08080017 CITY OF CUPERTINO .� '�p.s2�' rYnb "'�' '
BUILDINGDIVISION. PERNIIT $sCONTR4GTORINk'ORMA.TIO.1V-�
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BUILDING ADDRESS: PERMIT NO.
/')00 DUMAS UR LOS GATOS ROOFING 08080017
OWNER'S NAME: FERMTT ISSUE DATE
:'II:;I.�IEN 01.1 ANG P 0 SOX 1726 08/04/2008
NE: SANITARY NO. CONTROL NO,
ARCHITECT GINEER: BUILDING PERMIT INFO -
REMOVE 2 LAYERS OF EXISTING BLDG EUCr came MECH
O O O O
X00 LICENSED CONTRACTOR'S DECLARATION lob Description
wC 1 Istoby affirm Nn 1 am licensed under Provisions of Chapter 9(commencing ^^^-^
ZW with Seeuan7000)of Division Jof Ota Business Pmfessimu Code,ad myli u
in full forte m effect.
LicenU la 3 Lk.0
Date Contramor
ARCHITECTS DECLARATION
I t understood my plans shun W used as public accord.
JyU
g o in Licensed PmfesslonJ
3
OWNER-BUILDERexemptDE DECLARATION
E 0 E 1 Mrtby affirm Wel 1 1. exempt s an the Cantracftumns Co Lkensu Law for the
E00 o (snowing RSWa.Permit
to co IS.BLLiiter. and NOfecd"m Code:Any oily of meanly
$
which me,Wo a pcmit ac construct.Jur,improve,demolish,ri mash ed auctum
-iy paewslicened .alioan to ftpaaft pdoicant for efdaaach Pemnmiemse rile a LaJ sus:mem
x�S< (Oat he mmeied,w Section7Wapm„Jonaa3Wecanaicosu«nee�...Codm9 Sq.F[.Floor Area Valuation
OammenangwiWSauon 7000)of Division Jof We Bainasad Prefessvi Code)of
^ Net W u esunpm thmefmm and the breis for the alleged eUmptiou Any violation of
Section 7071.5 by my appikant far a permit subjecu We applicant to a mil penalty of APN Number Occupancy Type
not more Wan 0w hundred dollars(5500). Pane y yP
0 1,n banner of the property,n my=play.whis warm as Weir sok compensation,
will do Ow wart and We swmtum is ointended or aRerd for sale(Sec.7046,Business
and Profession Code:The Commences Liao Law does not apply in an owner of _ Required Inspections
property who builds a imp.O m e,and wW docsouch workhimulforthmugh his
awn employm,pmJded that such improwmaRs art not intended oranerd for sale.If,
however,We building or impmwmenl is sold within ane yar of completion,the owner-
builder will nave On Whom of proving Out he did amt Wild or impman far purpme of
sale.).
0 1,as owner of the property,am enclmively contracting with licensed enntrawrs to
mmuuct the project(See.7044.Basin ea ad Fear..ism Cade)The Contractors U. .
cave Law does not apply to an owns of property who Wilds or improves thereon,and
who contracts for such pmjecu with a contrawr(a)licensed paramos in We Cenmetora
Liecom Law.
O lameampaundm Sea .B&PCfor Wuresmn
Owner Mae-
WORKERS
onWORKERS COMPENSATION DECLARATION
1 hereby affirm under penally of perjury ane of the fallowing dealan0oa:
1 hammed will maincein•CeniOvmof Coaem in Ulf-Tatem fur Worke'.compm.
miles,an pmvidcd for by Section 3700 of Oe Labor Code,fm We Performance of the
wart for whim this Pemll is issued.
0 1 have sand will mainuin Workers Compromise Insurance,m mgrird by Section
3700 of the Lsba Code,four the performance of We weak,for which Wu permll u intend.
My Wo aJJmpe sox anion and Polley n are:
Coni- JO- 1 _Polity No.: -
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu Ucdon nand nal W completed ifft permit is foram hundred collas(51010
or less.)
