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99090193 (3)
1 PERMIT APPLICATION FOR CITY'OF CUPERTINo NUMBER INSPECTION DIVISION PERMIT EXPIRATION REROOF PERMIT (408)7/]-3'2'28 PERMIT EXPIRES IF WORK IS NOT STARTED _ WITHIN 1W DAYS OF PERMIT ISSUANCE OR • 100 LAYS FROM LAST CALLED INSPECTION, BUILDING ADDRESS ' / 1 7 RESIDENITAL V COMMERCIAL OTHER OWNER'S HAZARDOUS FIRE AREA YES ❑ 11 yes-I Lh)dorstand that a Class A ' NAME M r . Sfey enso h - roof asserMly Is required. NO ❑ Initial I.C.B.O.x ADDRESS 1044 62 Fru e -tree 1-R77e � EXISTING ROOF COVERING PHONE - - NUMBER OF EXISTING COVERINGS �✓�-�. CONTRACTOR'S _ (' NAME �e�rnnS/ b l e 9Zl- I n LI TO BE REMOVED 1� TO BE RETAINED ADDRESSJ TYPE OF ROOF COVERING aa CITYBZIP -1i8-8 u Ppiri naby-W AVe• Moun-fainVic . EXISTING PHONE_U0510 19 Vq- 116 BUILT-UP ROOF ❑ LICENSE ' NUMBERASPHALT SHINGLES ❑ LICENSED CONTRACTORS DECLARATION I hereby affirm that I em licensed under proWslons of Chapter 9(commencing with Section WOOD SHAKES 7000)of DlWs cm 3 of Me Bullnose and Professions Code,and my license Is In full force eM egecl. - WOOD SHINGLES License Clea. �— xJ l Uc.Number ❑ 9-36 -991 ��'� ER(SPECIFY) Date Contractor OWNER-BUILDER DECLA• MON b l hereby affirm Bu that sm exempt from the s: My ore or roue Lew for the requires ng remits. (Sec.7031.5,Business end Professions Code: My airy pr crony whkh rsq a1w a permit to ) construct,soar.Impnwe,demolish,or repair any Mmcture,prbrto lb issuance,oleo requires the BUILTU ©[�^ applicant for such permit to file a signed statement that he b licensed pursuant to the provlaicns EP of the Contractors Ucense Lew(Chapter 9(commencing Won Section]000)of DMalon 3 of the 2 • Business and Professions Code)or that he Is exempt therefrom end the bele for the alleged ASPHALT SHINGLES ❑ 1999 �! exemption.Any oblation of Section 7031.5 by any applicant for a permit subjects the applicant to A a cMl penalty of not more then fiw hundred dollars($500).): say` ❑I,as owner of the property,or my employees with wages as their sok ccrnpensaon,will do WOOD SHAKES �yJ the w and the structure is not Intamded or offered for vete(Sec.704/,Business and Proles. slonaCoda:The Contractors License Law does not appy to an owner of property este Wilde a r- WOOD SHINGLES Improves thereon,and who does such work himself or through his own employees,provkled that El such Improvements are not Intended or offered for sats.If,however,the Wilding or Improvement1.� k sold within one year of comdetbn,me owmerrbulldar will have the burden of proving that he did OTHER(SPECIFY) �W MV_a SI TI Oki not build or Improve for purpose of all - ❑I,as owner of me property,em exctusWely conmichnp wlm lkenaetl contractors to cdrntruct the project(Sec.7044,Business entl Professions Code:TTa Contractors Ucense law does rot PROVIDE I.C.B.O.REPORT NO. apply to an owner of property who builds or Improves thereon,and who contracts for such projects wlm a contrectogs)licensed pursuant to the Contractors License Law. PROVIDE MFGR.INSTALLATION SPECS. ❑1 am exempt under Sec. ,B&P.C.to,this reason Owner - Data APPLICATION DATE VALUATION PERMIT FEE WORKER'S COMPENSATION DECLARATION I hereby affirm under panalry of perjury one of the following declare on: �^L Fj I have and will meMon a C"Ificale of Consent to eoM-Insure for Workers Compensetkn, a Building as provided for by Section 37DO of the Labor Cade,for the performance of the work for which this �13� 1/q ,ye 1� l�j.C^•OU permit to Issued. - W r-1 OJv Z500 1 have arta will maintain Workers Compeneetlon Insurance,as required by Sscikn 3700 of Seismic me Labor Code,for the performance of the work for which this permit k Issued.My Workers �/�� -me _Ins—urance carrier and Policy number are: tt ww�1 Total �1. - Canter y�nh n� - C'� Policy No. _I�L3oW72V 98 PERMIT AUTHORIZATION DATE JJJ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE N.CQ ^ (This saciton need not be completed If the pelma Is for one hundred tidies(5100)or lass.) 6 (y I certify met In the performance of me work for which he permit Is faeued, shall rot am any person In any manner so as to became subject to the Workers'Compensation Laws a Cah. All roofs shall be inspected prior to any roofing material being forrha. installed. If a roof is installed without first obtaining an Date Applicant inspection,I agree to remove all new materials for inspection. NOTICE TO APPUCANT: If,after making ink CemMads of Exemption,you should become Applicant understands and will I with all non point subject to the Workers'Compensation prcWft one of ton Labor Code,you mum forthwith compry PP comply Y P with such proWsions or thle permit shalChe deemed revoked. source regulations. 