99090056 `3 G t qcj 0 '0055 �;
PERMff
APPLICATION FOR CITY OF CUPERTINO NUMBER
INSPECTION DIVISION PERMIT EXPIRATION
REROOF PERMIT (408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN IN DAYS OF PERMIT ISSUANCE OR
lao DAYS FROM LAST CALLED INSPECTION.
• BUILDING ADDRESS
illlott /110�ItEla-E7 Ct �L-tP'c4a+��v0
RESIDENTIAL COMMERCIAL OTHER -
OWNER'S HAZARDOUS FIRE AREA
NAME t�/ ✓ /�.I E q I /`— YES ❑ It yes—I understand that a Class A
tr nwf assernbly Is required.
NO ❑ Initlat I.C.B.O.A
ADDRESS I aU (? / _1 V.A/`r .I'y (� EXISTING ROOF COVERING
PHONE
W/ O 15 D NUMBER OF EXISTING COVERINGS
CONTRACTTOR'S //�1 '
NAME 81,Li E SKY Rtp o a— � 0-0 TO BE REMOVED�TO BE RETAINED
TYPE OF R F
CITYRBZP lDSS /�)ANrrt p� e79_ SU,ytyJ.�G� � . _.
QQYERING—
ExlsnrlG
PHONE 4101— 73'7—�L°L I BUILT-UP ROO I SSP - 9X99
LICENSE . li
NUMBER !S S ASPHALT SHINGLES ❑
LICENSED CONTRACTORS DECLARATION I ipV
I hereby affirm that I am licensed under provisions of Chapter B(commenting with Sectkm WOOD SHAKES—"'-------
1000)of Dlvls on 3 of the Business and Proleeslons Code,and my license a In lull force and
ane`t. q Q WOOD SHINGLES
Ucenser Ck 1 Be.Number, �" /
q�a Ig °� OTHER(SPECIFY) ��
Date -BUILDEI
OWNER BUILDER DECLARATION PROPOSED
hereby affirm that am exempt from the Contractors License Lew for the vires ag meson. Q
(Sec.construct,
It Business and Professions Code: Arty city or county which requires a permit to
conebua,alter,Improve,demolish,signed
or repair any structure,ispoor tokoon Its Issuance,eke squires the BUILT-UP ROOF ❑
of the Ce for such Permit Ilk a elgrpt statement lel g b h e eN pursuant m Na provolone
of the om and!cors tomes Lew(Chaplet h(commenting with re and 1000)of for Me 3 le the
Busmotio entl violationof
Cade)or that he Is exempt arerelrom entl the base for the alleged ASPHALT SHINGLES
ai pen.Amyl net
Section 1031.5 byany s($S ),Iwapermit sub
e tivll penalty of rest me property,
len floe hundred dollars th wag):
❑LesOwner ndthe structure
1.no;
to enpbyeeered for wileesic.70,1 , gU-1
❑
Ne wodt and the alnrtlure Ie nd Inlerdetl or offered for eels(See.1044,elons
Cade:The Contractors License Law•does nd apply to en owner o pr
arprooes Imms
thereon,and who does such work himself or through ho own employees resided tel ❑
such improvements are not Intended i offered for sale.ll,however,the bulkYrg praaa,,a���
is add within oma year of completion,the owner-builder will have the burcano pr thatq ❑
net WIM or improve for purpose o sale.).
p L ecasoc.of the property,am aecluafvely,control;Code�g with licensor eonaea
N,project owner o/r Business and Pror imphre Code:The Conaeaors Ucerrse law does notR"Vi6FORT NO.
wife to an properly wireuuntt orImprovesthereon,entl vAro con pppr�
wIN a contraalar(9)licensed Wreuant to the Cwlreclore Lkerate Law. Wyl TION SPECS.
01 am asemfa under Sac. B r YY
Owner Dela
WORKERS COMPENSATION DECLARATION APPLICATION DATE VALUATION PERMIT FEE
I hereby affirm under penalty of penury one of the following dedam ion: f I�� y
as providedforfor by and Slectionmaintain
3700 o Certificate
LLaaborfCode,fare to
perforrmmancfor
e ofthe worAoi kkffoorrwhich this �/ I / p q "'] D �rL o BUIId Ing J TU�O
permit is issued. 1 I 1 c V
❑I have and will maintain Workers Compensation Insuranr�,as required by Section 3100 of X Seismic s
the Labor Codo,for the pedcrmance of the work for which this permit is issued.My Workers /
Compensetlon Insurance carrier and Polley number are: Total
Carrier Polo No. PERMIT AUTHORIZATION DATE
_ CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE N.0,
(Tho season need not be completed if the permit Is for one hundred dollars($1 eo)or less.)
I certify Net In Me performance of the work for which this permit Is Issued shall trot employ
any Person In any manner so as to become subject to th@ rivers' ompe satlon Laws of Cali- All roofs shall be inspected prior to any roofing material being
formin. / I� installed. If a roof is installed without first obtaining an
Data 2 �• f Q q Applcant/r inspection,I agree to remove all new materials for inspection.