I arufy Oat in The Performance of We work for which this Permit is issued,l shaft not
employ any pawn in any manner so as in bcamc subject to We workcre Compensation
Lam of California.Due
Applicant
NOTICE TO APPLICANT.If.after making thus Certificate of Exemption,you should
Woman subject m dm Worker's Compeoden provisions W Om Isom Cade,you muse
.,z forthwith comply with such provisions or this Permit shall W deemed rtrvoked.
z O CONSTRUCTION LENDING AGENCY
[-w 1 thereby affirm Oat there is a construction lending agency for tW performance of
C the work far which this Permit Is issued(Sec.3097.Cl,C.)
la1 A forum's Name
z Lenders Addeo
U O 1 metify vel 1 haw and Nus appikuion and sum thu the mow ufmmden u
It,!' corset I a&=to comply wins JI city and county oNinuuea and state laws totaling in
O building construction.and hereby atmorine spasenuliws of this city to enter upon One
ft7 ¢hove-menudgm propertycosts
far experaan pmpaUa
G (We)agree w saw,idcanny ad kap harmless Om City of Cupenfno against
to I-muaomen of On
apcvawhich may in ay way acrncagalnsm said City
V z inconsequence of the groan{of Wu
^' S U (R�EdGPU1LA
APPLICANT UNDE0. NDS AND WILL COMPLY WITH ALL NON-POINT
Issued by
: DateO S. Re-roofs
g�ort
-
of ApplieseeU msentr pa
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicam or future Wilding occupaluere or hadle hamddes materia
U defined by the Cupenia Municipal Code.Chapter 9.13.we OU Health and Safely
Code,Section 35532(a)?
Ya 7mb All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
.Iso har0udna air conuminau a defined by tW Bay Area Air Quaily Management all new materials for inspection.
OWtict7 P
0y. Ergo
I haw sad the hancedmss marries requircmenu under Chapter 6.95 of du Cellar, ' //n
me Health&Safety Code
es a ,¢aft,Sections 25505.27537 ad 73574.1 udersund due ifthe Wilding ,`7('j�'/ Ol
dot currently haw a nl it my respanthe ahinly w anory aeepaal of the f((///III///YYY r a
m4 it n esu whkh mal be t Paar w moss of a CctaReaw of fk p cy.
” ffi 'p Signature of Applicant Dale
/)(gip ) I A /u-dn� T ld(�
Owh'er�rwauWodsd.gem DataAll roof coverings to be Class'%Q."or better
CITY OF CUPERTINO
• 2 ITEMS OF 8 PERMIT RECEIPT OPERATOR: pdtg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35926009 . 00
DATE ISSUED. . . . . . . : 08/04/2008
RECEIPT # . . . . . . . . . : BS000005674
REFERENCE ID # . . . : 08080017
SITE ADDRESS . . . . . : 7500 DUMAS DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : HELEN CHIANG
ADDRESS . . . . . . . . . . : 7500 DUMAS DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
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
• FL;S ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
-------- ------------- ---------- ---------- ---------- -------- -------
1.13SE].SMICR VALUATION 9, 042 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1REROOFRES SQ FEET 25 . 50 331 . 50 0 . 00 331 . 50 0 . 00
---------- ---------- ---------- ----------
TOTAL, PERMIT 332 . 50 0 . 00 332 . 50 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-- ----------- ----------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
�Q- CITY OF CUPERTINO
REROOF 0
OCUPEIZTiNO PERMIT APPLICATION
APN# Date:
3 s q- 2( - oo 713 C/ e
Building Address:
506 u m c4 o, Dr.
Owner's Name: Phone #:
Helen Chian r �'ok ���- y977
Contractor: LOS Gtr7'
. / o S 4 d 7? I o L{ Phone #: l�lQ 8 2 8_ 9_3 .J 9
`J Fax #: /3 -71
Cupertino Business License #: /, / Contractor License #:
7 3oo ,207
Type of Roof Covering:
Existing: Proposed:
` ❑ Built-Up Roof ❑ Built-Up roof
76— Asphalt Shingles )2" Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) 4 Other (Specify) �j
Number of existing coverings Z ❑ Provide I.C.B.O. R port#
To be Removed ' l�d, Provide,Mfgr. Installation Specs.
S s ZS ,S ooi^ elgss —�—
Job Description:
7///, 0,S B
Residential Commercial
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: ❑
qb
Valuation:
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
*4S a
S a e
CITY OF CUPERTINO
REROOF
•CUPERTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
Zs s 1RER00FRES Re-roof Residential B 1SFDWLROOF
/ 1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
•
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: P P.h 7ptj q
Job Site Address: 72soo Du rna S Or
Roofing Company Name: y S /7
Applicant's Signature:
v Date: 30 O
i
. Greg Casteel
Building Official
Revised 11/2/04
Community Development
J 1030
Cupertino CA 95014
�k
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
OUPEkTINO
Building Department
JOB ADDRESS: i PERMIT # G�� ��
7s6o O�MQS Q
_ OWNER'S NAME: 1� ej�I ).may PHONE #
GENERAL CONTRACTOR: S FAX #
I am not using any subcontractors: —Zrbar_.
Signature t&-- —
Please check a licable subcontractors and complete the followin information:
RF 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
% 7
Own r/C ntractor Signature Date