08030092 CITY OF CUPERTINO
BUILDING DIVISION PERAIIT -C77
C11' 'RA. (1_R.I `QTTa,
PERMIT NO.
Bu1Lp211y2c43aTess:l;UPERTINO RD A. QUINTERO ROOFING 08030092
OWNER'S NAME: PERMITL%UEDAIB
SUNNY VIEW LUTHERAN HOME 457 MCCAMISH AVE 03/18/2008
NE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMff INFO
RMV EXSTNG ASP HLT BO EO PLUMB O
300 LICENSED CONTRACTOR'S DECLARATION Job Description
haroby affirm Jul 1 am licensed under provisions of Chapter 9(commencing "-'-'"'-' '----"`" _" ""
with Section 7OMR)ofDiv)eion 3 ofthe Busineu and pretensions Code,and my license is
rte in full farm and effem
3 License Clus Contractor si,ti 124y
eS p Dam ARCHITECT'S DECLARATION `
y.u.T9 1 undersand my Items NW be used as public mcnrdt
DyU
gal. Licensed Professional
yO OWNER-BUILDER DECLARATION
E I hereby affirm that I am exempt from do Committees License Law for fee
O O following wan.(Section 7031.5,Business and Profession,Cole:Any city m county
9 which requires a permit I.omnnmL alter,improve,damolbh,or mpur any structure
gi'y^ prior m its Woman.also requires the applicant for such permit to file a signed statement
VO NatMis licensed pursuant innovation Common's ns
Limiaw(Chapter9 Sq.Ft.Floor Area Valuation
Y g (commencing wife Section 7000)of Division 3 of We Busineuand Prorrasiont Code)or
the,he It exempt therefrom and We bub fm Ne alleged exemption.Any violation of
Section 7031.5 by airy applicants far a permit subjects the applicant m a civil penalty of APN Number Occupancy Type
ret mom than an hundred dollars(550(1).
❑1.as owner of the property,Or my employees with wages an Nem sob compensation,
will do den wok,and the muelun Is Out intended or offered for ule(Sec.7044,Soaineu Required Inspections
and Pmtesiom Cade The Contrsl es Lkmue Law tloas not apply m e an Owner of q p
property who builds otimpmsec thereon and whodoessuchworkhimself or Waugh his
awn employees,provided Wal such improvements are not immnded oraaered formate.B,
however,We building or impmvemsnt is sold within one yea of mmpledon,We owner.
builder will have W burden of proving that he did not Wild or improve for purpose of
sale.).
❑1,u owner of the property,un eulualvely conaacti tS with licensed canuanom in
.1.1 fee pmjecl(Sec.7044,Businea and Profesdorm Code)The COMbsemes V,
mase Law does not apply in an owner of property who Wilds or impeovss Demon,and,
who contracts for such projects with a eaanacroRa)licensed pursuant to de,Cawutoes
License Law,
Qlare examam nder See .B k P C for then moon
Owner Dam .
WORKER'S COMPENSATION DECLARATION
I hereby affirm under permlty of perjury,am of the following decimations
I les and will mainmin a Ce n 3700 of the Labor
Coda,furt her Woken ce of the
wean,r provided for by Section 3700 of the labor Code,for Nn performance of W
were for which this permit b heated.
ve and will maintain Werkees Compensation Insurance,w required by Section -
3700 of the Labor Cade,for the performance of W work for which that perank is waned.
My Worke't CompemWkn Insurance carrier and Polity number are:
Cartier: al'i�� Polity No.: _
CERTIFICAOPTION FROM WORKERS'
COMPENSATION INSURANCE
(Then swim toed nol M cam pleted if the permit en font hundred dollars(5100)
or mss)
I certify that in the performance of W work for which this permit Is Waled,l"I not
employ anypersm in my manrorm as to Mneme subject to W Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT.If.One,making thin Continuum of Exemption,you should
became subject in We Woken Compensation provision of One Labor Cade.you men
O fanhwith,amply with such proviuorm o then permit shall M dcemm
ed ated.
