08120029 CITY OF CUPERTINOT�a,FY Y_7_
BUILDING DIVISION PERMITWV" ;{yV: l Jll F Q �y( j� '
BUILDING ADDRESS: x PERMIT NO.
10786 WILLOWBROOK WAY LOS GATOS ROOFING
OWNER'S NAME: PERMIT ISSUE DATE
SA Y CONTROL N0.
ARCHTECT/ENGINEER: BUILDING PERMIT INTO
RE-RF RMV 2EXTNG CMP SHK BLDGO O PLUM O
Z' LICENSED CONTRACTOR'S DECLARATION RFS, 'INSTIL 7/16"OSB oco
I bemby eRrm Net T am licensed.mor provisions of Chapter 9(commencing ^^-^^T ^_T -------
( if.
-_^--^-- ^I Q�eSCrlpuOn
Lt 9 with Section 7d1O)of Division 3 of the Badness and Pnefeuia sCode,and my license is
^ N in( if.sMcife '— 9 Od707 .
N Z LIUILV:CIirI I.iL.
�k,� Doth Camrmmr
ARCHnECI- DECLARATION
� 1 wtl.vati Y P tbdtb ed a p4MiwwmNa
?yU ^YI
;w C; Licensed Prof Tonal
OWNER-BUILDER DECLARATION
s� E I hereby affirm that 1 an exempt from the Conuactoes License Law for de
OC following mumm.(Section 701.5.Business and POefesvons Cade:Any city.county
I3 9 which requires a permit m emomct alter,improve.demolish,or-Pem any sanctum
ai prior m its issuance.dm requires de applicam forsuch Permitto file a signed statement
< mar he is littered pnrmantm me provisions Of the Canaaemra lima Law(Chapter 9 Sq.Ft. Floor Area Valuation
i�$ (crremmung with Section 7")of Division 3 of the Samoa and Profusions Cods).
that he is exempt therefrom and the buts for the alleged eumptian Any vmbdon of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more man five hundred dollars(5500).
❑I,uawnerofJ propmy.amywploymwim"g uJ kolecampemadw.
will do me wort and tee sWnum is rot intended araQesed for ask(Sec.]pU,Busi».•
and Pmresslom Cade The Consumer License Law does not apply to an owner of Required Inspections
propmY who builds arimproOm thereon.andwho does suchwort Ideadfor Waugh his
own emplayeu,provided that such improvemmu art nm idserdril aanuod forsake IL
however,me,building or impmvunent is mid within orayearof completion,me owas-
builder will an the burden of proving that Ito did trot build a Improve for purpose of
sok.).
0 1,u owner of the property sm esclusively contracting with Headed cenuactms to
construct the project(Sec.]Odd.Business am Professions Code:)Tie Contractors U.
cause Law does not apply to an owner of property who builds or hnpmm merman,and.
who contracts fee such projects with•contracmr(s)licensed puna to the Camaetars .
• Liana I..
❑Tamuemptundersm. ,B&PCfathuneson
Ower Date
WORKERS COMPENSATION DECLARATION
1 hereby alfim under Penalty of perjury one of the following meurations:
I haw am will mumu.•C.tificem ofConsom m self-Wure for wmr scomyca-
sation,u provided for by Saver 3700 a me labor Cade.for the pat.. ce of the
wworrc for which oris permit is issued.
t7K haw and will maintain Watr1s Campvuation Itwrame,u required by Session
3700 of the Labor Coda.for the perfamance of the Onset for which this Permit is iswed.
My Workers Cam�sPemadm l/uoun�tc.rti.and Poll,.u/mb�pam:
Cartier. S/p�/v'�� Policy No.: b31 Poo/9'y
CERTIFICATE OF EKEMMON FROM WORKERS'
COMPENSATION INSURANCE
musseetim raedna Weampketed ifthe pc mit is form.hundred dollars(SIOM
or leu)
1.mify mot in the performance of the wort for which this permit u issued,l seedl an ,
employ any Person in my matter m as m become subject m the Warken'Compenudon
Laws of California.Date
Applicsm
NOTICE TO APPLICANT`.If.arm,making this Cenifiesm of Exemption.you should
become subject to the WorkCs Compensation mansions of the Mbar Cade,you mute
Oforthwith comply wire such provki..or this permit shall he deemed n:smkcd.
