08050244 (2) CITY OF CUPERTINO -
BUILDINCDIVISION PERMIT xC�NTRACTORI1�Tk'ORMATIf3N.%:
BInL,p�Irq p�pa LAS ONDAS WAY LOS GATOS ROOFING PE 0690244
OWNER'S NAME: PERMIT ISSUE DATE
H'LIZABETH MILLER P 0 BOX 1726 05/30/2008
ONE: SANITARY NO. CONTROL NO.
AacxITF-CDENCINEEa: RE—RF RMV EXSTNG SHKRF -BLDG BEIIECTG PERMITPLUMB O MECH
u00 LICENSED CONTRACTOR'S DECLARATION 7ob DaSCTI uOn
w 1 hcrtby,film Nit l m licensed under provisions of Chapter 9(commencing -"" �-"-'-" "' " - ..— p
zW with Section y0fl0)of Division l of the Business and Professions Cum,and my liceneis -
in full faresandoffices O
n License CS oE—Cantnctor D .
gF0 Dae 'may
n m� �'T—�IIECTS DECLARATION
U 1 understand my plans slWl a used as public records
& Licmred Professional
=03 OWNER-BUILDER DECLARATION
'ys E I hreby alErm mat I am exempt from the Contractors License,LAw far the
i o O following rcamn.(Scevon 701.5.Business and Professions Cole:Any city Or county
e m_ff! which requires a permit on construct cher,improve,demollsh,or minor any sl(trmure
uiy prior to its issuance,also resumes tM applicant forsuch Permit re file a signed statement
ESG Out Wislicensed pursuantmthe provisions ofthe ConuacbriLicanaLaw(Chapter9 Sq.FL Floor Area Valuation
x-S (commend.&with Section 7=1 of Division J of live,Business and Professions Code)or
Q`<- Cut W u earnpt time(¢¢and the baso for the a leged mxcmpums My A.Istfan of
Section 70 M by any applicant fm a permit subjccu the applicant to a civil penalty,of APN Number Occupancy Type .
let mom than five hundred dollars nXn P y yp
❑I,asewner ofue property,amympl%ccs with wagesa Netr sole eampewtion,
wid dmfewort,andthe he ConturosLia craw desfarsak(Sec.in a,..of
and Ply-MWilds
Cade:The Contemns Liceve oes does not apply m rt owner of Required Inspections
ownenywyeact. doActed oven himpre ndwho daessahsoakhimrelfaf Waugh his
awn however.
rbuipmNded that sato int is semenu are trot ear ldc mrmlced for sale a,
Wilder the building or res avemvnt u hatd within ane year of c prove for
Nepose of
Wilder ill have tfe nurdco of provin8 that k did rot GUW a improve for purpose of
sok.). r
0 1,a owhher of she propeny,am sore usivsly contracting wits licensed contractors in
construct the pmjeer(Sec.]Oso,Busince,aM Professions Cade)The Contractors U,
cense Law does not apply an an owner of progeny who Wilds or improves thereon,mad,
who comm far such projects with a cenuacmr(s)Braved puauant on Ne Contractors
License Law.
❑1 an,mompt under See ,B b.P C for this recon
Winer Dau
WORKERS COMPENSATION DECLARATION
I hereby affirm under Fenslty,of perjury one of the fallowing declanuone
❑I hsve and will munuin a Ceniunte of Conscm m self.houre for Workers Compen- t
sasom.as provided for by Section 377 of the Labor Code,far Ne performance of the '
wart for which Nis Permit is issued.
❑1 have and will maintain Workers Compensation Insurance,m required by Sceoon
37W of due Latour Code.for Ne performance of the work for which de,Permit u Issued. '
My WorkersCompensationWumrm cap
and Policy number art:
Cartier.JrTnT( Zt f, Fac.. PolicyNo.: /99-0009
CERTIFICATE OF]EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu securn need oat x completed If the permit is forms,hundred dollars(SIM)
or less)
I terrify Nat in the Performance of the work for which this Permit at issued.I shall not
employ any Forma in any manner so as in become abject to the Waoen'Compensation
Laws of Cuifomia.Dam
Applicant
NOTICE TO APPUCANP.If,after making this Certificate of Exemption,you should
become subject m the Workers Compensation provisions of the Labor Code,you most
Qforthwith comply with such Proviunns of Nu permit soul W doomed nevek,d.
Z CONSTBUCr10N LENDING AGENCY
[-s Ihereby alrum Nat Nem isaconstratirm lending agency for the perfurmance of
rt Ne work for which this Pennell is issued(Sm.309y,Civ.C.)
tender's Name
Qvz Lenders Address
U Q 1 certify Nat 1 have read this application and sum this the above information in
Uv F coven.)agree In comply wit all city and county ordinances and sum laws rtbaung m
0U building conutratian,and hereby waitede¢Presscnutivcs of this city to c.W,.,a tie
vbov,-mentioned pmpeny for inspection purposes
Fes„y (We)agree to nae,indemnify and lace,harmless do City of Cupertino!guns,
(11liabilities,judgmcnu,cons and expenses which may in any way acermc agmeat aid City
U Z in consequence of tM&recon&of this permit.
