05080011 CITY OF CUPERTINO
s BUILDING DIVISION PERMIT 'CONT cT.UR TNFORMA'�IO
BUILDING ADDRESS: PERMR N0.05080011
22707 VOSS AV
OW NER'S NAME: PERMIT ISSUE DATE
KEITH URAUCHI 08/02/2005
NE: SANITARY NO. CONTROL NO.
ARCHI=1ENGINEER: BUILDING PERMIT INFO
BO ELECT PO MECH
O
Sop
LICENSED CONTRACfOR'SDECLARATION Job Description
t� 1 hereby shbon that 1 am licensed under provisions of Chapter 9(commencing
with section 7011n)of Division 7of the Business and Profession Code,aM my license
In Ull freco and en REROOF W/COMP.
? ? License les Uc.• mac=
3g Dam canusear CONTRACTOR: RAINBOW ROOFIN
ARCNRECTS DECLARATIO `
I undersand my Firm shall W used as Public rton
SyU
Licensed Profcu+onal /.lr r
V n
OWNR-BUILDER m the Com em e.��
i F I hereby.(Sect Lan[Ex.1. esempt from the CanusemA License Law far thefollow _ f- q r _ ?OOC
g o which ng won.(Section u 713 1.3,Business and eve,de Professions Code:Any itym m couhny < r 'p d
$ which its issuance.
•promo ac eanswct,alter,improve,demahah, fl mpsig say structure Iq y4 N. 1`3{e
z� LhtWitsiuuenm,aaumquima 0mapimis.for wchpemiitmclasa Law(Clned aunl)
�< thnhais llansed purnanuo me provialoes of Nc Canwcmr's License Ow(Chspmr9 Sq.Ft. Floor Area aye VaIU �' 10
_ ! [t
(cummea murpt tSen+on 70n d of Division r of Ne eget axe end om.Anysn hnion of N `SIA
— Nat Zia cumpt tmufrom and the basins fa the alleged exemptan.Any violaton of
Section 7071.5 by ay applicant for a permit subjects the applicant a a civil penalty of APN Number Occu ane
not mom them fiwhundreddollars(5500). 34215049 . 00 P y�YPe
❑I,u awrmr of to ryopeny,or my employees with wage.u their sem campensadon,
willdotheworltandNcatacmreanot intendedmaWmd forsale(Sec.7014,Budrmu Required Inspections
and Professions Cade:The Cor acmra License law don not apply m an owner of q P
property who Wilds wimprove,dmmon.andwho doessmhwork himself orthrough his
awn employams,provided that such Improvements see cot intended oroRemd for sale.IL
however,me building or Improvement is sold within arc year of complemm.me owner.
builder will have 0th burden of proving that he did not Wild or Improve for purpose of
sale.).
❑1.as owner of the properly,am exclusively contru3ing with licensed conlnemn to
construct the pm)ea(Sec.7044,Business and Professions Cade:)The Contractors Li.
ase law does not pply to an awnm of property who Wilds or improve theme,and
who contracts for such projects with a commitments)licensed Foramen In she Centracara
License Lew.
❑Lem exempt under Sec. B k P C for this recon
Owner Dam
Adk WORKER'S COMPENSATION DECLARATION
1 lamby affirm under penalty of perjury aro of the following declarations:
i low ahhd will main Wn•CesiOesm.!Consent uulGinsum for Workce$Compen-
sation,u provided for by Section 7700 of the lobo Cade,for Nn performance of the
work for which suis permit is Waned.
I'1dI
have W will maintain Worker's Compression Iaunnce.u enquired by section
W of the Lebo,Code,for dm performance of the work for which this permit is issued.
My Works re madam Insurance carrier d Policy number am:
Cartier: n `^ a— Policy No.: 2. 2`7-01)Q✓ss,�
CERTIFICATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(Thhscotnn need not W completed Ifthe permh Is formic hundreddollan(SIM)
or leas.)
