06040126 CITY OF CUPERTINO r
BUILDING DIVISION PERMIONTACOR,INF9 JON
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BUILDING ADDRESS: O TOS ROOFING PERMIT N0.06040126
1375 PRIMROSE WY
OWNER'S NAME: PERMIT LSIIE DATE
APT RONALD L AND VIRGINIA 888 FAULSTICH CT 04/21/2006
ONE: SANITARY NO. CONTROL NO.
(408) 298-9399
A0.CHITER/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
?op LICENSED CONRACTOWS DECLARATION Job Description
mF 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
I with Smimn 7()M)of Division Sof the Business and Profession Code,arm my liceme is
inrallrereeaneerr l REMOVE EXISTING 2 ROOF LAYERS . INSTALL 7/16" OS
'qz Li"n clpsa��ca^M�Hrao s ROOFERS SELECT FELD AND LANDMARK 40 COMPOSITION
9 ARCNIIECsSDECLA0.ATION SHINGLES #:'A1
I�< I understand my Plans shall M used u public records
16 U
'off Licensed Professional
z OWNER-exempt R DECLARATION
I hereby alRrm Hnr I am exempt from the Canuumh License Law for the
CDC O fallowing mee
reason.(Sdon 7113 L5,Busime a and Professor.Code:My Airy m
of oray "
ff
which requires a Permit to cnrhswc4 alter,improve,demolish,er repair any stromuro
.R11111
prior m its issuance.also requires the applicant forsuch Permit o Ole a signed sutemem
s< thmW is liccucd puruant m to pnvuiom of the Contracmrs liana raw(Charter 9 Sq.F[. Floor Area Valuation
��$ (commencing with Section 7000)of Division 3 of to Business and Procession,Code)of $8778
Nat he u exempt thererrom and the thesis for the alleged esempton.Any violation of a
Section 7031.5 by My applicant for a Permit subjects the applicant to a civil penalty of APN Numberpanty Type
not mart than five hundred dollars(SSW).
0 1,As owner of We property,in my employes with wages As thew sole mmpereation,
will do Om work and the smuchre b net intended ter offered for Muc(Sm.70".Busioess Required Inspections
and Prefessimu Cade:The Conarumrs License Law does ml apply m e ns an owner of q P
property who bu i lds or im prows thereon,and who does s uch work himulf or though his
own employees.provided that such impmwm ants Am maims m ed maBared for sok B.
however,the building orimpra mens is sold within one year ofcompletion,the camer-
builder will have the burden of proving that W did ret With or improve for Purpose of
sale.)
0 1,as owner of tW Property,am exclusively toms cling with licensed mnuActors m
conswct the Pmjea(Sec.70/4,Business and Rofessums Cade:)The Camnemr's Li-
c.taw d.An,Appy m An owner of property who builds or improves Hereon.and
who contracts for such projects with aconuaerar(s)lice"ud pursuant u the Conuaetoh
License U-
0 lamuemptunder See ,B&PCforlhismamn
Owner Date
WORKER'S COMPENSATION DECLARATION
1 thereby affirm under Penally of perjury noun of the following declarations:
t]1 have and will mamasho acerti0mteof Comcnl ieself-insure ro Worke(scompem
sstion,
As provided for by Set 37th of the Labor Code.for tW Mdmmmce of the
work for which this permit is issued.
0 I have orb will maintain Warkeh Courn,mostmon Insurance.As required by Sermon
37M afte Labor Code,for the pedarmance of Ne work for which His permit is lssmQ '
My Wa s/Com uatie Inmrame artier and Policy number are:
Camer:�r S Poli,No.: O
'j'/-: DG
CERTIFICATE P130N FROM WORKERS'
COMPENSATION INSURANCE
(Diu aemlan timed not W complemd if IW permit is fmanc hundred dollies(SIM) r
err less)
I comfy that in the Performance of tW work for which this permit is issued,I shall not
employ any person in my manners"As to become subjecuo the Worken'Compematon
Laws or Califoroia Date
Appnanl
NOTICE TO APPLICANT:If.after making this Ccnifiatc of Exemption.you should
bmome subject m thv Worker's Compensation provisions of He Labor Code,you maul
.JO fuMwith comply with such provision or this permit shall W decreero
d oked.
Z '-' CONSTRUCTION LENDING AGENCY
[—i= IWreby AM.that Hem u Acomwcinn lending agency car the Md...of
C He work fm which Wu permit is issued(Sm.3097,Civ.C.)
