06060007CITY OF CUPERTINO
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FRACTOWINE IiMA'PL
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SUILDING• DIVISION PERNUT
,
BUILDING ADDRESS:
LOS GATOS ROOFING
PFJiMrf NO' 06060007
20095 APPLE TREE LA
OWNERS NAME:
,A
PERMR SUE DATE
MARIAN RICHARD
888 FAULSTI H Q1
06/01/2006
SANITARY NO. CQ OL NOWINE.
(408)298-9399
ARCHIIECT/F.NGINEFA
BUILDING PERMIT INFO
BLDG FdFCT PLUMB MECH
0 0 0
LICIINSED CONTRACfOWS DECLARATION
Job Description
I barcby .m. "a"1 w li¢ucd mtcr Pto^mna or C WPc+ 9 (..1.,P
Albs«Jan]0]M Of DMacm 3 of be D°drra And fill) ont Cada."my Ike"ab
in full raa.od coca 9
0070'1
REMOVE EXISTING CAL SHAKE ROOF. INSTALL OSB
Lka
ota��cmmn=+^r lei 474
ROOFERS SELECT FELT AND 40 YEAR LANDMARK SHINGL
ARCHRECTS DECLARATION- -
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I untiraaN my plAtt Wdl be ivW u publk rccwtlt
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FINALE
IJcc+ucI Pmfcsdow
OWNER-BUILDER DECLARATION
I hcmhy tad rnoco be
bat I em ezvnpt from tK cmuamnrt Lkny
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fobuth t wan. (S¢Jm ]BS l.5, a and P Code: MY my a aunty
whkh cL atc . lornO
a Pump oc co=ft alv, tnfmw. dvod(d. a tcpob any aot.1
AT u
prlawsfitc re.tt .leatppxorthotu°hpt 'sIrr,aLAed,a�mnl
Baurlavar
dof
Sq. Ft. Floor Area
9 ) I1C Valuati¢6)931
C UU
ort to nper9
funbenficcnsd Putman) w Jr of Dtiou
BuactmY
� (mmmemint villi SeNa7000)d Diviti°n7of the Buynasutd Ptofemom Codc7n
Nt he It MMPL barefian and dr bAcA fm that dieted armpum. My ridulnn Of
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F6N3
an t Y�'Pe
.0icw.avilPuultyof
Swint, 071.5 by attytPPB=wrIlaumittubj-athml
nm man m,n nw bn�ma dda.t asom0
3 16 3 nn 0 0
❑ 1. u owner of th prmpcny, u my aroWoYca Ave Aatu u w:. mw awprm�n,
Required Inspections
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w�ao n .on.^dw "°°mob"° a ma"a°Bae° ° (s ' °"•B°°"
and Prafaldad- m CoTir Contraerdt IJ�ae La. dm as apply r An wmer d
P°w+ywho wild.aimplate tuarxim. w.mo ma�wet W-Wirmdwnte bit
aria aropbrycm PtoM that mLb impmremetu Are tut mkudad aoQaW ra ala If.
bowerer, war Wiwi, a winwmrn btow v inveyeademopmuao.the ouer-
WJdcra bow be Mnden a( lmc•nt dao M owl m bmW Or imiamn fa ii l d
ale.}
LmarmdJrlaaPanl,w"e1e lyemB intmNum ®taamaaw
caavact Jr Ptoyam (Sea ]M0, Butwat.d Pmfedora Cul-) The Cma.ctda U.
.{aw dW enl "t, an anter d"P.My Aha Wild) Or Import. IbaR aW.
wW mnuw fa tub pmjcat Aim a mnnac=U) Iimncd pumaaa an do Cowcwh
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❑I.m uarpt Indo See .B&PCfu rib mnaa
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COMPENSATION DECLARAMON
I hereby alruto Millarr perdi/ of Parlay mtc of thatthat(albAw� Mt•^^,•••
piWORKERS
I
hart adv [Marna.. Cerdfrau a cwtem w".dime for Wort, tCompen.
.
tat,. u provided for by SecJmo 3'1`C00 d be Lally Code, fa da Pcrfato.n¢ d be
wort fa vhlch bis pmoit u itautl.
❑ 1 hue anti wJl maNlaln Watrft Compemu3m lmuran¢, As tRldltd by Satim
.
3'AIB d the tabs Cock, fu Jr pcRotmaaa ache . for wbkh tov permit is hind
My Watces Catnpemd® 4``uam¢�ami. aM Pdlp number art:
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-z �
Carrier. i�r�c /f�+3C/ Policy Na. i �d
C'9RnACATE OF EE\'E murr FROM WORKERS
COMPF1 SATIN MSURANCZ
mn, ralm trN m W eumpkrd'dbe perch b for m hatouled doJus (SI00)
aka)
I e+ufy bm in be perfamatLe of the wart for whirl this pemil it iaued. I tbdl nd
.
e9Ploy Any prawn In Any manKrtn at b bm9nM mbIct In the W°rt2rt'enmpemYl®
taus d CaiJomlL Dar
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NAaanccEEfTo ArPucnn r. If, arrr Town wit cmrlaa Or Eutopdm, ym ahww
bccam mbjon to we Watch Caopcntauaa pmWsbm d dr Labs code, you mm
ratbvib amply Aiw tech pmrid°nt a Jut Penni) dull m deemed mnaked.
