08050244CITY OF CUPERTINOBUILDING
TRACTORI1�Tk'ORMATIf3N.
DIVISION PERMIT
Blnlp�Irq p�pa LAS
PE Ol��S0244
ONDAS WAY
LOS GATOS ROOFING
OWNLERU'SUNAME:
PERMIT ISSUE DATE
ELIZABETH MILLER
P 0 BOX 1726
05/30/2008
ONE:
SANITARY NO. CONTROL NO.
AacxrTECDENCINEEa:
RE—RF RMV EXSTNG SHKRF
BUILDING PERMITO
-BLDG EIECTPLUMBMECH
LICENSED CONTRACTOR'S DECLARATION
DaSCTI uOn
y unions at 1 w licensed under provisions of Chapter 9 (commencing
1 hcrtunionsth
....JOb
-" " �- "-'-" "' - p
With Section 7(as), of Division] of the Business and Professions Cum, W my license is
-
in full font and offices- O
License CIyy Lie. Ja3lD
Dae off—Contractor
'may
�r+�
T—' ARCHITECTS DECLARATION
1 underwnd my plans shall rte used as public records
Licemood Rufessional
OWNER -BUILDER DECLARATION
I Iemby .11 ren into I am exempt from the Contractors Licose Law far the
I following Asan. (Section 701.5. Business and Professions Cole: Any city Or county
Which ,quires a permit to conwum, cher, Improw, demolish, or minor any structure
! prior m its issuance, ales requires lM applicant forsuch Pencil re file a sigred,rtemenl
Out W is licensed pursuant to the provisions of th, Conuacturi Licanse Law (Chapter 9
Sq. Ft. Floor Area Valuation
(commend.& with Section 7=1 of Division J of live, Businoss and Protections Code) or
Oust W u euro,, theef can atW the bases for the alleged acception My riolatfan of
Section 70M by an, applicant fes a permit subjccu the applicant to a civil penalty, of
APN Number
Occupancy Type
rat moo dun fres hundred dollar nXn
P y yp .
Cj I, u owner orde proprry, ar my umployces with wages r thetr sole eanpewtion,
wid da fe wart andm, The O le Isrot, Lia aro a w des rawak (ss-. in as .. of
and Professional Cade: The Lecewe law does rot apply lf an owmr of
Required Inspections
vensramors
thmwnand who daessah wale himrelrar Waugh his
ownemplo cobuild,. roAcimpsovea
ownever.0 rbuipnngded such improwmwtaretest inteMedaraRnW for sale a.
howWilder.thebuilding pr within ane year ofcprovefrtheowuer-
aitesa provnt e.usaid
builder will have IK nurdco of provin8 that he did rot GUW a improve for purpose of
sok.).
r
0 1, ss owner of Ile propeny, am aelwivtly mmossmting with licensed ronuaemrs to
construct the proem (Sec. 7Wd, Business mal Profrilons Cade) The Contractors U,
cense Law does not apply to an owner of progeny who Wilds or emprvu thereon, mad,
who contums far such projects with a conuacter(s) located hunwnt he Ne Contractors
License Law.
❑ 1 an, eumpt under See , B & P C for this recon
war Dau
WORKERS COMPENSATION DECLARATION
I hereby Niro under penslly of perjury one of the fallowing dcclantione
❑ I hsw and will maintain a Ccnihcae ofConsent W self -iniac, for Wooers Compen-
t
assom. ss provided for by Section 377 of the Labor Code, far the performance of the
wort for which Out Permit is issued.
❑ I have and Will maintain Workers Compensation Insurance, u required by Scctu n
37W of dm Labor Code. for Ne performance of the work for Which this Permit It issued.
'
My WorkersCompensationbuunwce capand Policy number art:
Cartier. JrTnT( t f, la...PolicyNo.: /5`9-0009
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu secdrn need rat x completed If the permit is forms, hundred dollars [$IM)
or less)
I certify Nat in the Performance of the work for which this Permit is issued. I shall not
employ any Forma in any manner sa u in become subject to the Worker'CompewNon
Laws of Califoris Date
Applicant
NOTICE TO APPLJCANP. If, After making this Certificate of Exemption, you should
become subject to the Wooers Compensation provisions of the labor Code, you most
forthwith comply with such Provisions or Nu permit shall W deemed nevnkcd.
CONSTBUCrION LENDING AGENCY
1 hereby afrtrm Nat Nero a a cmwrucdon lending agency for the perfurmance of
the work for which thus peroil is issued (Sec. 309), Civ. C.)
tender's Name
Lenders Addmct
1 certify Nat 1 have read this application and sum this the abew ieformadun in
ccs 1 agree to comply wit all city and county ordinances and suis laws oc adng to
Wilding cosutruetian, and hereby awharir ¢pmxnutivcs of this city m c.W,.,a the
alive -mentioned Property for inspection Purposes-
urpoes(We) agree to save, indemnify and lose, harmless de City of Cupmnino agdon,
(We)
iabiliti
I judgmcnu, moss and expenses which may in any Way acmme grinst acid City
in consequence of thm &renting of thus
pmmis-
APPLICANT PNDFRSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
sOURCER LATIONS.
S 1:70
Re -roofs
Smgnat of APplicanJCortinumar ate
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant an future building nompant cart orhandle haesrdow m ns ria]
as defsrmd by the Cupenmm Municipal Cade. Chapter 9.11, and the Health and Wet,
'
code, Section usg3(,)± 05 NO
All roofs shall be inspected prior to any roofing material being installed.
Will the, Beam or mora buildin oar ant rte
tar Mwg
If a roof is installed without first obtainingan inspection, I agree to remove
.it haaardnw moouminsnu r dedmtl b the Bay Area Aiirr Quality mens
walric%7 y
all new materials for inspection.
