06060047 CITY OF CUPERTINO x �'<n a '� =-� ' i• 'i
-BUILDINSDIVISION PERMIT �ONTRACTCIRINFORMATION -x'
BUILDING ADDRESS: MICHAEL LUNNEBORG ROOFING PERMIT NO. 06060047
'l OWNER'S NAME: PERMIT ISSUE DATE
� JANE KAMVAR 328 W SANITARY NO, CONTROL NO.
E. (831).278-1837
ARCHrtER/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
0o LICENSED CONTRACTOR'S DECLARATION Job Description
mC 1 hereby affirm Nal 1 am li¢nxd umkr praviaians of Chep.r 9(eommcneing P
�ZW with Stcdon]ll(1U)of Division Sof Ne Businev and Prafessiors,Cade.and myli<enmu
„ imfull fo.cand e « 41fF7��� TEAR OFF WOODSHAKE AND INSTALL LIGHTWEIGHT META
License Class Lie.Daley^6 tom TILE SYSTEM. CLASS A
ARCHf1ECTS D Ne1undersmnd my �r
plans iha11 be uud vurets
iCeU
°�� Licensed Professional
5 OWNER-BUILDER DECLARATION
<f I hcrehY.alTirm Nal I am exempt from the Conuanar's License law for the
O O following return.(Section 1031.5,Business and Protections Cade:Any city or county
5m which.quirts a permit to construct alter,nnPmsc,demolish,or repair any structure
i< prior 0 its issuance.slasnaimms use applicant for such permit to file a aliens]statement
C
that he is knescd purmant m Nc pmvisiom of the Ccumme m's keens,Law(Chapter 9 Sq.Ft. Floor Area Valua$(17 0 0 0
f (commencing with Section 7000)o(Division 3 of the B term and Professions Code)or
Nat he is exempt Nurerrom and Ute brands for the alleged eumption Any violation of
Sesdon 7031-5 by a"applicant for a Permit subjects Nc applicant to a civil penally of APN Number Occupancy Type
not mane Nan five hundred dollars($503). 36618026 . 00
P y yP
I.uowrcraf tie the ammYemntendedwith Mmol
als(salee C4.Busuon,
will Prfictionsrl,Code:
The uucunots LMcd arawdo farsa apply R1 s4, owner of Required Inspections
us
and property
who bu Code:The Conuecrofs std wh•law does trot apply lf an owner is q P
property who hui Ids car improv thereon.and who does such work himself or IMugh his
aomwcr.theu,Dingo riNarownsimproold witinneyear off aroiertd for matt r. ��
hsider.Nebuilding orimprovementaanld within year ofunpomn for Neowned
builder will have the burden of proving Nal he did wt build or improve for purpom of
salt.).
NALELA
❑h as owner of the property,am mclmively contracting with licensed mnuacluss to
construct the project(Sec.7014.Business and Professions,Cade:)The Conuaesar's Li. 'Da47 05
ryG
cents law dots not apply to an owner of property who builds ar impmw Nerean,and ���J oUU
who contacts for such projects with a conuac.rts)Iisrnxd pursuant to Ne Conuanah /.
Liceve law.
❑lam tempt under Sec. ,B&PCfar this rcman
Owner Dau
WORKERS COMPENSATION AATIN ` IJ
DING
I bemby a16rm under penalty of perjury one,of the following deGaratios:
haw and will maintain accnifncau of consent to self-insure fm WarkeYsCompen-
colom,as provided for by Section 3700 of Ne Lobar Cade,far the performares or Nc
work for which Niu permit is issued.
1 hale ride will maintain Wook h Compensation Irssuran¢,as,required by Section
3700 of dm Labor Code,for the performance.f the work(or which this permit is issued
My Worker's Compensation Insurance carrier and Policy number ase-
Carrier.
rt:
Carrier. .4Fa+✓ Polity No.:17A-f/1^J^�_
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need Can be completed Buse permit is farom hundred Wilson(SIM)
nr loss.)
I certify that in the anfomus.e of the work for which this Permit u issued,l shall nal
employ any person in any manner nor as to become subject to Ue Warken'Compusatan
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.oder making this Certificate of Eaempdon,you should
become subject to use Worker's Compensation provisions of the labor Code,you must
.,O forthwith comply with such prnvisims,or Nis permit shall be deemed revoked.
