing p
nzl withSae0anMoffrDivwon3orWBusinmaandl'rawW.mt:om.wamylwensei. RE–RFrT/OSHKS INSTL1/203B SOYR CLS A 275Q
.n sets rase and erten. C�5 Lw.g GRNDCNYN
''g,3 License Cl a
M Dim CO
7W CHITF.0 O D TION ser
U 1 understood my Porch Nall be used an public awards
en
5� Licensed Peareasi...I
r. OW NER-BUILDER DECLARATION
'I otoby a?set we i am asempt from the
Corvus&$License law for Use
0 o following mason.(Sudan 713I.S,Business and Professions Code:Any city or=only
�3 9 which mquirm a Permit to construes ally.hnprove.dem.11sh.m repair say structure
4ZL prior w its issuance,alw acquittal the applicant forsuch Permit to Ble a signed m¢ment
< that hehlicensed pursuant tomaprowionsofwecantrwmnuamnLaw(Chapter 9 Sq. Ft.Floor Area G• Valuation
n`�s (amenwrtlng with Sudan 7000)of Division 3 of the Business and Prorbeem.Cod $
e)or 10000
was o w..at werefrom and the Buis for the alleged eamption.Any violation of
Sudan 7031.5 by any applicant for a Permit subjects the applicant m a civil Penalty offf Number Occupancy Type
not mom than fav hundred dollars($50B. 36907012 !
❑I.u owner of the property.or my employees with wags as their sale compensation.
will do the worts and the annum u not intended or offered for We(Sal.70/4.Business
and Profession Cade:The Communes License law duet MI apply w an awKr or Required Inspections
property who Wilds Or improves wemon,andwMdoessuch work hintWfmthroegh his
own employees,provided that such impmwmenis are not Intended aroffeand for sale If,
however.we building or impmwermat is said within one Year of comptetion,we cannot,
builder will have W Weaken of proving that o did rot build or Improve fm purpose of
sale.),
❑1.as norm a(the property,w seclWvely wnuacting with Ilcenaati cenumma to
comuuct tic Project(So–7044.Butlnets alba Professions Code:)The Conuan.fs Li-
aise law does net apply an an owns or property who builds or Mprow domain,and,
who onmnm far such pmJem with a com acmr(s)licensed putsmmt w we Commourns
License law.
❑lunuemptuulu See ,B&PCfmthOreason
Owner —Dow—
WORKERS
amWORKERS COMPENSATION DECLARATION
1 hereby dnm under penalty of Pejury one of that following declaruwv
1 haw and will maintain a CeNOesm ofCumem w self-Insure fm Worker's Compcn.
matlon,an provided fon by Sudan 3700 of the lobar Code,fm W performance of ft
woo for which this Permit is issued.
1 haw add will mlintaie Worker's Compema0on Imurma,as required by Suntan
3700.1'the L Ixe Code.fm we perfa e...f low work foormwh this pcemit I.issued. '
My Workeh Cme samuion lard see sni/cr and Policy rumor am:
Cartier. licy No.:I t .7 �I GG
CERTIFICATE OF EKEMP ION FROM WORKERS
COMPENSATION INSURANCE
(TLB aCetion red set kcmnplewd Uwe pemlt V Toone hunakmdakaBus(5100)
m leu)
1 certify that In the perf rrmarce a the work for which this Permit Is leaved,I loll not
employ any person In say samosa u in became subject m the Warkcn'cc mpeuWan
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Ceninnw of Exemption.you should
become subjw in the Worker's Compensation provisions of the labs Cade,you muss
.J O forthwith comply with such prov+siam m permit this peit shall k deemed rewked.
CONSfRUCnON LENDING AOENCY
�N+ I kmhyalibm wallow.issunsosubm leadingaenT rm theperromraceor
the woo far which this Pont,is Issued(Sec.309'$,Civ.C.)