J
codslRUCTION
isa=w knfinGENCY
atcncy fm be prrfammce d
1 bemby affirm that Jrm b. cmrnISM
3 . cl,
be disk (a which Ws permit b iaiei (Ste 7f/9], Clr. G
LeobYt Naar
� Iatdcls Addma
I cau(y tint l haw tud bit applkuiun ard nark ihu we .how idaandm b
cornea 1 atter to c°mPly With JI city and county mmimncct and tar b Ntint Or
buiwin, ocmwnion, and hcmby.0 na rcpn-tcnat &unit city to coke unn oc
fa impeeuoa
ahora-manuuncd Pmpamy pwP
(We) apne w an, iMemniry Ant] keep hunikss the City of Cuycnino attmt
MAY
A to cmtia,jWtmenlLeousanithisxvhkh m./wmytny aatue tttmttak city
A
Of JCERtr�arlAnnN(q°$IJ�IYp�C�r1111IL
r
A APPLICANT
APPLICANT UND
LV DO PLY WITH ALL NON-POINT
Issued Date C
SOURCE REG
�
✓�.A7V/
`/✓ /
Re-roofsfs
Type Roof
Sitnatac ofAirplicLaKnOtrin.,.
HAZARDOUS MATERIALS DISCLOSURE
of
WIB Ne appllaa a fmura W mint occupant nae Or bundle havtdao material
u dc(irctl by be Cltpcnim Maddpal Co4.0upa 9.11. aM the Hetb adi Softy
Duck, Seed. 25531(.)T,J
❑Yu
All roofs shall be inspected prior to any roofing material being installed.
�(tLo
If a roof is installed without first obtaining an inspection, I agree to remove
will war afrPlirad a fay. Wilting otter w war a ioillrnmt ado a, wh a
anmcnt
Ma Air wity Mgc
emit air mnamWnru,.aAs Acfurd by be Bay MQ
all new materials for inspection.
Dautcca ya awe
I line mad Jr bnatdout olakdaisoc pitemcmt toutrCh.,. 6.95 dba Califa-
ma Hwb h S0cty Cock, S¢tivu 15X15.15573 ant] 25530.1 undcttmd tbatirbc eWktt
,in,, mtl CurmnJy M.. roar.. Jut it b my reMoramhilily w mury Je oxtrytm d dr
a.ircnrma whkb mut w d,(sulktr araap.my.
Signature of Applicant Date
All roof coverings to be Class "B" or better
Ovncr a wbaysd.Icn,
!m 3 of 3
•FEE ID
BPERMFEE
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 31633090.00
DATE ISSUED.......: 06/01/2006
RECEIPT #.........: 34643
REFERENCE ID # •: 06060007
SITE ADDRESS .....: 20095 APPLE TREE LA
SUBDIVISION ......
CITY .............: CUPERTINO
IMPACT AREA ......
OWNER ............: MARIAN RICHARD
ADDRESS ..........:
CITY/STATE/ZIP ...: ,
OPERATOR: amyw
COPY # : 2
RECEIVED FROM ....: LOS GATOS ROOFING
CONTRACTOR .......: RANDY BROWN LIC # 23481
COMPANY ..........: LOS GATOS ROOFING
ADDRESS ..........: 888 FAULSTICH CT
CITY/STATE/ZIP ...: SAN JOSE, CA 95112
TELEPHONE ........: (408)298-9399
UNIT
-------------
VALUATION
VALUATION
TOTAL PERMIT :
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
•
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
----------
NEW BAL
----------
----------
6,000.00
----------
126.36
----------
0.00
126.36
0.00
6,000.00
0.60
0.00
0.60
----------
0.00
----------
----------
126.96
----------
0.00
126.96
0.00
AMOUNT
-----
413.58
413.58
NUMBER
------------------
1734
•
40F
UPEkTINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
PERMIT #
OWNER'S NAME: iPHONE
# _ '� -
GENERAL CONTRACTOR- Oe. ,•
FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
21
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
Date
•
•
CUPEDT INO
IV,
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Building Department
Telephone: (408)777-3228
Fax: (408) 777-3333
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.
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:
Roofing Company Name:
s Signature:
Greg C4dteel
Building Official
Revised 1/30/03
Printed on Recycled Paper .
Ile) 9"�`/h
Date:
�1
LJ
0
OCOF
CUPEP,TINO
CITY OF CUPERTINO GUO�M
REROOF
PERMIT APPLICATION FORM
APN #
31
Bldo Permit Fees
BUILDING
Date:
Building Address:
BUILDING
BSEISMICRE�_��___�Seismic.F,ee.Res.__
'BSEISMICOM
Owner's Name:
BUILDING
BPLANCHK
Phone #:
Contractor:
Pho e Py
Business License
License #:
Contact:
Phone
Cupertino Business License #:
2?
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑
Built -Up roof
❑ Asphalt Shingles
Wood Shakes C.4� 5NAKC
11
❑
Asphalt Shingles
Wood Shakes
❑ Wood Shingles
❑ Other (Specify)
❑
�r'
Wood Shingles q
Other (Specify) OS/3
Number of existing coverings �_
To be Removed
❑
Pr
Provide I.C.B.O. R port #
Provide Mfgr. Installation Spec
I Have Read, Understand and Will Comply
With Cu ertino's T
ar O Polic :
JoDescription:
Residential Commercial
Fire Zone: Yes El No Er
Confirmed with Planning Dept. if
LJ
there are any restrictions:
Cost of Proj ct: 3 / Type
of Construction: OccupancLF jp:
1 Sl/l
F llir.,
Qty. if
Applicable
Fee ID
Fee Descrition
u
Fee Group
BPERMFEE
Bldo Permit Fees
BUILDING
BENERGY
Energy
BUILDING
BSEISMICRE�_��___�Seismic.F,ee.Res.__
'BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING