08040113 OF CITY CUPERTINO
Buaow�DrvlsldN PERNIIT .�CbiV1TRACTORINF'QRMATION
BUIIDI G D FSS: PERMTr No.
MIRA VISTA AVE DADDARIO ROOFING 08040113
OWNER'S NAME: PERMIT ISSUE DATE
VERNON WILLIAM F 3 AND BILLIE 1734 WILLA WAY 04/15/2008
E: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMITWFO
T.0 SHAKE INSTALL O. S.B AND SLOG MECN
419 O O O O
30o LICENSED CONTRACTORS DECLARATION IObDescription
4 I barely alliren Nat i aA li¢mcd ander pmvi,imu of Chapter 9(m .I., ^- - ^^ -
with Section 70 1R of Divasoon 3.fdse Resonant and Pmfeanmu Case..,my license u
n in full Imea end effett a�r�
License Clant C '39 Lle.P U734 .
g Dent < G Contractor
0 �7 roc 9ARCHRECT3 DECLARATION
I undaruaml my plane shall ba used u public rtCan&
g ted Uaeucd professional
`w OWNER-BUILDER DECLARATION
ZO E hereby.Sm onl 1 1. ,Bumps from he Cantmme.Lkmac taw fm IW
ZOO which rad reason.(Saito NO mccou,eL aftue and Psdfeuitu Code:Any airy or county
which its issuance.
a a prisms re ennMCL pplicter,Irt for such
do permit
t ri mpmr ed tWaent
Zcs primbir iuuance.auu require the applient for pteh permitwfik aai[nW statement -
`owtbakwithScaantaumofDivisionsin3ofmammnmsandPasdomCapmr9 Sq. F[. Floor Area Valuation
9
(commencingelscauent5auo70001 mandth afor ofmseged Business my
Cade)of
this W u eanmpt therefrom and the baW for me alleged eaempuoe My a.latiOn a(
Section 7031.5 by any applicant for a perch subjects the applicant to a tial penalty a APN Number Occupancy Type
rot mom man Bve hundred Man($5007.
❑L u swan of the p ostrac m hms is employee"o yoga a thee.(Sec.
cmnpeunkn,
al do Prmeweek,and me she Cmeknot Intended Lawdafmsal apply us 44.Business
sm...of
Nd en,wh bac Cache The m tleLlMa License IJW ach (IOL apply m ri oWna N Required Inspections
propertywho Wlldsaimprawa h improandwho smuahandatt GffcmrtNtughm
awnow.th w,provided that ver improwmema art not inundrd ssdRertd for Galen,
Wilder the WildingorimProvemmtla sold did auyear or mproefor the mance,of
Wilder Will have the Wtdet of proving mat W did rot build a improv for purpose of
sae,.),
❑1,u owran of the Property,am uclu,lvely... auin[with ficerred mmunmer as
mmvun the project(Sec.70M.Buten and ProfeWoem Cade:)The Co tuaeufa U.
an=Law dee not apply to an owner of progeny who Wilds or improv Neeson.and,
who convects for such projects with amuses ort0licensed pursuant in ths Commerce.
License taw.
[II wa exempt under See ,B h P C for this moan
owner Dan
WORKER'S COMPENSATION DECLARATION
I hereby affirms under penally of perjury mat of the following declinational:
haw and will maintain a Certifier of Consent w self-iuum fm Woh4Ya Compan-
,Won.u provided for by Section 1700 of the I Code.far me performance of the
wast for which thus Permit is Wool.
0 I have and will maintain Wakee,OompeuWon loom¢,u acquired by Section ,
7700.17 the law CoM,for me per(armance of me were,for which mu permit in isaa6
My Warimes Cmnpenuuon lou caacier and Policy number awe:
Cannot, Polley No.:
CERT( CATEOF E%EMPf10N FROM WORKERS'
COMPENSATION INSURANCE
(Thu aced.Wad mabacanplet d If tW permit i,panne hundred de1IN(SIM)
m lead)
I certify dant In me pWar mace of the woric for which this Permit is mood.l Nall rot
employ any Name in any resource so u at Wanted subject in the Waken'Cmnp omadm
Law,of Caltfumil-Dar
Appllcut
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
Woman subject in the Worhera Compemardon pro•isim n of me Labor Cmk,you mute
.,O forthwith comply With.such Provisions m this Permit shall W domed revoked.
tiCONSTRUCnON LENDING AGENCY
(.r Ihereby affirm that mem i,a coutroctinn lending agency for the performance of
CL me work for which this permit is Issued(Sec.3097,Civ.C.)
W�Q Lsndee.Nurse ,
]Z Lenders Add.
