06090121 CITY OF CUPERT NO � r re� -> `" y >„,
BUaou:G DIVISION PERMIT �L ONTjtACTORII ORMATIQMRX
BUILDING ADDRESS: WOODS ROOFING , ""o'06090121
OWNER'S NAME: PERMIT LSBUE DATE
MYRNA YITZACHAK GUEST HOU E 2179 STONE
E SANITARY NO, CONTROL NO.
(831) 637-5576
7, r"
ITECryENGINEEA: BUILDING PERMU INFO
BIRO EIRLf PLUMB MECH
UCFNSED CONTRPCILtlIS DECLARATION Job Descrl tion
1 bmeby aline Ihm I w limrmtl aawcr PrntvOu a Chaps 9(mmmueinrpCmbe700U)aDbtimon3ofde Budrrsaed Profcaams Coek.ab rrYBrcemuram.na 3 q Luc 3y5c 3 J REROOF-GUEST HOUSE-T/O SHAKE,ADD GERARD STEEL T
! oD. Cm 47 1 . 5 PSF, CLASS A-REPLACES EXPIRED PERMIT 051200
my "R ileo PAY 1/2 FEES
i i I aMemand
'yU
:LLp Livened Pmressiovl
OWNER-BU1rDER DECORATION
10 C I hereby,(lam Nal 1koo1. eaunpt rvm the Convenor,Ixcne law for the
:00 following rt. .pemo0 t 71n 1�.Bad Ur.ho d Pmfcmbuv Ca roles cbY Or ore
S$� MY
hich ngwru.permit m Coamruct.dmr,haPmte,dcmaLs4 rr mfm0.ay smewm
-2r piatU0,iSWOnCe..b,r,,.ires;Um applkw ror Coen pmm11 W Me a,ignw S111mrrni
< "beisiiCC epees,atla�pmiHonanfweceelretw',L�La.(oapan9 Sq.Ft. Floor Area Valuation
'FG (commeodnl with Setim7000)a Divivm 3 of the Budrsesokd Praeadau Code)m $13000
$ thu be h eampt therefrm and ft basis for the a0egra mmoptlm AnY vialuioo of
section 7031s by so, pp)[mot for. rmh,ubjeu the spp� to a"I pmulrya APN Number Occupancy Type
our mom than Br,boedrrd dollar,(SSW).
1,as owner of Ube pWmry,or my emplvycra w wagu as their stio compeastdm,
WUd,,ft°.t ands r,,moo,4 timmtem,a o(ertd for aele(Sce.TOIA,Badmm Required Inspections
and Pmfeadau code The Cmnmcmr,I.,law docs not apply m an or c of 9 pe
Wo Wry vho dWd,uimpoteotbmcm.»d who daes,uio w d OroxJf or Wmu�h hu /
awn aoptboipfwlded pr,shIm ut Wd auue rot oOOfmaafered toe Aare B.
bo.s,r wil sr,%, tttrcMpmprerrmu,olde dW of Wdcaep for;,eowxr- r I/
halldu.iC Acte the Madre a Pmvlee Nu k ala not WW a improve for Iwo of
nk.5
❑1..a owwea of Ue P^Perry..ao ocluively emvaming with llaued moo steres to
Covtve Ute pro)cm(Sec 7014,Bud—and P9fekd.Code:)TIe Cm seise-U-
r..•-lavdoenotapply0,.atr rc aProp+ry vebo Mdld,or mrpmws thertoo,ked, /
who mous,fm smb pe)ecu Coin a mmrmar(s)lieased puaranr to me Camncsces
Lienee{J W.
❑I am uemp unaQ See .B&P C for tbL trusea
Owe
Date-
WORKER'S
amWORKERS C0f.1PFNSAT10N DECLARATION (ao
1 hereby.that,tmEe,penally of Pale?arc of the(tilvwMy A-.�
J 1lbs a aed wiB mdnuie a Cerdfiram a Covent m rJf-lout,for Workers Compen-
ts m.u p AcJm1 fm by Seamot 3700 of due labor Code,for the Md..of Us
work for t mch Dia permit is issued
1 hive W v U main.worker,fsaopmulon "N'med by Senlat .
Of the rake Code.for thc Pafaro'""ache wart ra witch this pmh M Mmed .
My Waters Compmube rasda nd Policy mmrha.m:
"yN,:�-8t5 ,000Wi •off
CERTIFICATE OF EXEMMON FROM WORKERS'
COMPENSATION INSURANCE
(ni,semim end as be carp,.. .U the WmU I,ream horded ao0us(310x)
orlev)
I cudfy Ihm M We pMarmaece a We work for whit NV permit V imwd,l"l em
.,I,go,peon in keymovermss to bekme mbjcet to Na Waken'C^ pmosol^
law,a Cdirnmi,L Dam
Appl oty
NOTICE TO APPLICANT.If..lYc tusking this Ccni(°ae of E—POW Yeo Should
benne mbpet to the Woe .eomPamdee oro t iotu of the Ialtor Code-ym most
.,Z fmit.tb Comply with such pry=of Ud,Wmit,lWl W aemed mwtca
?O CONSritucnoN I-ENDING AGENCY
P4 1 hwb,t,mrm tiu dmre u.cmavunlm ktMinh.p^ry for the Pmfumace a
W .>-, the Cort to w nch this permit is Cooed(Sa.3097.CM.C.) ,
W Q
LeNen LmOiCes Num
a z y..