W�Q lundcfa Name
.7 z Lumbers Address
U 0 1 certify that 1 have read this application and sate this the above information is
U F comet.I agree to comply with all city And county aWi.s sed sum Iowa m:la big H
O V Wilding consuuction,and hereby authorim representstises of Hiscity to enter upon the
ahovc-mentioned judgments.
c st for inspector purposes.
Hy (We)agree to asm.Indemnify and keep harmless the City or CoMmine agahvt
Z incoisequeneofthecmuang exPcmawhich mryin any way accrue against ssid Ciry
C)z A APPLICANT
a(thegranting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:. Date
SOURCER ULATIOt
A , �V_U( Re-roofs
Signinum or pplicann/Cenu`xtor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applieur or forum building ocet panlsmm m handle huardous manurial
As defined by ate Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
Code.Sceriea 25532(a)7
C]yea All roofs shall be inspected prior to any roofing material being installed.
�Nu
MomIf a roof is installed without first obtainingan inspection,I agree to remove
41Will us applicant ler nts A buildingby the Bt esu equipment or Manna which P g
emit harabnus air contaminants u refined by Nc Bay Area Air Quality Management all new materials for inspection.
District?
DYa
1 have mad the huabnus mao:dals mquimments under Chapter 6.95 oldie Califor
nu Health Cade.Scmimu 35505.M533 MOI 25334.1 urbersuM thin ifthe Wilding
dam not eAme.dy how A tenant,that it u my.spomihility m mtfy the occupant of He
rcyumom,.ezichpmustWmc ertainuanceoraccrokawerampancy. Signature of Applicant Date
`5""�—� y L� &e All roof coverings to be Class hB"or better
Ownermret Domed agent Date' g
�. Community Development
10300 Torre Avenue
� r' Cupertino CA 95014
�^ Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
UPEkTINO
Building D partment
JOB ADDRESS: PERMIT#
S 19mrase Itk4OD (--(6 (-1—(",
OWNER'S NAME: PHONE # 4 E
GENERAL CONTRACTO os p06
�F-AX #
I am not using any subcontractors:
Signature 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
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
• �,Z_ /0 U�
""Owner/Contractor Signature D to
j Community Development Department
Building Division
City of Cupertino
w 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
• C p[n'rI N® 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 buildinginspector. 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.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An LC.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
y .
Homeowner's Name: ) r 1 I n t 'c Ar) �-
_.-_-.Rcofing'CompanyName:- - - _ 0.. .,__..._ .._
O
A plicanYs Signature: Date:
Greg
ti
• Building Official
. Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
am 2 of 3 PERMIT RECEIPT , OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36617047 . 00
DATE ISSUED. . . . . . . : 04/21/2006
RECEIPT 4 . . . . . . . . . : 34089
REFERENCE ID # . . . : 06040126
SITE ADDRESS . . . . . : 1375 PRIMROSE WY
SUBDIVISION . . . . . . :
CITY CUPERTINO ,
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : APT RONALD L AND VIRGINIA E
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5229
RECEIVED FROM . . . . : LOS GATOS ROOFING
CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481
COMPANY . . . . . . . . . . : LOS GATOS ROOFING
ADDRESS . . . . . . . . . . : 888 FAULSTICH CT
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 298-9399
OEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 9, 000 . 00 158 . 76 0 . 00 158 . 76 0 . 00
BSEISMICRE VALUATION 9, 000 . 00 0 . 90 0 . 00 0 . 90 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 159 . 66 0 . 00 159 . 66 0 . 00
•
CITY OF CUPERTINO0 W04-01 9 �
REIIOOF
CUPERTINO PERMIT APPLICATION FORM
• APN# Date:
Building Address:
Owner's Name: 0 Phone#:
/h/q 7 7
Contractor: Phone #: O License#:
, -
Contact: __� Phone#: Cupertino Business Lice n e#:
Type of Roof Covering:,
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles 46 y,-.
�Cr Wood Shakes ❑ Wood Shakes
Wood Shingles ❑ Wood Shingles
❑ Other(Specify) g Other(Specify) 711, "6513
Number of existing coverings ❑ Provide I.C.B.O.Report#
/1y To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Desert tion: e r-C Z •���cy�c 7�� ,
• /S•L �rz
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning De t. if.
there are any restrictions: u
Cost of Project:, '0 / Type o Construct* Occupancy group:
k Z,
Qty- if
A Hcable Fee ID Fee Description Fee Grou
BPERMFEE Bldo Permit Fees BUILDING
BENERGY Ener BUILDING
--- .......
----.- ----- ---.__.-.-.---..--- ---BSEISMICOM----------------•SeismicCommercial•- --- ... ._.__-.�BI•TII:DING--•• ---
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
•