08120066 CITY OF CUPERTINO
BUItsDIM9,DIVISION PERMIT CONTRAC.I'Ol2gINEORMATION -.
BUILDING ADDRESS: PERMIT NO.
10933 LEAVESLEY PL R E ROOFING & CONSTRUCTION 08120066
OWNER'S NAME: INC PERMT ISSUE DATE
i SA Y CONTROL 10.
ARCHITECffENGINEER: BUILDING PERMIT INFO
REMOVE EXISTING 1 LAYER OF BLDG ELECT' PLUMB Mecx
o SHAKE, INSTALLNEW 1/ O O O O
O Z LICENSED CONTRACTOR'S DECLARATION 1
I bveby affirm that l am paved under provisions of Clupbr 9(commencing
_^2fSb Description
with Sinton 7Wn)dr Di 3oflhe Bvinessand Pmfessi...Code nd my license is
=y ball fora and e0 .• �l a.1
p�Z Licens CI Lie.N l— '
.Cdntiacbr
ARCH DECI.A
1 u ersund my plans shall k uyd u pubj cords
JyU
s O Licas¢d Pmfcssimul
5 Dal I am cU mph from
DECLARATION
.� f I hemby,(Sero Nal 1 1. aempr from l o Csawns Co e:My.law for the
O o which reason.(Salon 7 o 1.5,Rua lmr.and Rofeetiom Code:Any city m utwo
�i which mquircs a permit b lutom t ct,pplic imphvw,demolish,or mash od strvctum
_ZT
prior bsImco da,almmquiws thovisio sof far acM1ractue Liccom Law fCom ant
x < Nwleinwing, ithSecuantbNepmvivioion3of ConuscbrenianxLawlCook)or Sq.FL Floor Area Valuation
�$ thus he acing with Salon 7000)of Division J of the Business;and Profvsy vi Cade)of
lw he b oomph thuefrnm and is heath for tax alkgnd awption My violation of
Satan 7031.5 by any appllantfor+Permit subjects the applicant o a civil penalty of APN Number Occupancy Type
sat mom Nan fiw hundmd dollars ISM
0 I,u owncr of Ne property,or my wployses wish wages as their sol.compenadon,
win do the work,and the shocbm ts not tns.nded or oRcrtd fm sale(Sc.7044,Business
and PMw .awns Codm The Contractors License raw dos not•pplr b an dwncs of Required Inspections
property who builds or im prows thereon.and who duct such work himself or through his
own cmployres,provided Wt such impmwments are not ounJnd orsRaed for sale H.
hwewr,onto building or orprow ownt is sold W thin enc year of compbtion,the owrcr-
buildv will have the burden of Proving that he did oat build or improve for purpose of
saw.).
0 L n weer of the Property.am eselusively convecting with Iiansed anvacbrs b
construct lar pmjea(Sec 7044.Business and Haf.sslons Code:)The Conuacmrs Li-
cove law docs not apply to an owner of Property,who builds or impmvcs thereon,and.
who contracts for such projects with a conustor(s)lianud Pursuant to the Convsmrs
1renu law.
❑lamexemptunderSee .B@PCfMwismason
Date
WORKER'S COMPENSATION DECLARATION
1 heMby of hm under penalty of pmjury one of the following dnclaratiorte
I ham and will maintain a CertfOcau of Consnuo self-ivum for WorkchCompen-
cation.as provided for by Secuan 3700 m tin Labor Cade.for the performance of the
for which this permit is iauN.
1 haw and will maintain Workor's Compensulon Insunna,as required by Section
J of the labor Code,for the perfmmsoce of the wmla for which this permht Is I tied.
My Workers Compewti n lnsurana carrim and Polity number>R:
Cartier, 'f Policy No.:
CERTIFICATE FEXEMMZNFROMWORKERS'
COMPENSATION INSURANCE
(This salon reed not de compleud now permit Isforane hundmd dollen(5100)
or baa.) .
I certify that In the performance of the work for which this permit is issued.l shall not -
cmploy any perwn in any mamur an as to trmme subject to the Wortrrs'Cosupcwlan
Laws of California.Due
Applicvn
NOTICE TO APPLICANT:If,afcr making Nu Certiftam of Exemption,you should
become subject on the Workers Compcmation provisions of the tabor Code you mm
.� z forthwith comply with such provisions or this permit shall de doomed rowked.
.zi O CONSTRUCTION LENDING AGENCY
F+hN+ Itouchy off.mon,them is.conswnbn bningagbwy,for the pod..na of
D:> the work for whim that permit b issmd(Sec.3097,Civ,C.)
W� A Lenders Norm
z Lender's Address
U 0 I cosily that I have read this appliaton and sub that the show information is
If. F coma I agra b comply with all city and county oNiwues and sum laws mlating to
0U bilding.nnsuunion,and hemby•utbria rtpmsehuutiws of this city m cnwupnn the
W ahow-mendoncd Pmpcny for ivp.ction Purposs.
