06040173 CITY OF CUPERTINO - + `'''
BUILDING DIVISION PERMIT �O ., I2i .C 'C1R11�'I'OII.Me 'I"X( N
�.",m`a .ir
BUILDING ADDRESS: PERMITNO.06040173
10110 FIRWOOD DR
NEWS NAME: PERMrrMUEDATE
OW
DE ANZA OAKS HOA 04/27/2006
14 ONE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECX
t� t�
jot LICENSED CONTRACTOR'S DECLARATION IOb Description
(jC 1 money affirm Nal I am licensed under pm ravaioof Chapter 9(commencing
!�W with Sued.70(10)ofDivision lafft Buslnw and Professium Can,sad my leen.Is
y infullforeeandeffect. TEAR OFF SHAKES, INSTALL 1/2" CDX AND GAF GRAND
D. Ca' L"'a SEQUOIA SHINGLES 50 YEAR CLASS A
ARCHRELTS DEC re I N V
1 underwnJ my Pana Nall be used As public recwN
'tad Lassman encs Professional �'
Oy OWNERS.amar ER DECLARATION FINAL
em
i I hereby affirm that 1 em exempt from the Canumtafs Leen.Low for Um (t■Ib
o O following reamn.(Santo]D7IS,Buhneu and Rafaalom Code:My my w county
`e S� which requires;n Permit re eonwruee aline tmforsu demW4h.ri e pair ed museum
Gu
0_� Priwmita issuance.atm rtquira Jre aPPliunt for such permit to asipnnd statement
E�C
that he la llamcd pursuant m the provision of the Contractors ll¢tts law(Chapter 9 Sq.Ft.Floor Aiti$A( pry— ^oo Valual 15500
e 3 (commencing with Section 7000)of Division 7 at Ne Business and Professions Cain Jl�1Y Q
e — Nat he is eumpt therefrom and the basis for the alleged ewnpnon.My violation or
Section 7031.5 by arty appllanl for a permit mhjecu the applianl to a civil penalty of APN Occupancy'type
not mo.than fro hundred dollars(5500). 3423
1,As ownof the property.a my employees with watts As their mic Cmmpemadon,
windo Neworls. awttureunOlmandnd ordRemd forsale(Sa.ION,Buchu d tions
and Pmfasamn,Codes The Comr.mYs License Law does int apply m an Own Of q
propenywho builds orimproverthereon,and who dmswhwork himselfora mugh his
Own emplayma,provided Nat such improvements Are,int Intended Worland for sale.X.
however.the buildint or improvement is sod within Ooe year of eempknon.the own-
builder will have Ne hurdrn of proving W,M did nor beid a imp.ve for p mpom Of
Gale.).
❑1.u own Of the property.aro exclusively canumnng with Hamm ce moserm ad
comment da project(Sec.70W,Boar®and Profnslom Code:)The Contractors LJ-
sena Taw dam MI apply an an owner of property"a huids an innocents demon.and.
ahocrmuacta(or suW projects viN amnuactor(q Iiamed r aatam m tha Conuamees
Licensed Law.
❑Iamermmotunda See .BdPCrathis.
Own Data
WORKER'S COMPENSATION DECLARATION
1 hereby,Mon under pereby of perjury an,of the fallowing declamations,
❑Ihave and"I maintain a CenifimaofComem toself-hssureforWorkeYaCmmpcn-
sadon,as provided(a by Section 1700 of the Labor Code,for the performance of Has
wink fur which this permit is issued.
❑1 hoe and Ali maintain Worker's Compensation ImWunce,As requbed by Session
7700af the mbar Code,ror Has performance of the wak for which this permit is Wued.
My We scanpemWen beou rte artier and Policy numba an:
Cartier. liry No..12 -
CERTIF CATS O (EMPnON FROM WO ERS'
COMPENSATION INSURANCE
(This section reed Out becOmplead Xthe permit is random hundred dollan(SIM) .
w tell)
1 cannily that N the perfor mem,of the work for which Nis Permit is(slued.I shall and,
employ myperann in any mannse,u in became subject a the Wari Compensation
Lam of Califomfa.Dao
Applicant
NOTICE TO APPLICANT:If,after making this CertiOaa of Exemption•you should
bamme subject m Had Waleau's Compensation provision of she labor Code,you most
..J 0 forthwith Comply with such Pro WOM or this Permit Nall be doomed rooked.