APPLICANT NDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
sOURCER LATIONS.
S "ate
Sm&oat Re-roofs
mApphcanJConuacmr ,m
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the appliant an future building amupant core.,hand),hauAo o maeriu
a defloorl by the Cupertino Municipal Cade,Couper 9.11,and the Health and Safety
code,Section uss3(,)± 05NO All roofs shall be inspected prior to any roofing material being installed.
Will the, Resitorfume whdin occur ant If a roof is installed without first obtainingan inspection,I agree to remove
mit haaardnos sir contsminanu as defined b the Bay Arco Air Quality Management
oi,tric%7 A y all new materials for inspection.
❑Ya gy No
Ihave mad the ha,aces¢smaterials requirements underChaperdmat line,
the Califon-
nu Flaw&$afctyhim,a i mou1,. 5533 myrand355Jd.1 understand tram consbuof the ,fG`�_ S�3 B�a8
dans not caU h hvaa,roma L this it u ver maponuhility m rotirY the mvpanl ver the .Gr._
negaimmenu rich¢hut be epnarmivuanccor,Cenirncae afOcmparncy. Sig ure of Applicant Date '
Yom+ ✓�. 1 SLo/o S
ow raumori>magcm IAll roof coverings to be Class'%T'or better
CITY OF' CUPERTINO
• 2 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36932030 . 00
DATE ISSUED. . . . . . . : 05/30/2008
RECEIPT # . . . . . . . . . : BS000004951
REFERENCE ID # . . . : 08050244
SITE ADDRESS . . . . . : 20071 LAS ONDAS WAY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ELIZABETH MILLER
ADDRESS . . . . . . . . . . : 20071 LAS ONDAS WY
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3132
RECEIVED FROM . . . . : LOS GATOS ROOFING .
CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481
COMPANY . . . . . . . . : . : LOS GATOS ROOFING
ADDRESS . . . . . . . . . . : P 0 BOX 1726
CITY/STATE/ZIP . LOS GATOS, CA 95031
• TELEPHONE (408) 298-9399
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- -------- ---------- ----------
1BSEISMICR VALUATION 7, 915 . 00 0 . 80 0 . 00 0 . 80 0 . 00
1REROOFRES SQ FEET 26 . 00 338 . 00 0 . 00 338 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 338 . 80 0 . 00 338 . 80 0 . 00
VOICE ID, DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• PERMIT INVOICE OPERATOR: patg
Sec : Twp: Rng: Sub: Blk: Lot:
APN 36932030 . 00
INVOICE DATE. . . . . . : 05/30/2008
REFERENCE ID # . . 08050244
SITE ADDRESS . . . . . : 20071 LAS ONDAS WAY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ELIZABETH MILLER
ADDRESS . . . . . . . . . . : 20071 LAS ONDAS WY -
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3132
CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481
COMPANY . . . . . . . . . . : LOS GATOS ROOFING
ADDRESS . . . . . . . . . . : P 0 BOX 1726
CITY/STATE/ZIP . . . : LOS GATOS, CA 95031
TELEPHONE . . . . . . . . : (408) 298-9399
FEE DESCRIPTIONDUE FOR AMOUNT DUE PAID BALANCE
--------------------------- -------------- ---------- ---------- ----------
SEISMIC RESIDENTIAL PRINTING PERMIT 0 . 80 0. 00 0 . 80
RE-ROOF: RESIDENTIAL PRINTING PERMIT 338 . 00 0 . 00 338 . 00
---------- ---------- ----------
338 . 80 0 . 00 338 . 80
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
SCD CITY OF CUPERTINO
REROOF
cm o
*CUPERTINO PERMIT APPLICATION
APN#
Date:
Building Address: ✓ O
2 "o w
Owner's Name: Phone #:
Contractor: L 0 S 6—CL.7—o S U 0 y 1 r?j Phone #:
Fax #:
Cupertino Business License #: 2 ? ' / / Contractor License #:
J'7 0 70
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles jb�J
>11 Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify)
X Other (Specify) �IL" OS
Number of existing coverings / ❑ Provide I.C.B.O. Report #
To be Removed o Provide Mfgr. Installation Specs.
S s ooP C!l4sS —
Job Description:
Residential Commercial
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
Valuation:
there are any restrictions: ❑
� ,V q s .��
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Qature
CITY OF CUPERTINO
SIM REROOF
OcuPEROF
TINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
1RER00FRES Re-roof Residential B ISFDWLROOF
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roofMulti-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 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:
Job Site Address: ,b
Roofing Company Name: S
n
Applicant's Signature: /}�/�� ) r� C70Date> / j
• Greg Casteel
Building Official
Revised 11/2/04
Community Development
10300 Torte Avenue
A-1
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
*CUPERTINO
Building Department
JOB ADDRESS: PERMIT #
_ 20'7/ ��c5 ���s /�f/
OWNER'S NAME: p/rJ g< y r- �� PHONE #
GENERAL CONTRACTOR: s FAX # G__�9 _q
I am not using any subcontractors: G
Signature D te-
Please check ap2licable subcontractors and complete the followin 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
/Owner/Contractor Signature D e