(We)erg.to saw.indemnifr and keep huml.the City of Cupertino against
tiabiltics,Judgments,costs andexpenses which may in any way aam•govt said City
U z' no gncnee of the granting or this permit.
/ APPLI NT,UND STANDSa ,WILL COMPLY WITH A N�+-P IM Issued by: Date --r-{J�
sop/ f�po � �Z�� Ip� Re-roofs
Thrown df ApplicanVCooMiscuu, Dow /�---
__HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant orfutuc building oamlIALSOM e w handle hrurdov mamsial
as defined by Om Cupertino Municipal Cods.Chapbr 9.13,and the Hooks and Sarety
Colw Section 215331,)7 - All roofs shall be inspected prior to any roofing material being installed.
0YcsNo
Will the spplh:ent or futum building occupant uta equipment ordevil.which )an�ew
If a roof is installed without first obtaining an inspection,I agree to remove
-'emu haamawt air conuminann ss Aeftr�cd by the Bay Area Air ua ity Management materials for inspection.GYa `� �] /IhavemaJthehvamousmucrialsmquimmenuunder Chapmr Q93 of Ne Calif. , I LI
nuH.I"Se,ty Cade.SaSions25505,35533v 25534,1urdcrvanddmiftm bolding,
d- t curtcntlY haw•unapt.this it u my mspovibility b notify Ih aalupuR of _
G rcam nawh n- P^^ ta�ananr,cmtraaoraaP�^� �Si natuie of-A licant Date
if 171 `moi It) g
Owurwthansd qem. Dow All roof coverings to be Class'%"or better
P Community Development
5 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
�UPE(�TINO Fax(408) 777-3333
Building De artment
JOB ADDRESS: L'� �P , PERMIT # 0-O CC
l I �j 2.
OWNER'S NAME: -KG--1 itl M(L,t.A R PHONE # - b 2� — 3 2-
CJ
GENERAL CONTRACT R: G Rjuf�In,4 FAX# 1+0k— - -7
I am not using any subcontrac`rs: T�' 12-I514
_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
Owner/Contractor Signature Date
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35615028 . 00
DATE ISSUED. . . . . . . : 12/05/2008
RECEIPT #. . . . . . . . . : BS000006766
REFERENCE ID # . . . : 08120066
SITE ADDRESS . . . . . : 10933 LEAVESLEY PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KEITH &SUSAN MILLAR
ADDRESS . . . . . . . . . . : 10933 LEAVESLEY PL
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4747
RECEIVED FROM . . . . : R E ROOFING
CONTRACTOR . . . . . . . : PROCTOR, PAUL LIC # 20615
COMPANY . . . . . . . . . . : R E ROOFING & CONSTRUCTION INC
ADDRESS . . . . . . . . . . : 15230 CLYDELLE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95032
TELEPHONE . . . . . . . . : (408) 626-9320
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----
1BSEISMICR VALUATION 13 , 500 . 00 1 . 40 0 . 00 1 . 40 0 . 00
1REROOFRES SQ FEET 25 . 00 325 . 00 0 . 00 325 . 00 0 . 00
---------- ---------- ---------- ---
TOTAL PERMIT 326 . 40 0 . 00 326 .40 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- ------------- ----------
CHECK 326 .40 12644
---------------
TOTAL RECEIPT 326 . 40
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- -------- -----------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
Community Development Department
�J
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 2007 IBC Standards
and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino
municipal code 16.04.080.
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-Ne:
7
• Apphcans Signa Date: whl (f
Greg Casteel —�
Building Official
Revised 07/30/08
CITY OF CUPERTINO
REROOF
• CUPERTINO PERMIT APPLICATION
APN # Date:
� 15- a28',Ov � 2 � Q�
Building Address: O ` C LL
ij 11V 1 ,
Owner's Name: �l 1 ^ l Phone #:
Contractor: Phone #: 93 2-0
Fax #: 4U - 62L — -11(�
Cupertino Business License #: Contractor License #:
2
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
'>i Wood Shakes ❑ Wood Shakes
❑�'Vood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfg. Installation Specs.
Job Description:
� � l I./�1�--- � Slk�•� � 1 ry STxL� t��
V' ODBC , �o 4 ASTM kuT N7 " COW- � s ��—
Residential Commercial ❑
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicabie, include in plan set & the sheet index.
Valuatio ;�
•I Hav Read nd and Will Comply with Cupertino's Tear-Off Policy:
1.
Signature
Revised 6/16/08
-� CITY OF CUPERTINO
tc REROOF
CUPERTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
1REROOFRES . Re-roof Residential B 1SFDWLROOF
/ 1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08
•