NOTme
subjects to IN WorkeAPPUm Oompensa on provisionsing If the Lale of Exemption,borr Codo,you must foou�wHhc comply Applicant understands and will comply with all non point
w9h such provlatons or this permll Bell be deemetl revoked. - source regulations.
I cern,that I have read this application end state Mat Iha above Information is correct 1 agree
to comply with all city end county ordinancee and state laws alaWg to building coesiftoon.end. All roof coverinQ � or better.
hereby euawdze representatives of Ne city to enter upon the above-menWned property for Im ,15 t0 be SsIr
spection purposes. '/. ,I^ q/4/q A
(We)agree to save,Indemnify and keep harmlaea are City of Cupertino against liabilities, - wvwww ��-lll _I -1 l
judgments,costa surf expenses which may In any way accrue against said City d caaequerra
of the granting of this pernul. SIGNATURE OF APPLICANT DATE
PRE-INSPECTION: PLYWOOD: IN-PROGRESS: •-
INSP. DATE INSP DATE INSP. DATE
TEAR OFF INSPECTION: BATTENS: FINAL
INSP. DATE INSP. DATE INSP. DATE
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION
OFFICE COPY
• CITY OF CUPERTINO - BUILDING DEPARTMENT
RE-ROOFING POLICY
1. Prior to permit issuance, you must agree to comply with U.B.C. standards and
manufacturers specs on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspections 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 types of roofs.shall be inspected prior to any roof being installed.
4. In order to receive a final, you must complete steps 1,2, and 3.
t. Pre-inspection or tear-off approval
2. In-progress inspection approval
3. Final inspection approval
a. Operable smoke detector verification
5. If plywood is installed, a plywood nail inspection is required.
• 6. If any roof is applied without first obtaining an inspection, you will be required to remove
all new material down to the cheating and a building inspector will inspect all sheating at
that time.
IIMPORTAYT:
1. Flat roofs must have a 'A" per foot slope, or demonstrate that there is no ponding.
2. I.C.B.O. reports are required to be on the job site at the time of inspection. If you do not
have one, contact the building department.
WE UNDERSTAND THE ABOVE POLICY ON RE-ROOFING AND WILL COMPLY
WITH THE POLICY.
HOMEOWNER'S NAME: �0 ZtEsg JE
ADDRESS: [J 9UU Mo/u --Efe E-y Ct CuPt--
RE-ROOFING COMPNAY NAME: BnLUj 6- � 9/KY poop ✓ & 00
APPLICANT'S SIGNATURE:
• CITY OF CUPERTINO
BUILDING DEPARTMENT
Rc-rool7winword
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: christya
Sec: Twp: Rng: Sub: Blk: Lot:35621021.00
INVOICE DATE......: 09/09/1999
REFERENCE ID # ...: 99090056
SITE ADDRESS .....: 11266 MONTEREY Cr
SUBDIVISION .......
CITY ... . . . . ......: CUPERTINO
IMPACT AREA .......
OWNER .. . . . . ......: BROWN JENNIFER S AND ZIEGLER R
ADDRESS . . . .. .....:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4739
CONTRACTOR .......: LIC #
COMPANY . . ........:
ADDRESS . . . . ......:
CITY/STATE/ZIP .... ,
TELEPHONE . .. .....:
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ---------"" --""--""'
BPERMFEE P 127.00 0.00 127.00
BSEISMICRE P 0.70 0.00 0.70
_________ ____________ ___________
127.70 0.00 127.70
VID ------- DESCRIPTION--_-.---- VOICE ID ------- DESCRIPTION
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•
CITY OF CUPERTINO
I* 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: christya
COPY # : 1
Sec: Tp; Rng: Sub: Blk: Lot:35621021.00
DATE ISSUED....... : 09/09/1999
RECEIPT #......... : 10021
REFERENCE ID # ... : 99090056
SITE ADDRESS ..... : 11266 MONTEREY CT
SUBDIVISION ...... .
CITY ............. : CUPERTINO
IMPACT AREA ...... .
OWNER ............ : BROWN JENNIFER S AND ZIEGLER R
ADDRESS .......... :
CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-4739
RECEIVED FROM ... . : TIM
CONTRACTOR ....... : LIC '#
COMPANY .......... :
ADDRESS .......... :
CITY/STATE/ZIP ... .
TELEPHONE ........:
FEE ID UNIT QUANTITY AMOUNT PD-TV-DT THIS REC NEW BAL
__________ _____________ __________ _____
BPERMFEE VALUATION 7,000.00 127.00 0.00 127.00 0.00
BE SMICRE VALUATION 7,000.00 0.70 0.00 0.70 0.00
______ __________
T PERMIT 127.70 0.00 127.70 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ _____
CHECK 127.70 2277
••
TOTAL RECEIPT 127.70
VOICE IO DESCRIPTION VOICE ID DESCRIPTION
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•