U0 I mnifY that I lute read Wi,applic.tion and sue aw Ue.tort lefarmation V
rF"VSWy' buddin eI Amgra w coanoapnlYdhereby
cmhayll city.ndUthofiM crtowryrn
ULi"rcOf.NW u Cityto
lacwnsrirtr ulapdmer0mu
a1bov . yfi.icmionpuo
(We).g.to ka M.if, d oesthe Cry of Cupmm.&M
fimlltlo.)twencm,.C.aroie.pmwmssyio tot,eyam .rdmr midl City
Uz incrosmryuce aUe,nnting athi, I�
t-. APPucANT DUST D WILL MPLYaWRHAIYNON-POINT Issued by: Date
SOIIRCE UOTf
I S° Re-roofs
Sigvtwe of ApPlioatlC C, Dere
HAZARDOUS MATERIALS DLSCLOSURE Type of Roof
VIII Ue appli-ant a future bullmnr omupwtstart v bandle haeudou ruertal
u deMN by the CupaUno MoOdcipe Code,CWPW 9.13,aha ft F th.nd SafetY
Code.senbm 1553](.)? All roofs shall be inspected prior to any roofing material being installed.
❑Ya
aIf a roof is installed without first obtaining an inspection,I agree to remove
Will thc.ppliast or fount,boddieg cm;OOM me equlpmmt a amraa. iw
.colt ba�dr mmmMano n&JI teJ by the B.y Arra A4 Qklity Mwgcmcu all new materials for inspection.
Dtdrkt7
❑Ya i]No
lhue mad the ha>vEou m.mrulsrtquvcmaa,n.lc,Cbgpae fWe C.lif (� /
oLHWth& myCodc,Smms
rSOS,ZS573 and td
ZSSJ4.IwvtaM thairthe bwWirtS
does no.... ft it is my®SpomUpli1Y m eodrY de oecoP.at or Ue
s1eaD;,�j"(3j & Signature of Applicant Date
owteeeraatharittd, t 7 7� Daae/- All roof coverings to be Class tB" or betted
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$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-/roofing.
Homeowner's Name: `/yX•v �ic a� sC�
Job Site Address:
Roofing Company Name: C�PD Sri
Applicant's Signature: Date: 2 /5 D 6
• Greg Casteel
Building Official
Revised 11/2/04
Community Development
10300 Torte Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
(APEkTINO ( 5lD) S 3$ - 3282 - P�o1�N�f
Building De artment
JOB ADDRESS: PERMIT#
OWNER'S NAME: PHONE # 57 ,4 -p 3 3
GENERAL CONTRACTOR. ;6e FAX #
* I am not using any subcontractors: 6
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 ontractor Signature Date
CITY OF CUPERTINO
sm 2 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN 34245038 . 00
DATE ISSUED. . . . . . . : 09/15/2006
RECEIPT # . . . . . . . . . : 36059
REFERENCE ID # . . . : 06090121
SITE ADDRESS . . . . . : 10366 AVENIDA LA
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : MYRNA YITZACHAK (GUEST HOUSE)
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-3947
RECEIVED FROM . . . BONITA JENKINS
CONTRACTOR . . . . . . . : WOOD, "LAWRENCE E LIC # 20810
COMPANY . . . . . . . . . . : WOODS ROOFING
ADDRESS . . . . . . . . . . : 2179 STONE AVENUE STE 22
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (831) 637-5576
•EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---- --- - - - -- - - --------- ------- - -- ----- ----- --- -- - ---- ---- ------ ----------
BPERMFEE VALUATION 13 , 000 . 00 100 . 98 0 . 00 100 . 98 0 . 00
BSEISMICRE VALUATION 13 , 000 . 00 0 . 65 0 . 00 0 . 65 0 . 00
------- - -- ------ - - - - ------ - --- - ---------
TOTAL PERMIT 101 . 63 0 . 00 101 . 63 0 . 00
CITY OF CUPERTINO
REROOF -/:ZCUPEkTINO PERMIT APPLICATION FORM (L-S oL/- >
APN# / $ O L
Building Address: C/ /
/D
Owner's Name: Phone#: /
ar 6
Contract 9c� License#:
W� ,,Q 'r
Contact / Cupertino Business License #:
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)Q/tAAA St�Ot-Q�-
Number of existing coverings Provide I.C.B.O. Report#ES R- /�y/
❑ To be Removed ❑ Provide Mfgr, Installation Specs.
• I Have Read, Understand and Will Com I With Cu ertino's Tear Off Policy:
Job Description: 7-o
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dfft. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
D
Qty. if
Applicable Fee ID Fee Description Fee Group
J BPERMFEE Bldg Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
•