Z'-' C0Nsmuc TION LENDING AGENCY v
E+� Thereby affirms that Nem tea crossmrcdm lending agency for the peNomanceor
<Yirte.. W work for which this permit U issued(Sec.3097,Civ.C.)
lenders Name ,
0. z Lenders Addmn,
t)0 1 Codify Nat I haw read this applies mn W sum than the show mromatim is
I7.F comm 1 groe to comply wit all city and county ordinances and sum laws relating m
.0U building construction,and hemby authorise rtPcetmuuws of mu city m enter,upon the
r U akve-mmtioncd property for imm clirm Proposes
CL (We)agree to an.indemnify and keep hamlets the City of Cupertino.guns,
E"fA liabilities,judgments,costs and expenses which may in my way acme against said City
V Z in consequence of the pressing of this permit.
^� APPLICANT UNDERSTANDS AN WILL COMPLY WITH ALL NON-POINT Issued by: Date
S0URCE REGULf7R)F' /��3�08'
A &
��//�� m✓ I Re-roofs
Sigwurn of Appli.HAZAR cmr DT
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII de applicant Or loom Wilding Co acupaptuort or handle h earda.d Safety ety
u mBtred by the Cupertino Municipal Code.Chapter 9.13,aM the Healer mJ salty
Com.section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Y. o
the au priicmt or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
irpt et air comm non s defined by mrta e Bay AAir Quality Management all new materials for inspection.
se
Dyes @ifs
I Mw read W huallous mamriab requirements under Chapmr6,95 of the Califor-
.is Helm&SafayCOdc.Seen.ZM.25533 mJ25534.1 wa ersimd matifue building
don rot currently law:a meant that' is my respontiMlity m notify the oecupmt of me
numirtmenuwhk miss onCcrufmam.fOccu Signature of Applicant Date
Z'/"/ All roof coverings to be Class'W'or better
Ow.'ea ct gent ' 6me
CITY OF CUPERTINO
• 2 ITEMS OF 4 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 36922048 . 00
DATE ISSUED. . . . . . . : 12/03/2008
RECEIPT # . . . . . . . . . : BS000006739
REFERENCE ID # . . . : 08120029
SITE ADDRESS . . . . . : 10786 WILLOWBROOK WAY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : DONOFRIO JAMES AND MARYJANE
ADDRESS . . . . . . . . . . : 10786 WILLOWBROOK WAY
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4541
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 5 , 748 . 00 0 . 60 0 . 00 0. 60 0 . 00
1REROOFRES SQ FEET 23 . 50 305 . 50 0 . 00 305 . 50 0 . 00
----- --------- -------- -------
TOTAL PERMIT 306 . 10 0 . 00 306 . 10 0 . 00
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 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: S( Q 7�(D ZO�/ 1�J
Roofing Company Name: )S TC. //7
yy ✓, n.:
Applicant's Signature: Date: /6
Greg Casteel
Building Official
Revised 11/2/04
-'- Community Development
10300 Torre Avenue
z Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
OCUPEkTINO
Building Department
JOB ADDRESS: /Q �O(O /, ��� PERMIT
OWNER'S NAME PHONE
GENERAL CONTRACTOR: FAX
I am not using any subcontractors:
Signature Date-
Please check a2plicable 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 a�
Owner/ ntra for Signature D to
CITY OF CUPERTINO
REROOF
CITY OF
CUPERTINO PERMIT APPLICATION
APN# Date:
22 - 0 L l23 0 �
Building Address:
Ile tj coo
Owner's Name: Phone #:
2S � y9 � C1
Contractor: )LO S C7-C� �c, `` C�o �? 1�� Phone#: Z16;g 2 9 g_ 9_3 '9
Fax#: 'VOS 2 ff-- 73 -7l
Cupertino Business License #: Contractor License #:
23`Ig / 3C,o 7
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles X Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles a
❑ Other(Specify) ❑ Other (Specify) � 6513
Number of existing coverings '2- ❑ Provide I.C.B.O. keport#
To be Removed �� cY Provide Mfgr. Installation Specs.
c
Z-5,S s
J - /,'USF !'HSS
Jot
Description: �
G" o)542
�y
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: ❑
Valuation:
8 -
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Sign