08120082 CITY OF CUPERTINO
BUILDING DWISION PE rCONTRACTOR INFf)RMA"CION.
BUILDING ADDRESS: PERMTT NO.
7764 OROGRANDE PL MBROWN CONSTRUCTION INC 08120082
OWNER'S NAME: PERMIT ISSUE DATE
NAKATIMRA 00NE: A A CONTROL NO.
(408) 260-1260
ARCHITECT/ENGINEER:
BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
u p o LICENSED CONTRACTOR'S DECLARATION Job DBSCrIpI100
m FF 1 been,affirm We am licensed under provisions of Chapter 9(commencing
.Z., withSection 7000)o(DivisionJofWBuanessrotiPrafasiomCode.sndmylicemcs RE—RF RMV EXT SHK & INSTL APPRX 26SQ CLS A COMP
u in full forte and 2 _
a�? License Clm I Lk.N
r o Dam Conuac.r RF
I. RCHf1ELTS DECIA ATION
wI understand my plans Nall W used As public meords W/SHEATHING
0
A o t; Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm We I am acmpl from W Contractors License law for We
HO following..on.(Statim,7031.5,Business and Prefeasiaam Code:Any city ar county
S which mc,ims a permft b construct,slot.improve,de rnicb.nr.,.it any almetum
priar in is issuance.also reliance W applicanlfor such permit to file a signed statement
< that he is licensed pursuant to the previsions of We Contractor'sLicenm Law(Chapor9 Sq.Ft.Floor Area Valuation
Y�3 (commencing with Section 70W)of Division 3ofW Business and Pro(auiam Code)or $5200
Nat he is exempt therefrom and the basis for W alleged exemption.Any violation of
Section 7031.3 by any applicant for a permit subjects the applicant m a civil penalty of APN Number Occupancy Type
not more Nan five hundred dollars(S500). 3 6118 019 . 00
❑1.m owner offt property,m my employees wit wagea ss their solocmnpeuation,
will do W work,and the smacbm is not intended oroRecd forsale(Sec.7004,Business
and Profession Code:The Conuxmra License law does Out apply to an owner of Required Inspections
property who builds or improve tartan,and who dors such work himself or through his
own employ=.provided that such improvements am not intended oraffemd for We.If.
however.We building or improvement u mid whin arc year of completion,the wms-
builder will haw the harden of proving tat he did not build or improve for purpose of
We.).
❑1,as Owner of W property,am admiwIY concocting with licensed rnnuactars m
comwct W projem(Sec.7044,Been.and Professiau Cade:)The Common's Li-
cense Taw d=not apply to an owner of property who builds or improws Wmon,And.
who worms far soh project with a ammo,(,)licensed pursuant.W Convector's
License law.
I am exempt under Sue .B&P C fmthis reason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of W following declmatiom:
I have and will maintain aCrnifiao of Consent be Wf-insert for Workers Compen.
tion.As provided for by Section 3700 of W labor Code,for to pettazmabee of the
wars:for which this permit is issued.
I have and will maintain Warkefs Compensation I===,As required by Section
OWI the labor Code,for the pedormanec of the work for which tis permit is issued.
y Wmkceren ensf�don(7a�raqcx artier and Policy... am: -
Cartier.� 1f reA H^�' Policy No_' `t LO'�7 '
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This metioo need notal completed if the permit is fmanc hundred dollars(SIW)
or lou)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any perm r in any manner an As be become mbj..t to We Worker'Compensation
Laws of California.Dae
Applicant
NOTICE TO APPLICANT.If,after making this Ccnifiate of Escmption,you should
become subject to the Wahefs Compensation provisions of W labor Code,you mint
,,. Z forthwith comply with such proveim at or this permit shall be deemed rooked.
z O CONSTRUCTION LENDING AGENCY
[-+ I hereby arum that Were iso construction lending agcrey for the performance of
6i We were for which the permit is ssmd(Sec.3097.Ci,C.)
