06100062 7777777777777
CITY OF CUPERTINO10
BUILDING DIVISION PERMIT liQZ ION;
PERMIT NO.
BUILDING ADDRESS: MONKS ROOFING 06100062
7877 BELKNAP DR
OWNER'S NAME:
PERMPC ISSUE DATE
STEPHEN CULVER 794 BERRY
NE: SANITARY NO. CONTROL NO.
(408)262-4797
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p C LICENSED CONTRACTOR'S DECLARATION Job Description
m I hereby affirm that I am licenced under provisions of Chapter 9(commencing
Z� with Section 7000)of Divisio of the Business an C d my license is
A. in full force and fc�fec{`3 REROOF- TEAR OFF SHAKES, INSTALL OSB, 5 0YR COMP
0 Da �ey/ L'� * CLASS B, 29 SQUARES
;Ftp pate Contractor
ARCHITECTS DELLA ATION
i a< 1 understand my plans shall be used as public records
)yU
O
H Licensed Professional
t h OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
3 p O following reason.(Section 7031.5,Business and Professions Codc:Any city or county
which requires a permit to construct,alter,improve,demolLch,or repair any structure
Zprior to its issuance,also requires the applicant for such permit to file a signed statement
_`e that he is licensed pursuant to the provisions of the Contracwr's License Law(Chapter 9 Sq.Ft. Floor Area Valua$W 3 0 0
I.-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than rive hundred dollars($500). 36208035 . 00
[11.as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered forsale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of q P
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If.
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
0 I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and,
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
0 1 am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker' m�Watioq1rAsu-rance trier and Policy number are:
Cartier. 1—7 � Policy Na.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
0 forthwith comply with such provisions or this permit shall be deemed revoked.
z, CONSTRUCTION LENDING AGENCY
Fr ter I hereby affirm that there is a construction lending agency for the performance of
a+
the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
az Lender's Address
V 0 I certify that I have read this application and state that the above information is
Li,t correct.I agree to comply with all city and county ordinances and state laws relating to
0 U building construction,and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
rA liabilities,judgments,costs and expenses which may in any way accrue against said City
U z in consequc of the granting of this permit.
� APPLIC UNDERST NDS A WILL COMPLY WITH ALL N-P INT Issued by: Date G'4P'Z i--
SOUR GULA O /,X�
�( V Re-roofs
Signature of Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes GV No
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminrN.defined by the Bay Area Air Quality Management all new m erials for inspection.
District?
0 Yes
I have read the hazardous materials requirements under Chapter 6.95 of the Califor- I zA/10/
niaHcalth SafctyCodc,Scctions25505,25533and25534.IundcrstandthatiClhebuiWing l
�E�
��w
ponsibility to notify the occupant of the
of Cer0catc of Occupancy. Signature of Applicant Date
Owner or authorized age t Date roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
'7UPEkTINO
Building Department
JOB,ADDRESS: PERMIT.#
OWNER'S NAME: LLA e (2- PHONE # `
GENERAL CONTRACTOR ,)t J FAX # /
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
eet Rock
;dile
Owner/Contractor Signature Date
CITY OF CUPERTINO
,m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36208035 . 00
DATE ISSUED. . . . . . . : 10/10/2006
RECEIPT # . . . . . . . . . : 36370
REFERENCE ID # . . . : 06100062
SITE ADDRESS . . . . . . 7877, BELKNAP DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER STEPHEN CULVER
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : MONKS ROOFING
CONTRACTOR MONKS, DAVID LIC # 22117
COMPANY MONKS ROOFING
ADDRESS 794 BERRYESSA ST
CITY/STATE/ZIP . . . : MILPITAS, CA 95035
TELEPHONE . . . . . . . . : (408) 262-4797
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---- ------ ------------- ---------- ---------- ---------- ---------- --- -------
BPERMFEE VALUATION 11, 000 . 00 180 . 36 0 . 00 180 . 36 0 . 00
BSEISMICRE VALUATION 11, 000 . 00 1 . 10 0 . 00 1 . 10 0 . 00
---------- ----- ----- ---------- ----------
TOTAL PERMIT 181 . 46 0 . 00 181 .46 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
--- ------ -------- ------------ ------------------
CHECK 181 . 46 1630
TOTAL RECEIPT 181 . 46
DO I WOW-
CITY OF CUPERTINO
4!j(1V REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
Io
Buildin r e
p
Owner's Name: PhO
Contractor: ,� License#6
Contact: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt 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.
I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: c
C- oS
Residentiat�K] Commercial ❑ � S
�S S P C�
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of P�ojec�•� Type of Construction: Occup�y...�roup:
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
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: U LU10 ,Q_Ye_
Job Site Address:
Roofing Company Name: AAOWA,S ,
/' L
Applicant's Signature: �/ Date:lo//o � 6
Greg Casteel
Building Official
Revised 11/2/04