08110082 CITY OF CUPERTINO /s��//��n*a ^�t �*"ry�
BUILDING DIVISION PERMIT y C:VLIRA6Q,M4 F1rYxID1� IV.1�
BUILDING ADDRESS: PERM,NO.
22126 CLEARCREEK CT nAnnARTO
OWNER'S NAME: PERMIT ISSUE DATE
r0 A CONTROL NO.
831) 476-9109
AR CHr1ECMENGINEER: BUILDING PERM,INFO
BLDG ELECT PLUMB MECH
0 0 0 0
500 LICENSED CONTRACTOR'S DECLARATION lob Description
wins Section 70
9 1 hereby affirm(Ind I am demand under provisions of Chapter 9(commencing P
110)of Division 3af the Business and Professions Code.and my license 0
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q'n ocunmcls„ j's'iiia7-3� RE—RF T/O SHK & INSTL OSB 31SQ CLS A 5QYR COMP
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- ARCHITECTS DECL.ARATON
U 1 understand my plans shall be used as Public¢cords
t G Ilcened Professional
c OWNER-BUILDER DECLARATION
Contractor's
f I hereby.(Sero 16x1 1 1. exempt froma the Cssions Co License LAW for de
p O following reama(Section me ran Busixss aM Professions Code:My oily m roume
t m� which requires a permit to eoasmrcL alcor.improv.demolish,or repair any rmctum
yiy prior b its issuance.alas requires dan.,licant for such permit d Jilt a signed stalcmmt
< mu heislicenedpu=.ItulbepmvisionsofineContracb .UsemeLaw(chapmr9 Sq.F[.Floor Area Valuation
152 (...code,with Somm.7000)of Division 3 of dre Business aM Profcssiom Cedd)or
y 8 dont he is esempt monchand and the basis for the atkgcd exemption.Any vioutfan of 2 2 5
Section 7031.5 by any applicant rm a permit mbjas the applicant In a civil penalty of APN Number Occupancy Type
amt mare than five buedsed dollars(5500).
nmmrofN ro 32618021 . 00
C] p gamy.ar my employes with mgn ume'vmk comPenssuon,
anddo thcwodc and me,wctu;u net inended ar a w do forsak(Sed.7044.Bud r of
and ProRwans code:The camvacdfs L.kane law aaca trot apply d,n owner or Required Inspections
property whab skumimpmws Narcan and whodoessuchworkhimmelror dprougb his
own employes,provided that such impmwmens arc not intended moneyed for sale.if.
however,the building or Improvement is mid within ane year of eompleuon.the owncr-
builder will lave the harden of proving that he did not build or improve for purpose of
ilk.).
❑L as owner of the pdPemy am vcluively contracting with licensed commando;b
construct the project(Sec.7014.Business and Pdittdars Code:)The Commodes U.
erea Law doe,not apply in an ower of property who builds or impmws therean and.
who contracts for such projects with a commacdrts)Ifaaed pussund in the Canuxbr'a
Leena Law.
❑IturnemptunderSec .BAPCrosmisreason
O . Dan
WORKER'S COMFENSAnON DECLARATION
I bemby sBbm under Family of Paddy bond of me following dalantionc
1 haw and will maintain a C;Gbcae of Consent to elf-insure fes WwkeesCompen-
sin,as provided for by Section 3700 of the Labor Code.for the perfarmso a of the
woh for which mu permit is issued.
❑I ban and will mainuk Worker's Compensation h mratue,u required by Section
37M of the Labor Codc,for the Performance of the work for which mu permit is Issued.
My Workees Compensation Imursncd camier and Policy number am:
Carrier. .1a ry j Policy No.:f+d C)
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
('Thu section need tat be can plemd if lie Permit is form=hunmed dollua($100)
or leu)
1 certify met in the performance d the work for which this Permit Is issued.I shall nu
employ anyperson in my undem, as become mbjcl tithe warren'Compensation -
IAws of CNlforoic Date
Applicant
NOTICE TO APPLICANP.If,after making this;Ccnifiw¢of Eared don,you should
became subject be me Wortrls Compensation provisions of the Labor Coda Yen mum
.J O forthwith comply with such providans or mu Permit.hall he domed marked.