QLender's Name
z Lender's Address
O Q 1 sonify that I have mad this application aha stab that W show Information is
Ty ^ correct.1 agree to comply with all city and county anlinsnas and state laws.].do&to
.� Wilding consuuctian aha hereby auhorim mpmsentariws of to city to enter upon ft
aMvcmentimed property for impeetian purposes.
H0. (We)agree b saw,indemnify and kup Wamless the City of Cupcnina against
Vl liabilities Judgments.emu and expenses which may in any way acerae gaet land City
in conpermit.
e itume of the granting of this peit.
V Z APPLICA UNDERSTAN S AND WILL COMPLY WITH ALL N NPO NT Issued by:9 Date
SOURCE NS. q
e ! Re roofs
Signmurt of AppliaHAZA HAZARDOUS
Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will We appliam m future building mcapml store or handle hazardous materia
As defined by We Cupertino Municipal Cade.Chapter 9.12,and We Health and Safety
Cade,Seethe.25732(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yu run
Own the.pp0a t ar f tam banning Occupant am equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hmatdnuz air conumina ts u dcfned by the Bry Ame Air Quality Managcmcnt all new materials for inspection.
mrin?
❑Yes
I hawmadWhazad mmSU5,2533Andns4.1tunround t93 if
Califon.
rias net&Safcsy Cade.Sutiois23505.25533and75534.1 le ofndtmethebuilding
does not c nay how a snare this it s my mxpomihiliry a ratify W acupmt of W
mgaim Or inch mam Iprior.issamecOfACCNra:aoar Signature of Mplicant Date
Owner atauthonwda On All roof coverings to be Class'%"or better
CITY OF CUPERTINO
�2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36118019 . 00
DATE ISSUED. . . . . . . : 12/09/2008
RECEIPT # . . . . . . . . . : BS000006794
REFERENCE ID # . . . : 08120082
SITE ADDRESS . . . . . : 7764 OROGRAND E PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . .. NAKAMURA
ADDRESS . . . . . . . . . . : 7764 OROGRANDE PL
CITY/STATE/ZIP . . . : CUPERTINO, C 95014
RECEIVED FROM . . . . : KRISTINA M HAGAN
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
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 5, 200 . 00 0 . 60 0 . 00 0 . 60 0 . 00
1REROOFRES SQ FEET 26 . 00 338 . 00 0 . 00 338. 00 0 . 00
---------- ---------- -- ----------
TOTAL PERMIT 338 . 60 0 . 00 338 . 60 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 338. 60 AMEX
---------------
TOTAL RECEIPT 338. 60
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
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 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/ " 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.
LMHomeowner's Name: Y V Vl�lil hi L C.1
Job Site Address:
Roofing Company Name: hJ �1, C .
Applicant's Signature: Date:
• Greg Casteel
Building Official
Revised 07/30/08
oP1a oO(D
CITY OF CUPERTINO
`- REROOF
nY OF
•CUPEkTINO PERMIT APPLICATION
APN # Date:
Building Address:
OYl� YQ
K07_Owner' N (n Phone #:
+� Imv�ra yam- y3� b13�
Contractor:µ �C Phone #: kqp g. 2-&0• ( 2too .
Pax #: bg'. 2e 0 • a(�p .
Cupertino Business License #: Contractor License #:
d�ZZ .
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles gP Asphalt Shingles
�( Wood Shakes ❑ Wood Shakes
• ( Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings_ ❑ Provide LC.B.O. Report #
To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: genq e WS-{zrn 5VA10, Q I0-ertQ C�D� . 2(os�}. c{'
\I
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: ❑
applicable, include in plan set & the sheet index.
Valuation: Jr— =,aD
I Have Read, Understand and Will Comply- with Cupertino's Tear- ff Policy:
Signature
Revised 6/16/08
Community Development
10300 Torre Avenue
e w Cupertino CA 95014
,H ` ~ Telephone(408)777-3228
CITY OF Fax(408) 777-3333
WUPEkTINO
Building Department
JOB ADDRESS: PERMIT # OVA 0 0 8"61�
OWNER'SNAME: ( 1 PHONE #
GENERAL CONTRACTOR: FAX # /
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
61
Owner/ ontractor Signature Date