µA
❑Yes gy No
Ihave mad the hxaardaumaterialist requirements underdhapterd.9J Califon-
ifW
nu Fkaw& Wnyraw a mime ut 11 uddl an bili.] to unity t e isto cupantft of the`�
docs not,wrendr raw , Ibis h des it us ser mponuhility to rotirY the occupant ser the
.Gr._ — S�3 0/0 8
egaimmcnu rich ¢acct be a pnarto issuance or, Cenercale al gc.pancy.
Xs-
Sig acre Of Applicant Date '
sLo/o g
All roof coverings to be Class '%T' or better
ow rauthwiza., m ' Dar,
• 2 ITEMS OF 4
E
11
CITY OF'CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub:
Blk: Lot:
APN ........:
36932030.00
DATE ISSUED.......:
05/30/2008
RECEIPT #.........:
BS000004951
REFERENCE ID # ...:
08050244
SITE ADDRESS .....: 20071 LAS ONDAS WAY
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
VOICE ID, DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
OWNER ............:
ELIZABETH MILLER
ADDRESS ..........:
20071 LAS ONDAS WY
CITY/STATE/ZIP ...:
CUPERTINO CA, 95014-3132
RECEIVED FROM ....:
LOS GATOS ROOFING .
CONTRACTOR .......:
RANDY BROWN LIC # 23481
COMPANY ........:.:
LOS GATOS ROOFING
ADDRESS ..........:
P 0 BOX 1726
CITY/STATE/ZIP .
LOS GATOS, CA 95031
TELEPHONE ........:
(408)298-9399
FEE ID
----------
UNIT QUANTITY
-------------
AMOUNT PD -TO -DT
THIS REC
NEW BAL
1BSEISMICR
----------
VALUATION 7,915.00
--------------------
0.80 0.00
--------------------
0.80
0.00
1REROOFRES
SQ FEET 26.00
338.00 0.00
338.00
0.00
TOTAL PERMIT
---------- ----------
338.80 0.00
---------- ----------
338.80
0.00
VOICE ID, DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• PERMIT INVOICE OPERATOR: patg
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36932030.00
INVOICE DATE......: 05/30/2008
REFERENCE ID # ...: 08050244
SITE ADDRESS .....:
20071 LAS ONDAS WAY
SUBDIVISION .......
CITY .............:
CUPERTINO
IMPACT AREA .......
OWNER ............:
ELIZABETH MILLER
ADDRESS ..........:
20071 LAS ONDAS WY-
CITY/STATE/ZIP ...:
CUPERTINO CA, 95014-3132
CONTRACTOR .......:
RANDY BROWN LIC # 23481
COMPANY ..........:
LOS GATOS ROOFING
ADDRESS ..........:
P 0 BOX 1726
CITY/STATE/ZIP ...:
LOS GATOS, CA 95031
TELEPHONE ........:
(408)298-9399
FEE DESCRIPTIONDUE FOR
--------------------------- --------------
SEISMIC RESIDENTIAL PRINTING PERMI
RE -ROOF: RESIDENTIAL PRINTING PERMI
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
0
AMOUNT DUE PAID BALANCE
T 0.80 0.00 0.80
T 338.00 0.00 338.00
---------- ---------- ----------
338.80 0.00 338.80
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
cm o
*CUPERTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION
APN #
Date:
Building Address:
2 "0 r
Owner's Name:
Phone #:
y��
Contractor: L o S G-CL11
.7-o S U p y
1 r? c�
`J
Phone #: z1v 8' „2,9
Fax #: o� —2 f -
Cupertino Business License #: 2 ? ' / /
J'7
Contractor License #:
0 70
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
>11 Wood Shakes
Asphalt Shingles jb �J
❑ Wood Shakes
❑ Wood Shingles
Other(Specify)
❑ Wood Shingles
❑
Number of existing coverings /
XOther (Specify) � IL'' OS
❑ Provide I.C.B.O. Report #
To be Removed
o Provide Mfgr. Installation Specs.
25 Ss
S 5 anP Cl4ss—
z
Jo Description:
Residential
Commercial
Fire Zone: Yes ❑ No 14Confirmed
with Planning Dept. if
Valuation:
there are any restrictions: ❑
,V)915.
I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy:
Via.
OCU
CITY OF
PERTINO
r
L.
CITY OF CUPERTINO
REROOF
FEE SCHEDULE
Number of
Squares
Fee ID
Fee Description
Fee
Group
Permit Type
1REROOFCOM
Re -roof Commercial
B
1COMMLROOF
1BSEISMICO
Seismic Commercial
B
1RER00FRES
Re -roof Residential
B
ISFDWLROOF
1BSEISMICRE
Seismic Residential
B
1RER00FMRES
Re-roofMulti-Family
B
1MFDWLROOF
1BSEISMICRE
Seismic Residential.
B
1BUSLIC
Business License
B
0
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 Nai
Job Site Address:
Roofing Company Name: s
n
Applicant's Signature: /}�/�� ) r� Date>
• Greg Casteel
Building Official
Revised 11/2/04
A-1 (f�'� J +v
i.�;-1
CITY Of
*CUPER,TINO
41
Buil
JOB ADDRESS:
Z X07/acs
OWNER'S NAME: pjrJ g< /Zy
GENERAL CONTRACTOR- ] nc
Community Development
10300 Torte Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Department
PERMI6)2-6.5
p6.O
PHONE #PHONE ##
FAX#
I am not using any subcontractors:
le Signature
Please check applicable subcontractors and cmmnlptp the fnllnwina infnrmaHnn•
DYte��
'Owner/ Contractor Signature
D e
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/ Contractor Signature
D e