'I tartly,that I have read this appllcadon and state mat the above Informal Ie correct.)agree' to campy,with all dy and county ardnences and state laws relatlrq to Wlicing construotlon,and All roof coverings to be class'aor better. hereby euthores representsthies of this city to enter upon the abovamantloned property fcr In. lip reeee. We)agree (We)agreee m rive,Indemnity and keep any way the City of Cupertino against Iledlitlss, judgmeme,ng of and expenses whkh they h arty way accrue against sed Clry In cmneepuenre d t e granting of mla perms. SIGNATPRE OF APPLICANT V DATE • PRE-INSPECTION: PLYWOOD: IN-PROGRESS: INSP. DATE INSP. DATE INSP. DATE TEAR OFF INSPECTION: BATTENS: - FINAL: INSP. DATE INSP. DATE INSP. DATE NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION ' OFFICE COPY Plan Check Division 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 City of Cupertino Building Department Subject: Reroofing policy for the City of Cupertino. 1. Prior to permit issuance, you must agree to comply with 1994 UBC Standards and manufactures specifications on reroofing. 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 reroofing 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) Preinspection 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 that the proper City inspection can be performed. We understand the above policy on reroofing and will comply with this policy. Homeowners Name: Fir • ')it l f nso n Address: 109eI1a -Fri)n P Tree La nd Reroofing Company Name: /LCSfXJYJS/GAJ�P IZna �i rtA Applicants Signature: �-� Joe Antonucci • (Chief Building Official) INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE CITY OF CUPERTINO BUILDING PERMIT INVOICE OPERATOR: kmrenb Sec: Twp: Rng: Sub: Blk: Lot:31633082.00 INVOICE DATE..... . : 09/30/1999 REFERENCE ID H .. . : 99090193 SITE ADDRESS ..... : 10446 PRUNE TREE LA SUBDIVISION ..... . . CITY . . .......... . : CUPERTINO IMPACT AREA ...... . OWNER .. ....... . . .: STEVENSON DUANE E AND ANN L ADDRESS ....... . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2023 CONTRACTOR .... . . . : ELMORE, PAUL M. LIC q 105 COMPANY ........ . . : RESPONSIBLE ROOFING INC ADDRESS ...... . . . . : 918 N RENGSTORFF CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94043 TELEPHONE .... . . . . : (650)969-6151 FEE DESCRIPTION CHK 'TOTAL FEE PAID-TO-DATE BALANCE DUE _______________ ___ _________ ------------ _---___---- BPERMFEE P 207.00 0.00 207.00 BSEISMICRE P 1.50 .0.00 1.50 _________ ____________ ___________ 208.50 0.00 208.50 VOICE IO DESCRIPTION VOICE ID DESCRIPTION ........ ............................ ........ ............................ • 305 FRAME 307 INSULATION 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 603 ROOF BATTENS 604 ROOF IN-PROGRESS • CITY OF CUPERTINO I. 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: karenb COPY 4 1 Sec: Twp: Rng: Sub: Blk: Lot:31633082.00 DATE ISSUED. . ..... : 09/30/1999 RECEIPT 4. . . ...... : 10206 REFERENCE ID # ... : 99090193 SITE ADDRESS ..... : 10446 PRUNE TREE LA SUBDIVISION .. .... . CITY .... . . . ...... : CUPERTINO IMPACT AREA ...... . OWNER .. . . . ....... : STEVENSON DUANE E AND ANN L ADDRESS . . . ....... : CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-2023 RECEIVED FROM .... : TIM CONTRACTOR ..... . . : ELMORE, PAUL M. LIC ff 105 COMPANY ....... .. . : RESPONSIBLE ROOFING INC ADDRESS . ...... . . . : 918 N RENGSTORFF CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94043 TELEPHONE ..... . . . : (650)969-6151 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ------ ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 15,000.00 207.0D 0.00 207.00 0.00 BSEISMICRE VALUATION 15,000.00 1.50 0.00 1.50 0.00 ---------- ---------- ---------- ---------- 10 PERMIT : 208.50 0.00 208.50 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 208.SD 8027 TOTAL RECEIPT 208.50 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 •