U 0 I certify that l have and this application and sum mu that above Information u '
Uy comm I agree or comply with all city and county anlinerca eW sur laws relating in
0 Wilding muwcuan,and hereby aumodm rtpmaenutiwa of this city w mserupen the
[T7 show-mndared property fa iupectlm purposes.
(We)agme to save.indemnify and kap humku the City of Cupertino.,.I=
ItaMlitim,judgmenu,coomisna cue whichmaymanywayaaraaWutssid City
U tan'mosemanmofthegmun[ofthisperch.
APPLICANT UNDERSTANDS ND WILL COMPLY WITH ALL NON-POINT Issued by: Date _
SOURCE REGULAT70NS.
—� aq'«— G E) Re-roofs
um ofA run on r Dam
OUS MATERIALS DISCLOSURE Type of Roof
WIII met applicant m forum Wilding aceupant more or handle haarddu material
u deflnW by the Conceded Municipal Cade.Chapter 9.11.and the Health and Safety
Code.Section M532(a)7 All roofs shall be inspected prior to any roofing material being installed.
Oyer
weld the applicant or futum Wading deropam use cgaipmml a devicaa which If a roof is installed without first obtaining an inspection,I agree to remove
t huallou air contaminants u dcOncd by don Day Area Air Quality Management all new materials for Inspection.
iaWct7
El yes 6jda-
1 have mol thehuaeduusmateridsmquiacmcmu undcrCWprr6.95 ofine C,lifer-
nuHculOASofetyC.de,Smimu25SM.25733md25534.lw&c dthatlfthe Wihiel
does not currently how a tenant that It is my reamuibility w notify the aceumm,of the
mqulmmcnuwhlehmtusbc t riuvanmofaCeedftcarofocmpanry. Signature ofAppllcant Date
O S—dIR
rho' ape Date All roof coverings to be Class'W'or better
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: .Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35702029 .00
DATE ISSUED. . . . . . . : 04/15/2008
RECEIPT #. . . . . . . . . : BS000004491
REFERENCE ID # . . . : 08040113
SITE ADDRESS . . . . 10228 MIRA VISTA AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : VERNON WILLIAM F 3 AND BILLIE
ADDRESS . . . . . . . . . . : 10228 MIRA VISTA AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-2705
RECEIVED FROM . . . . : DADDARIO ROOFING
CONTRACTOR .. . . . . . . : EDGAR MONTOYA LIC # 26245
COMPANY . . . . . . . . . . : DADDARIO ROOFING
ADDRESS . . . . . . . . . . : 1734 WILLA WAY
CITY/STATE/ZIP . . . : SANTA CRUZ, CA 95062
TELEPHONE . . . . . . . . : (831) 476-9109
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 7, 350. 00 0 . 80 0. 00 0. 80 0. 00
1REROOFRES SQ FEET 23 . 00 299 . 00 0. 00 299 .00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 299 . 80 0. 00 299 .80 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 299 . 80 22091 '
---------------
TOTAL RECEIPT 299 .80
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- -----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
605 FINAL REROOF
•
i
CITY OF CUPERTINO
Gds-- REROOF
.CUPEkTINO PERMIT APPLICATION
of6 �0
APN # Date:
5 22, 02,01 6 _ — o
Building Address:
103.2 �Sh >
Owner's Name: Phone #:
Gam. cl 71�A"t_ ve ryioyi qeB ZS7 2 7 z1 7
Contractor: Phone #: 031 Ll7( —Q!0`f
r'o 12,10Fax #: 63 t yII _4 t S
Cupertino Business License #: Contractor License #:
o -7
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ phalt Shingles 6- :asphalt Shingles
ood 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: „
1 • o S�idK� � nS�� � � o - S (S °<^^ i Aja Yle
c�-r,Pos ; I'/-
0- 1
Residential Commercial
Fire Zone: Yes ❑ No El Confirmed with Planning Dept. if
there are any restrictions: ❑
Valuation:
U C-
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signat�e�— ,
CITY OF CUPERTINO
p" REROOF
•CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
23 1REROOFRES Re-roof Residential B 1SFDWLROOF
/ IBSEISMICRE Seismic Residential B
1RER00FMRES 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 " 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.
o
Homeowner's Name: Frci ti r , j
, Z�w N
Job Site Address: 10 7 2 5 1M i (a
Roofing Company Name: U0,✓' d
Applicant's Signature: Date: 6!q(-1 o t
Greg Casteel
Building Official
Revised 11/2/04
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
6UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
022cf01( 3
OWNER'S NAME: rrt PHONE #
GENERAL CONTRACTOR: FAX # l j
� l
I am not using any subcontractors:
ign a 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
u'mbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date