05070135 (2) CITY OF CUPERTINO of « x ,s '� '�"' ?° • '
BUILDING DIVISION PERMIT ,CONTRACTOR INFORMATION
BUILDING,ADDRESS: R E ROOFING & CONSTRUCTIO N PMtNO05070135
OWNER'S NAME: PERMIT ISSUE DATE
EDITH BARR 15230 CLYDELLF
NE: SANITARY NO. CONTROL NO.
(408) 626-9320
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
nest, LICENSED CONTRACTOR'S DECLARATION
e C I hereby affirm Nat I am licensed under provisions of Chaptcr 9(commencing Job Description
eiw wOSection7IXgBof Div'sion of sine and ProNc iom Code,andmylicenwis
;« mmurnrteanderrem'12 I° REROOF-REMOVE (E) CO V O� INGLES
5jj= ucen I a C. LT
Camrecto INSTALL 1/2" CDX 30L P COMP
RCHITECTS DEC
wu 1 aoECrsu my p1 s shall be used ¢me
=a� LieemedProfessional 2005
Z S OWNER.BUILDER DECLARATION
'�<F 1 hereby al'frm
that I am exempt from the Contractor's License Law for the
p o following reason.(Section 7131.5,Business and Professions Cade:Any city or county
m which requires a permit to eonswct,a w,,improve,demolish,or repair any structure no oil mohl"Il
—Zy prior m ill issuance.alio aciploe3 the applicant for such permit to file a signed Statement< nw
Otis he is licensed pursuant m the iormiomaf NC Co...,',License law(Chaper 9 Sq. Ft. Floor Area sW67s,
3000
Y_G (commencing with Section 7")ofDivision 3 of Ne Business and Pmfssions Code)or
i 3$ Nat he is exempt therefrom and the basis for de alleged exemption.Any violation of
Section 703 1.5 by arty applicant for a permit subjccas the applieanto a civil penalty of APN Number Occupancy Type
not more than five hundred doll.(SS(M). 36933021 . 00 p y yp
❑1.as,ownm of the prepery,or my employees with wages as their sole compensation,
will do the work,and the swcture is not intended or offered for sale(Soo.7044,Business
and Proreasioas Cade:The Contractors License law doer do,a,],m an owrter or Required Inspections
property who builds or improves thereon,and who Eocssuch work himself or through his
own employees,provided Nat such improvements are notinended at offered for sale,IL
however,the building or improvement is sold within one year of completion,the Craft
builder will have the burden of preving that he did not Wild or improve for purpose of
sato).
❑1,as owner of the property,am exclusively contracting with licensed Contractors to
Construct the project(Sec.7044,Business and Profusions Code:)The Contractor's Li-
cense law dots not apply to an owner of property who Wilds or improve fumes.and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
Cl I am.aempt under Sec. .B&P C for this reason
Owner Date
WORKERS COMPENSATION DECLARATION
411 1 hereby affirm under penalty of perjury arc of the following declamfons:
U I have and will maintain a Certificate of Consent to self-insure for WorReis Compere
.as provided for by Section 3700 or the Later Code.for the peAormaxe of Ne
wor for which this permit is issued.
1 have and will maintain Wwkcr's Compensation Insurance,as rryuirtd by Section
of the labor Code,for the performance of the work for which this permit is issued.
M Worker' Ca a cation In p..carmen and Policy number an,
Comer. Policy O V
CERTIFICA POF ENS Pr10NFRAN WORKERS'
COMPENS, ION INSURANCE .
(]This sectors need not he complmed if the Permit is for one hundred doll=($IOD)
or less.)
1 certify that in the performance of the work for which this permit a issued,1 shall not
employ any person in any mannerso as in become subject to the Workers eomprnunimi
Laws of California.Dow
Applicant
NOTICE TO APPLICANT.IL Our making this Certificate of Exemption,you should
become subject m the Worker's Compensation provisions of the labor Code,you must
.J Z forthwith comply with such provisions or Nis permit shall the deemed revoked.
z n CONSTRUCTION LENDING AGENCY
by
Cams Phe,which do Natthcrt issed(Sec.3W7nding agency or the perfmmanxe of
gL 25 the work fur whish Nts pcmtit is issued(sec.3097,Civ.C.)
a. Lender's Name
a landcr's Address
az
V Q 1 certify that 1 Nye read this city
and coup v,d sole that rbc above information u
0 U cortex 1 agree m comply with all city and county omimnces and sum laws r upon
m
V hve-haaing med!poand forhereby auNonartmais. lies of this city menterupon Ote
ateve-mentioned property findmnify an keeper
C (tes)agrte to save,indemnify and keep formless the City of Cupertino against
F'Z incoisegjnce of the
gracing ofpensesrinh. may to anyway accrue against said City _
V z mcoLICANTOUNDERSTANDS Aof rND WILL COMPLY WITH A L NO POI Issued by: Date /�'
S REGU _ _J
signal a f-ApNica Contract Duo Re-roofs
AZ US MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future byfaing occupant store or handle ba mous material
as defined by f¢Cupertino Mun)))Clpal Cod.,Chapter 9.12,and the Health and Safety
creta.se❑ctye.25532(a)? /No All roofs shall be inspected prior to any roofing material being installed.