E''-' CONSTRUCTION LENDING AGENCY
[—�� Ihemhy drum Nat Nem is a castsuactirm lending agency for the perfamess.of
lY.fir Ne work for which this permit u Wood(Sec.3097,Civ,C.)
CQ I.emdees Name
=Z, undees Add=
U Q I certify that 1 have read this application and sat.Nm the shove information is
IL correct.I agree to comply with all city and county ordinareas and state laws misting to
(]U building construction,and hereby amhorim repmaenutiw of this city to enter upon Uu
W above-mentioned propcny(or inspection purposes.
ty of Cupertino
F ta/1
liabilities,judgments.coats and expenses;which may Int any way�accrecagainst saki Coity
U.Z A eorlsrgrcrtoe of the Starting of this Permit. /
APP (CANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 6
5 RCE RE AT
- -� Re-roofs
Signal of ApplicanuC tractor Data
HAZARDOUS MA DISCLOSURE Type of Roof
Will the applicam or future building occuPantnom or handle havrd nus material
as dctmed by Uc Cupertino Municipal Code.Chapter 9.13,and 60 Health and Safety
Cade.Scene.25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
T r10
// If a roof is installed without first obtainingan inspection,I agree to remove
3YII that applicant i future building by the Bt use cyvi it Qu or Marta which P g
t nth hazardous air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection.
t Disuict7
I have read the har-iw mauriala reli.menu under Chapter 6.95 ofthe Cadfor-
niaHoalN&Safely Cade,S«ums 15505.25533 and25534.l understand Nairthe Wilding
data mol eunenuy hmc a unanl Nat a Is my res aihilily to ufy Ne o«upanl co-the
requirements which be met toiss to ee ' ea ora panty. Signature of Applicant Date
ct umedagerG D All roof coverings to be Class "B"or better
CITY OF CUPERTINO
�m 1 of 1 PERMIT ,RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36618026 . 00
DATE ISSUED. . . . . . . : 06/06/2006
RECEIPT # . . . . . . . . . : 34713
REFERENCE ID # . . . : 06060047
SITE ADDRESS 1339 POPPY WY
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER JANE KAMVAR
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : WESTERN ROOFING SYS
CONTRACTOR MICHAEL LUNNEBORG LIC # 25896
COMPANY MICHAEL LUNNEBORG ROOFING
ADDRESS 1328 WHITE OAKS RD
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (831) 278-1837
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 17, 000 . 00 245 . 16 0 . 00 245 . 16 0 . 00
BSEISMICRE VALUATION 17, 000 . 00 1 . 70 0 . 00 1 . 70 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 246 . 86 0 . 00 246 . 86 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 246 . 86 VISA
TOTAL RECEIPT 246 . 86
•
- Community Development
f 10300 Torre Avenue
%' Cupertino CA 95014
fatTelephone(408)777-3228
CITY OF Fax(408) 777-3333
#UPERTINO
Building Department
JOB ADDRE S:�i PERMIT �Od Lj
3 L , 6
OWNER'S N JA,�c KAeK PHONE # ofr Zv-3 9Frb
GENERAL CONTRACTOR: WeAiN S FAX#
I am not using any subcontractors: 4—L-o�,
ignatur Date
Please check applicable subcontractors and Com lt�2owing 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
41-9
Owner/ ontrac S gnature Date
o0JOoLh
CITY OF CUPERTINO
REROOF
CUPER�TINO PERMIT APPLICATION FORM
APN# "Lo— Date:
Building Address:
335
Owner's Na e: Phone#:
J4.✓t ar 41 of
Contractor: License M/
t n/ �JF� f7rAS 67S7Z1
Contact: Cupertino Business License #:
r c�4 Lunn `lJ
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) _tik-f
Number of existing coverings ❑ Provide I.C.B.O. Report# �—(,7.(.
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: /
Pq� o� a,v d r/,,,6e n,J l�f / /� !✓Pr L�.'�e74.1 7S�t s r r�.-•
Residential 9 Commercial ❑
C/G ft A-
Fire Zone: Yes ❑ No,O Confirmed with Planning De t. if
there are any restrictions: LJ
Co of Project: Type of Construction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
•
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 r/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.CJ
Homeowner's Name: 1N\)P__ kAVwr'
3
M
Job Site Address: I 3 c1 t r�,Ix,
VV
Roofing Company Name: l„ -es` g r+J YC r)cJt '.. S� r`�2ltiS
Applicant's Signature: Date:
• Greg Casteel
Building Official
Revised 11/2/04