zh� CONSTRUCTION LENDING AGENCY
[-r I Mosby allies that then be construction lending agency for We performance of
G'> W work for which then permit Is WOW(Sce.3097,Civ.C.) '
W�Q Lenders Name _
z Lundeen Addw
V Q I mnhfy that 1 ban used this application and sum that the aWve informaWn is
IL!". comem.I same in comply with all city and county on iwmm and sum laws relating to
0 Wilding construction.and Mouthy suhorim representatives ofthis city to enmruponW
[37 .have-mentioned Property for inspection purposes.
gL (We)agree an wave,indemnify and keep harmless;the City of Cupertino against
w liabilities.judgmomb.cow and upenam which may in way way K=against and City
C)�-+ APPLI. ICANT UNDERSTAuence of the NDS ANDWILLWILL COMPLY WITH ALL NON-POINT Issued by: Date
S URCE REGULATIONS.
�A I�_ -lit sm. Re-roofs
Signature of AppliaMConusctor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will den applicant Or fteues Wilding eccuPantsmm arhandte haradous material
as dented by that Cupenina Municipal Code.Chapter 9.12.and the Halt and Safely
Cole,Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
C3 Yen /0R
Will We applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It huM
snus fine
air contaminants u defined by W Bay Area Air Quality Management all new materials for inspection.
District]
❑YOn
I have real the huardmsmwriw requirements under Chapterd.95 Often Califor-
nbHcalth@Safety COM.Scetiorm 25505,25533 aruh25534.I undersand WatifWc building
docs not cormntiy hem a a:ant,Wu it is my responsibility to notify IM occupant Of the
requirtmcnu which muss W met prior in heancc of,Cerskae of!M(0,5?
cmpamy. Signature of Applicant Date _
�t �7 � 3�'�(®� All roof coverings to be Class'W'or better
Owner or mthorixed agent Dom
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: B1k: Lot:
APN . . . . . . . . : 32615124 . 01
DATE ISSUED. . . . . . : : 03/18/2008
RECEIPT #. . . . . . . . . : BS000004181
REFERENCE ID # . . . : 08030092
SITE ADDRESS . . . . . : 22445 CUPERTINO RD
SUBDIVISION . . . . . . . -
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SUNNY VIEW LUTHERAN HOME
ADDRESS . . . . . . . . . . : 22445 CUPERTINO RD
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-1043
RECEIVED FROM . . . . : A QUINTERO ROOFING
CONTRACTOR . . . . . . . : ANDRES QUINTERO LIC # 29852
COMPANY . . . . . . . . . . : A. QUINTERO ROOFING
ADDRESS . . . . . . . . . . : 457 MCCAMISH AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95123
TELEPHONE . . . . . . . . : (408) 823-9842
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------ ---------- --------- --------- ----------
1BSEISMIC0 VALUATION 9, 000. 00 1.:89 0. 00 1. 89 0. 00
1REROOFCOM SQUARES 43 . 00 337 .00 0. 00 337 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 338. 89 0. 00 338 . 89 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 338. 89 #0154
---------------
TOTAL RECEIPT 338. 89
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
605 FINAL REROOF
0103 DD 9A
Q, CITY OF CUPERTINO
REROOF
•CUPERTINO PERMIT APPLICATION
APN# / / 5 / .2LI' 61
Date:
l� //s lea
Building Address:
2
Owner's Name: Phone #:
5 n 40,6
Contractor: Phone #:
Fax#:
Cupertino Business License #: up�±�a Contractor 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)
Number of existing coverings ❑ Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:
Residential Commercial
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: ❑
Valuation:
s�
Q
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
i ature
CITY OF CUPERTINO.
REROOF
•CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
3 1RER00FC0M Re-roof Commercial B 1COMMLROOF
I 1BSEISMICO Seismic Commercial B
1REROOFRES Re-roof Residential B 1SFDWLROOF
1BSEISMICRE Seismic Residential B
1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
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: c n yr �/..cam✓
job Site Address: 2z vis s
Roofing Company Name:
Applicant's Signature: �k C�_. _� o Date: -3 r- ve
• Greg Casteel
Building Official
Revised 11/2/04