Z^ CONSTRUCITONLENDINGAGFNCY
[—i IhemhyalErs Yontme;isscmumuctinn kndingalivic m theperfmman¢uf
C > me work for which thispermit isissued{Sec.3M7.civ.ca .
aO Landers Name -
o z (.enders Address
U Q 1 a dly that I Mw read this almikauan and state that tie above information is
Iy E coma I agree to comply with all city and county ordinances and sum laws reading to
.p rU^ building construction,and hereby mmormmpsndamouses of this city to enter upon the
LTl shove-mentioned I dpdrty for inspection purposes
CL (We)bog.to rave.indemnify and kap humlrss the City of Cupertino against
ti liabilifialudgrom s.toss and expumes which may in my way aam agat^sUdd City n
U Z in amosmummomr theip ung ofrots Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR REGULATIONS
II l r 2/ Re-roofs
titan n
gnuurt ofA r Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
KSIIy teppliamos(stud building,.Cl ptantim hanWkha>atbanmabrial
u de0ned by me CuPeniro Municipal Code.Chapur 9.13,and me Hatband Safety
Cedm,Secsion 35533(.)7 / All roofs shall be inspected prior to any roofing material being installed.
❑Yes bN(
Will me applicant or mum building aapmt me egaipmet or devles which If a roof is installed without first obtaining an inspection,I agree to remove
It haraNnus air comamina.0 as derinal by the Bay Area Air Quality Managdment all new materials for inspection.
let?
❑Yes [aJ No
1 haw real me Wordimu materials rophromens under Chmer 6.95 of the C difor-
meHealthh Safety Code,Seeuons 35505,35533 am135534.1 mderseed mat if the Wilding
Joel not comently hast a¢nems at it is my mpauibility b notify tic eeupmn of me
regal;mcnuwhkhmunbcmetpom its aafa Cmr1md0f CemJPanq. Signature of Applicant Date
o umari> ,'get7 All roof coverings to be Class'W'or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32618021 . 00
DATE ISSUED. . . . . . . : 11/21/2008
RECEIPT # . . . . . . . . . : BS000006672
REFERENCE ID # . . . : 08110082
SITE ADDRESS . . . : 22126 CLEARCREEK CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : ELLIOTT JAMES P AND ELIZABETH
ADDRESS . . . . . . . . . . : 22126 CLEARCREEK CT
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1101
RECEIVED FROM . . . . :. EDGAR MONTOYA
CONTRACTOR . . . . . . . : EDGAR MONTOYA LIC # 26245
COMPANY . . . . . . . . . . : DADDARIO ROOFING
ADDRESS . . . . . . . . . . : 1734 WILLA WAY
CITY/STATE/ZIP . . . : SANTA CRUZ, CA 95062
TELEPHONE . . . . . . . . : (831) 476-9109
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ------- -----
1BSEISMICR VALUATION 12 , 250 . 00 1 . 30 0 . 00 1 . 30 0 . 00
1REROOFRES SQ FEET 31. 00 403 . 00 0 . 00 403 . 00 0 . 00
--- ---------- ---------- ----
TOTAL PERMIT 404 . 30 0 . 00 404 . 30 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
---------- ------ --------------- ------ -------
CREDIT CARD 404.30 VISA
---------------
TOTAL RECEIPT 404 . 30
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
--------------------------- -------- ------- ----
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
• 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 2007 IBC Standards
and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino
municipal code 16.04.080.
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/ "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: 7- l /���o I IC(Qn-y e,v�Q 1, G
fi
Roong Company Name:' Ua-N t t (k 4"0 �00
Applicant's Signature: - Date:_FI- 21_0,6
. Greg Casteel �"
Building Official
Revised 07/30/08
CITY OF CUPERTINO
e
` REROOF
• I OF
CUPEkTINO PERMIT APPLICATION
APN Date:
Building Address:
Owner's Name: Phone #:
D -0 � 83Z& — l 0
Contractor: Phone #:
Fax #: / _ /,�
Cupertino Business License #: Contractor License #:
O
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ ilt-Up roof
❑ tjsphalt Shingles 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.
Job Description: 'o �I_a�K� f (,( f5 -� p
Q/"4 CO y�e&-- Cff-v"�FOSrj0 lel C(0.J5
Residential I Commercial El
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation:
2 c)
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
,S; ature
Revised 6/16/08
CITY OF CUPERTINO
REROOF
CUPER,TiNO FEE SCHEDULE •
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FC0M Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
3/ 1RER00FRES Re-roof Residential B 1SFDWLR00F
/ 1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08