Will me, Tear1( rf re iia�n he u ant uae e t or devices which If a roof is installed without first obtaining an inspection,I agree to remove
pp s p vuipmen
baa.rdnus air co"' ,.n d Ilm d by the Bay Arca Air Quality Marta cat a ew materials for inspection.
Distiict7
❑Yes X0 NO j
Ihavcrudtheharardousmalerialsmquimmcnuundcr Chaper6.95 fthe Califon I^ ( I
niaH IO&samtyc.k.scc..IMS.2s533a 255.X.lumcratandlna, alts Wilding
of c hate•tenant.Nat it is my responsibility b rwtifY occ t of dre
rcyai ton um aarecaracertirmaeor Cr --Si�ature �Applican Date
r imhori'r.d agent DOW All roof coverings to be Class"B" or better
CITY OF CUPERTINO
1� 2 of 2 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 36933021.00
DATE ISSUED. . . . . . . : 07/21/2005
RECEIPT #. . . . . . . . . : 30470
REFERENCE ID # . . . : 05070135
SITE ADDRESS . . . . . : 10552 LA RODA DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : EDITH BARR
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4416
RECEIVED FROM . . . . : R E ROOFING/CONST
CONTRACTOR . . . . . . . : PROCTOR, PAUL LIC # 20615
COMPANY . . . . . . . . . . : R E ROOFING & CONSTRUCTION INC
ADDRESS . . . . . . . . . . : 15230 CLYDELLE AVENUE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95124
TELEPHONE . . . . . . . . : (408) 626-9320
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
_____ __________ __________ __________
BPERMFEE VALUATION 13, 000.00 201.96 0.00 201.96 0.00
BSEISMICRE VALUATION 13, 000.00 1.30 0.00 1.30 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 203.26 0.00 203 .26 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ --________--_--___
CHECK 471.92 9198
TOTAL RECEIPT 471.92
F - Community Development
10300 Torre Avenue
( Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
OUPEkTINO
Building De artment
JOB ADDRESS: lOr't�2 Lx a X , PERMIT # U
/
W
ONER'S NAME: 77 l'M PHONE # — 26 -/cl 3Z0
GENERAL CONTRACTOR: FAX # q O — U- l
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
i 1 --7 Zl I�7
r/Contractor Signature Date
Community Development Department
lipBuilding Division
City of Cupertino
O
affl
10300 Torre Avenue
CITY OFTelephone: (408) 777-3228
C�^�^_'�� Fax: (408)777-3333
�l ••K"1°° 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: I b I2 1A n
lob Site Address: 16"/ 2 L- A �o,)A
Roofing Comp e: I \ l �L I Y i(S % ��✓ D I Uv/Ci1 j �1 1 I ��
Applicant'sS'gna re: t Date: -7 12-1 IU
® Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
OCUPEkTINO PERMIT APPLICATION FORM X50 "7/3S
APN # al Q / - Date:
Building Address: IO l( LA
1^ 10PA l
Owner's Name: V b I V BLam.� Phone#: 2—r/2
Contract o : Phone#: License #: 7 l 7
�, Rod 1N 40k- b2(- _7276�1
Contact: Phone#: Cupertino Business License#:
406- v
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
XAsphalt Shingles ?< Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
Wood Shingles /I ❑ Wood Shingles
tOther(Specify) {�7?x' El Other(Specify)
'umber of existing coverings ❑ Provide I.C.B.O. Report#
ATo be Removed ❑ Provide Mfgr. Installation Specs.
jftl Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: 1040& atkrjNk 2- L,"e�5 Cly "RUC7\= C-CvMP v Wvow a gift
I tJ 51 A-L,l E\-J (12" CD t hSTM 11.t /`SPNA-LT- com
Residential Commercial ❑
Fire Zone: Yes ❑ Confirmed with Planning Det. if
there are any restrictions: Ll
Cost of Project: I� 12 0� Type of Construction: Occupancy group:
U
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
1 BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
s