Ez v~y., CONSTRUCTION LENDING AGENCY
thereby sM.Nal Nen Is a construction leadingatency for the Performance
rL> the wait for which this permit Is issued(Sm.3097.Civ.Cd .
GA Lender's Name
z Landon Addrom
V Q 1 certify Nat I have read this application and state that the above information is
LL, E~' contact.1 agree m comply with all city and manly Ordinances,AM state laws misting m
C) building construction,and hereby authorise representatives of Nis city In enter upon the
y W shove-mentioned properly for inspection purpos
(Wo)agree to save,indemnify and kap harmless the City of Cupertino Mint
'IAA. Iiabilider,judgments,cash and expenses which may In my my aamc All said City
()^ consequence
UNDERSTANDS AI
ND
APPLICANT WILL COMPLY WITH ALL NON-POINT Issued by: Date
EGULA
Re-roofs
Signure of ppl mtMananor Dam
HAZARDOUS MATERIALS DISCLOSU RE Type of Roof
Will ah:applicant or future building aaupanlatoro or handle to amours material
As defined by Oe Cupertino Municipal Cade,Chapter 9.11.and the Health and Safely
made.❑Yin rSedan vs7z(a All roofs shall be inspected prior to any roofing material being installed.
�u
Will the applicant or fuam building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants u defned by Na Bay Asea Air Quality Management all new materials for inspection.
District?
❑Yn No
I have mad Ne hazardous maadaH requirements under Chapter Q95 or No Califor.
rein Health@ SafctyCode,Sadao 15505,15577 tad 27534.1 undersand that train holding
dal not currently have a tenane that it 1G my responsibility in ratify the occupant of the
rayufrhmmemr+yhich must prior m Issuance of a Cen tc t�cupmcy.� Signature of Applicant Date
f/ All roof coverings to be Class"Bt'or better
Owner W!mho ad Cm Oote
Community Development
J10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CI or Fax(408)777-3333
WUPERTINO
Building Department
JOB ADDRESS: PERMIT #
O A' a&
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR:IF S FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors d com Tete .,. ...owing 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 ,I
er/Contractor Signature Date
CITY OF CUPERTINO
am 4 of 6 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 34233034 . 00
DATE ISSUED. . . . . . . : 04/27/2006
RECEIPT #• . . . . . . . . : 34163
REFERENCE ID # . . . : 06040173
SITE ADDRESS . . . . . : 10110 FIRWOOD DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DE ANZA OAKS HOA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2642
RECEIVED FROM . . . . : FOUR SEASONS ROOFING
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 6, 000 . 00 126 . 36 0 . 00 126 . 36 0 . 00
BSEISMICRE VALUATION 6, 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 126 . 96 0 . 00 126 . 96 0 . 00
•
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: 'Del An?_k cII c,�
Job Site Address: a (� �� U-.1o0 C �
Roofing Company Name: S�
Applicant's Signature: � Date:q -OLO
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
4- REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Z- Z O(o
Building Address:
10 O u r ro
Owner's Name: Phone#:
Contractor: ��77 License#:
Fa ,rSQ'tSonS 'I2cof el 7 / Z F
Contact: Cupertino�BBuusineLicense #:
t
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 311'—Asphalt Shingles
M— Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings / ❑ Provide I.C.B.O. Report#
;6 Tobe Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read,Understand and Will Com 1 With Cu ertino's Tear Off Policy:
Job Description: T(o FF- (£ 5t t Nsk- _. N. r71211 CD)( t av%
t o
Residentia ®� Commercial ❑
� 6�
Fire Zone: Yes ❑ Nom Confirmed with Planning Dept. if
there are any restrictions: u
Cost of Project: oo Type of Construction: Occupancy group:
S Soo "— — (100 P —
Qty. if
A licable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISNUCRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
•