1 comfy that in the parfmmenee of the wok fm which this permit is issued.I shall wt
employ anyperson in any maneru as In become subject o the Workers'Compemadan
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject in due Worker'Compensation provisions of the Labor Code,you must
.J Q forthwith comply with such provision,or this permit shall be dcomed mwitd.
tiCONSTRUCTION LENDING AGENCY
(—i IWmbyalTnm that New is a contraction lending agency for the perfurmermre of
ani ?
the work for which this permit is issued(Sec.7097,Civ.C.)
aQ Landers Name
0 z Lender's Add=
U 0 1 certify that 1 have mad this application and sum Last the above information is
W,:'" coven.I gree to comply with all city and county announces and suns laws relating to
0 SV' building construction.and heroby authorise representatives alma cry to enter upon the
W aW.-mendoned progeny for Inspection purposes
y (We)agree m save,indemnify and keep harmless da City of Cup ninth again
IA liabilitm,judgmenu.cnsts and safenaa which may in may way seem agalesiaald City
V Z in consequence of the Framing of this permit.
ti SAPPLICAYT OURCE R UND'R9SwT�DS AND WILL COMPLY WITH ALL N--POINT Issued by: Date F-'?
LJ�w �QS Re-roofs
Signature ofAyplianV numr Data
til
N seBOGGS MATERIALS DISCLOSURE Type of Roof
Will she applicant or future Wilding aecupnLSWM W bAMIe haardomt material
as deRned by flat Cupertino Municipal Code,Chapter 9.17.and tiro Health and Safety
adc,Secton 7337iD)7 42r� All roofs shall be inspected prior to any roofing material being installed.
Yes
Will ted opplbut or forum building=upon[use equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove
It havamna air cwamianu u dc0ud by the Bay Area Air Quality Management all new materials for inspection.
Disvim7 `'' _�
❑Yes mamr
Ihaawad Nedo Sccd 2,,,,, ,,33mme,514.,rC7upmrd.9.,,.Indsm.f.r ' O
nu Hoshm a Satuy Cada Sa9au23303.23577 end2S514.1 uuterauhhtl Nuif Lac Wilding
does non cuncoly ham s mnenL Nu It a my rommumb ility m notify tic o pant of Ne
requimmcntswhichmuslb m darwiuu nnflCertOcamofOccu ay. Signature ofAppl- ant Date
own,mr,mmmra<a sent ,m s All roof coverings to be Class "B"or better
FROM :RainbowRoofinq FAX NO. :6503630273 Rug. 02 2005 09:09A.M P1
08/01/2005 14:24 510538328: LEGALITIES INR PAGE 31
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Capmtloo CA 93"014
TokphM(409)777-3ne
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Date
Pleasecheckapplicablesubcontr infosmaS m.
SUISCONTRACTOR' BUSINESS NAME BUSINESS LICENSE#
Cabinets do Millwork
Cement FtrUshln_ g -- '—
Electrical
Excavation ----- —
Fencing
Pl
Undemm/Wood T
class ---
Insulation
Imulamping ----
Onuwwrttel Sheet Metal
Pain / Walla ----
pevktg —
HPIa�
Romfing
Septic
Tank _ — -
- Sheet Mehl
6heetRods
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owner—`— cAnaa�' ,lgr,a,ure -- X Date
Community Development Department
a-U
Building Division
tiCity of Cupertino
10300 Torre Avenue
O, I CITY O � Telephone: (408)777-3228
V P E�ITF I l v o Fax: (406)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: [��L aaa - �'•
Job Site Address: 7 00 7 ✓a'- 0,,
Roofing Company Name: /C nJ �ry 9er„n
Applicant's Signature: Date: 9/7 /S
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO U��//
a' REROOF
CUR"01NO PERMIT APPLICATION FORM
APN# Date:
Building Address:
02707
Owner's Name: Phone#:
Contractor Q Phone #: License#:
4.c . w 1 &50 3 L3 —,:fZ-73 �F 90 9 2-
Contact:
Contact: Phone#:Q Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles '1;1f, Asphalt Shingles
Wood 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.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Descri ion:
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are any restrictions: LI
Cost of Project: o Type of Construction: Occupancy group:
iQ 3 io
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
�- 2� 3•