Le
Wnde's Name
�Q
.7 z lenders Address
U Q 1 certify that 1 haw mad this appliadon and sum Nu the show information is
14! torten.I agree to comply with all city and county ordinances and slue laws totaling an
.0 Wildimgmmorecrum,and kreby authorise representation of this city to cow upno we
LP] akve-mentioned Property fm impaction pmp.ses
(We)agree to aw,indemnify a.d Trap harmless we City of Caperton against
ry liabilities Judgments.unit and upemu which may in any way amus agdmt cold City
V in consequence of the grumng of this perms (� /
A ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date /'
s UR UUP
—� ) Re-roofs
Signature of Appl+mntiCanuawr Dow
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dor applicant or future building occupant marc or handle ha'samom material
as defend by the Cupertino Municipal Code,Chapter 9.12.sad ora Health and Safety
Code.Sudina
❑Yes Oyu us331.)7 All roofs shall be inspected prior to any roofing material being installed.
p�hlo
Will the applicant or future Wilding=upon[um equipment Or devise which If a roof is installed without first obtaining an inspection,.1 agree to remove
I buardom air contsminwu u defined by we Bay Area Air Quality Management all new materials for inspection.
attract?
❑Yes
I haw mad the houseclean,mawriilamquimnenu under Caper 6.95 or the Coifor-
INkSafetyCode.=-255¢5.25533and25534.1undenundwcifuc building
dam eaertndr naw a wnwL was it is my mYpomduby to of,we occupant of the
mq ire nwhkhmu W=Lpdorwmuwaofacndnc,moraropae�. Signature of Applicant Date
Owner or auwariaa d set All roof coverings to be Class'n'or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36907012 . 00
DATE ISSUED. . . . . . . : 04/11/2008
RECEIPT #. . . . . . . . . : BS000004446
REFERENCE ID # . . . : 08040078
SITE ADDRESS . . . . . : 10251 VICKSBURG DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . :
ADDRESS . . . . . . . . . . : 10251 VICKSBURG
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3358
RECEIVED FROM . . . . : DAVE SMITH
CONTRACTOR . . . . . . . : DAVE SMITH LIC # 25701
COMPANY . . . . . . . . . . : CUPERTINO ROOF, INC
ADDRESS . . . . . . . . . . : 1052 KELLY DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95129
TELEPHONE . . . . . . . . : (408) 973-9427
• FEE ID UNIT QUANTITY 'AMOUNT' PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 10, 000 . 00 1. 00 0. 00 1. 00 0. 00
1REROOFRES SQ FEET 27 . 00 351. 00 0. 00 351. 00 0. 00
----- ------ ------ ----------
TOTAL PERMIT 352 . 00 0. 00 352 . 00 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 352 . 00 MC
---------------
TOTAL RECEIPT 352 . 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
•
CITY OF CUPERTINO
REROOF
•CUPER.TINO PERMIT APPLICATION
APN # 0 Q Date: _
Building Address:
I V Fj' V ,26
ner's Name: Phone #:
Contractor: Phone #:
�7 Fax #:
Cupertino Business License #: n�✓1 p Contractor License #:
d / S&�S_g3
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) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report #
❑ To be Removed ❑ Provide Mfg. Installation Specs.
Pq✓C 9 ,U T►-, -,4-4 k) z as VY I Pv S+9
Job Description: 5 p� tc� � CS0-$v of rr flas1 A
Resid Commercial
Fire Zone: Yes ❑--Nu-S Confirmed with Planning Dept. if
there are any restrictions: ❑
Valuation:
I Hav ead, Understand and Will Comply with Cupertino's Tear-Off Policy:
• I
Signature
CITY OF CUPERTINO
G REROOF
•CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FC0M Re-roof Commercial B 1COMMLROOF
IBSEISMICO Seismic Commercial B
2� 1RER00FRES Re-roof Residential B 1SFDWLROOF
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLR00F
1BSEISMICRE Seismic Residential B
1BUSLIC 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 with the above stated policy on re-roofing.
Homeowner's Name:
Job Site Address:
Roofing Company Name:
Applicant's Signature: Date:
® Greg Casteel
Building Official
Revised 11/2/04
Community Development
10300 Torre Avenue
� ) Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
q6UPEkTINO
Building De artment
JOB ADDRESS: ( t
V <��S �U G PERMIT ? L< U�
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: FAX#
I am not using any subcontractors:
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
Linoleum/ Wood
Glass/ Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal �,s CS peq,„� C
Sheet Rock
Tile
Owner/Contractor Signature Date