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08030106IQ.tNIA'.CIOyN= - BUILDING DIVISION PERMIT Ct�®1�CTTR.rG�T,O'R 0. Rfi R y. P+'ga'f i f v Fk i BUILLyfNOADDREShAHL ST tS MICHAEL LUNNEBORG ROOFING PERMIT NO. 08030106 OWNERR'SLNAME: PERMIT ISSUE DATE. CHI WEI CHANG 1328 WHITE OAKS RD 03/19/2008 E: SANITARY NO. CONTROL NO. (831)278-1837 ARCHITECT/ENGINEER: - BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION - Job Description (SSCrIP 1 hereby affirm that i sm licensed under provisions of Chapter 9 (commencing wishSeaian7gk))ofDiviaion3of the Businua aW professions Code mdmy Bonsai+ in full (area and effect. RE—RF,T/O WDSHK,FL SHTNG,40LBSFLT CLS Ar 35SQ License Class Cwih Lic.0 Dale T1 fl 02, Caelracla! ARCHITECTS DEC 1 undersand my plans shall be used as tic rc Ns Ltccaaad Professional OWNER -BUILDER DECLARATION I hereby 4Rrm Nm 1 am exempt from the Conlraeor's Licens w for the following rcunn. (Section 7031.5, Business and Profundum Cade: Any city a county which requires a permit to eonslmet, altar, improve, demolish, or repair any stracture lrlor to Its issuance. also requires the applicant for such permit to file a signed statement that he is licunsed to N' of the Contractor's Licaao Law (Chapter 9 Sq. Ft. Floor Area Valuation pursuant provisions $23000 0W (commencing wish Section 7of Division 3 of uta Business and Professions Code or that be is exempt thcmfrom and the basis for the alleged exemption. Any violation of A,�,p� Number 3 2 613 0 9 9 Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of art mare than rive hundred dollars (5500). : V Cl' ❑ 1'. owner of Ode property, a my employees with..". theirsale campewdom, Required Inspections will do the work ants the surname is not intended or offered for sale (Sec. 7044, Residues and Pr d essbns Cade: The Contractor's Limine Law dam rot spply as an owner of property who buildsarimpmvm thereon, and whodaessuchwark himaelfor through his own employees, provided that such improvements are not intended aria@.md fmsala If. - howeverthebuildingorimprovementissoldwithinaneyearof completion, the owner- .. .. builder will have the burden of proving that he did not build u improve for purpose of ane.). ❑ 1. as mvmr of she property, am eseludvely conuactieg with licanse l caatrwon be convect the project (Sec. 7044. Business and professions Cade:) The Cmmaaora U. mom law does nm apply b me owner of property who builds or imp.0mmon, and, who contracts for such projects with a conmacter(s) licensed pursuant m the Contractors Lkemse Law. ❑ I am exempt under Set ,B&PC for -this reason . Owner Data WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty or perjury am of the following declarations: have and will maintain a Cenifiettc of Consent to self -insure for Worker's Camper. .titian, as provided for by Section 3700 of the Labor Code, for the performance of the work far which this permit is issued. Khave and will maintain Worker's Compensation Imurome, as required by Section 700ofthe Labor Cade, fa the performance of the wok for which this permit is baci ' My Warkds Compensation Insurance carrier and Policy number am: �f•. Carrier:@ Policy Na.: CERTiFlCATE OFEXEMYDONFROM OW RKERS' 0!ttS& COMPENSATION INSURANCE - Mas seNon need not be completed if she permit is Faure hundred claRars(SIM) tar less) I cantly Nat in the performance of the work'for which this permit is issued, l shall not employ any person in any mannerm as in Woman subject to the Workera' Compemadan Laws of California. Dab Applicant NOTICE TO APPLICANT: IL after making this Cenifimte of Exemption, you should become subject to the Workers Compensation provisions of the Labor Cede, you must forthwith comply with such provisions or this permit shall be deemed revoked. - CONSTRUCTION LENDING AGENCY , I hereby affirm Net there is a comlmcunm lending agency (or the performance of the work for which this Permit is issued (Sec. 3097, Ci¢ C) Lenders Name ._.. , .. , Lender's Address 1 cantly Nat 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and sure laws relating in building construction, and hereby authorize MomSectudws of Nis city to amen upon the l shove-mcmumed property for inepecuon purposes. (We) agree to save, indcmni fy and keep harmless the City or Cupenim against j liabilities. judgments, costs and expenses which may in any way aceme against said City in consequence of the &natio& of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOU REGULATIONS. 3 ��5' Re -roofs n ontr tori Data NAZARDO TERIALS DISCLOSURE Type of Roof ' WIII tM appllesnt orf rebut ingamupa., stare tar handle Intendant material it, m defined by the Cupertino 'tai Cade, Chapter 9.12. and ore Health and safety crua.Secure25532(a)? ❑>m � All roofs shall be inspected prior to any roofing material being installed. .2r".,- 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 Will I harardnus air contaminants ns dcOncd by the Bay Arca Air Quality Managamant all new materials for inspection. Troia'? ❑Yes ❑No I have read the harardrdrs m unnu is requirements under Ciwpbrb.95 of the Califs - ria Health & Sarety Cara, Sections 25505, M533 aa125534.1 undersand thatifbe thinking it not currently has a mount, b it is my responsibility to noti the occupant of the rmmcntswnich moat dor risco r nirkam or Ocmpanry. Signature of Applicant Date )�-✓f All roof coverings to be Class "B" or better ' Tooth acda g6ri, Dam • • CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32613099.00 DATE ISSUED.......: 03/19/2008 RECEIPT #.........: BS000004205 REFERENCE ID # ...: 08030106 SITE ADDRESS .....: 22332 BAHL ST SUBDIVISION ....... CITY .............. CUPERTINO IMPACT AREA ....... OWNER ............: CHI WEI CHANG ADDRESS ..........: 22332 BAHL ST CITY/STATE/ZIP ...: CUPERTINO CA, OPERATOR: patg COPY # : 1 95014-1007 RECEIVED FROM ....: MICHAEL D LUNNEBORG CONTRACTOR .......: MICHAEL LUNNEBORG LIC # 25896 COMPANY ..........: MICHAEL LUNNEBORG ROOFING ADDRESS 1328 WHITE OAKS RD CITY/STATE/ZIP ...: CAMPBELL, CA 95008 TELEPHONE ........: (831)278-1837 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- ------------- 1BSEISMICR VALUATION ---------- 23,000.00 ---------- 2.30 ---------- 0.00 ---------- 2.30 ---------- 0.00 1REROOFRES SQ FEET 35.00 455.00 0.00 455.00 0.00 TOTAL PERMIT ---------- 457.30 ---------- 0.00 ---------- 457.30 ---------- 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 457.30 --------------- 457.30 VOICE ID DESCRIPTION -------- ---------------------------- 601 ROOF'TEAR OFF 603 ROOF BATTENS 605 FINAL REROOF REFERENCE NUMBER -------------------- VISA VOICE ID DESCRIPTION ------- ---------------------- 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS �CUPERTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION 063 0/o(p APN # 3 W C vl , 0 Date: Building Address: ZZ'S3 t iSa� l St Owner's Name: Phone #: Ck' {Je ; Chpoj AFirr 73S If .76 ti Contractor: Phone #:.yr s6zy/7r 4jJ?34f,d Fi^i� srr4Af Fax #: kcF 1T'4 / 73 5F Cupertino Business License #: F 9 Contractor License #: Ott G7f7zr 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) r`%e4A ( Number of existing coverings ❑ Provide I.C.B.O. Report # j' t 1, ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description:r�par o w*0� SAA/ -e T t> ..E�l� de -e4,-,,5 As rte-tdeL1 A*o Nc 1 N 5 11 y-ar_ 004V x—C40zs2 (a Residential - Commercial El Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are any restrictions: ❑ Valuation: 23 psi I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy: ®CUPEII;TINO Number L. CITY OF CUPERTINO REROOF FEE SCHEDULE o Squares Fee ID Fee Description Fee Group Permit Type 1REROOFCOM Re -roof Commercial B 1COMMLROOF 1BSEISMICO Seismic Commercial B 3s, 1REROOFRES Re -roof Residential B 1SFDWLR00F 1BSEISMICRE Seismic Residential B 1RER00FMRES Re -roof Multi -Family B 1MFDWLROOF 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B n LJ • 11 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: C ti ` We', (_ k Job Site Address: 2 Z 33Z 341 S1 - Roofing j' Roofing Company Name: "tkr^N 4)a1Cj;w x { Applicant's Signature Date: Greg Casteel Building Official Revised 11/2/04