06080231 CITY OF CUPERTINO ---- ** ` ''9"�*z' �-�`� « '' -BUILDING DIVISION PERMIT geo 1RAG" � 5 NP'ORMATIoN ;
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BUILDING ADDRESS: T D ROOFING PERMrr No.06080231
11603 FOREST SPRING CT
OWNER'S NAME: PERMIT ISSUE DATE
DI MA 675 TULLY RD
NE: SANITARY NO. CONTROL NO.
(408) 892-8872
ARCHITECTIENGINEEW BUILDING PERMIT INFO
BLDOO ELECTO PLUMB MECHO
x LICENSED CONTRACTORS DECLARATION
Job Description
�+ 1 huoby affirm Nn 1 am Iicenacd i n provisions of Chapter 9(mmmendng
;z wiNee
Suanln)(M)ofDivldon 3afNC BudnesaaM Profualoru Code,and mylicenu is 'r.
amnromemeer ( REMOVE WOOD SHAKaD. REP,L}NCEDTH 50 YR ELK CO
Laerue Igiwa
i Da¢ Ca,lrsaar
ARCHRECT'S DECLARATIO
1 untleruanJ my plana Mall he used u puhiic leen c�
G Ucotod Pufcstlonsl
OWNER-BUILDER DECLARATION
iS 1 hereby affirm that I am exempt from the Contactaft License Law,for the
•O o following lesson.(Section 7031.3,Business and Professions Cade:Any city at county
'$V. which requires a permit to cons=4 Alar.improve,dcmulah.or repair my sweture $6650
�2lt prior In its issunce,alw requires the applicant(arsuch Pennitto file a signed statement +2`.�' u.�s
: � NadaisllcensedpuraoestroNeprovisionsofd¢Canuamonslicense,law(Chapm9 Sq.Ft. Floor Area"' Valuation
(commencing with Section 70D0)of Division 3 asfNe Business W Pofrua ons Castle)or
that be is exempt therefrom and the bash far da alleged exemption.My violation of
Section 7031.7 by any appllesnt for a permit subjects the applicant M A civil Penalty of r u u Occupancy Type
Out more than five hundred dollars(2500).
❑I.u Male of otic property.or my employees with wages u Neo was eampensadon,
willdotheworkask thea =hwtamndedoranerodforum(See.70a4,Budneaa
and Professions Cade:The CamrxaYs License Law does let apply to an Manor of Required Inspections
property who builds orimprovesthellon,and who doesauehwokhimself ort rough his
ownemployees,provided Na well improvements m nothaended orMEemd foraala If.
herwever,the building or Improve seen Is said within ane year of completion.the owner-
builtlu will have Ne Weaken,of Proving Nat be did rot hula m improve for purpose of
ulcJ.
❑I,as want of de,property,am exclusively contacting with licensed comamars to
cunstmct the project(Sec.7044.Business and Pretenders Code)Tie Camacafs U.
costa law does oat apply to an owner of property who wilds or improves them st.and,
who contracts for such projects with a Contactors)licensed pursaanf to use Cmtr es
License law.
❑T am exempt under Sec ,B At P C for this reason
OwnerDam
WORKER•SCOMPENSA770NDFcUm-TION .
I hereby alMn oakcr penalty Mf perjury am of the following declaration
I have and will maintain a CeNftcaa of Consent to air-] for Workers Compen.
suian,as provided for by Section 3700 of the liber Code,for the performance of Ne
w rk for which this permit is Issued.
I have and will maintain Worte(s Compensation Iawranu.as mquhat!by Section
of the Labor Code,far use performance of Ne wash for which this pom0 m1MOML '
My Worker' Comp mmlop.l euranCo a cr and Policy nu egm ^
Grtier. Policy No.: 1S 9
CERTIFICA OF EXEMPTION FROM WORKERS'
COMPFNSA71ON INSURANCE -
Cihis section metl Out necompleted it the permit is!mane hundred tlnllam(31610)
or los.)
1 certify Nat in the performance of Ne work for which this Permit is issued,I"I nos
employ any person is my mmmrao as m become subject m NC Worken'Gmnpentedon
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If. net making Na CcnlOcnt of Exemption,you should
became subject on the Worteh Compensation provisions of the Labor Code.you must
.JO fanhwtth Comply with such provisions or this Permit Mill WC deemW aevaked.
Z,r� CONSTRUCTONLENDINOAGENCY
I hemhy AfRrm that than is a construction lending agency far the perf rrmmcc of
fY>
the wok far which this permit is issued(Sec 3097.Civ.C.)
0.Q Landers Name,
e,z Lender's Addrem
V Q I certify Net I have and Na application and sum that the allow information is -
n.t" Corect.l agree in comply with all city and county ordinances and ataa Iowa relating to
OU building construction.and hemby authorize represmmivns ordtis city to enter upon the
U allow-mentiunetl property for inspecuon purposes.
(We,)agree to an,indemnify and Loop baamleas p
Ne City of Conina against
f4g IiMili0u,judgmenu;xoats and expenses which may in any way acme Agalnaudd City
fJ7 inconsegmmaaf Ncpst Ingo(Nispermil.
F7 APPLICANT UNDERSTAN S WILL COMPLY WITH A NON-POINT Issued by: Date
SOURCE REGULATIONS. _.�-�,,,�
p 0/per; S�D-9 Re-roofs
Signuurt or AppliuHAZARDO Data
HAZARDOUS Wilding
IALS DISCLOSURE Type of Roof
Will citeCoolantor futuremipal as.Chapter
ser and M hmalthanmatelot
u defiled by the CuPeNm Municipal Code.Chapter 9.13.and tis HUIN and Safety
Code,Section 25532(x)7 `I 1 All roofs shall be inspected prior to any roofing material being installed.
❑Yu IANo
Will the applicant or(mora building Occupant use equipment or devices when If 2 roof 1S installed without first obtaining an inspection,I agree t0 remove
emit bararMus dr camamiu ps u de0md by fee Bay Ama Air Quality Management all new materials for inspection.
District?
❑Yu Nu
1 he.mad the hauNws materials requimmena unser Chapter 6.95 of Ne Califor. q (I n
ria HcalNhSaf:tyc e,Sctions25505.25533md25534.1unhr dNat(Ihe building
does not currently a ant Nu it h my respensihi111Y m natifY the ampant of the _I
requirements which ofacerura.mor Ocwpmcy. Signature of Applicant 6 Date
Owner ar,athadyeaagant Date All roof coverings to be Class"B"or better
Community Development
acof
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
Fax(408)777-3333
IOUPEKTINO
Building Department
JOB ADDRESS: I l I n i=Or C+. PERMTT # ccB02�s`
OWNER'S NAME: j! MCI PHONE # 44W W02,
GENERAL CONTRACTOR: FAX # —
I am not using any subcontractors: _
Signature Date
Please check applicable subcontractors and complete the following information:
RI 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
2�
er/ on c r Signature Date
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . 1 : 36651054 . 00
DATE ISSUED. . . . . . . : 08/29/2006
RECEIPT # . . . . . . . . . : 35803
REFERENCE ID # . . . : 06080231
SITE ADDRESS . . . . . : 11603 FOREST SPRING CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : DI MA
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : LESLIE HOANG
CONTRACTOR . . . . . . . : LESLIE HOANG LIC # 23155
COMPANY . . . . . . . . . . : T D ROOFING
ADDRESS . . . . . . . . . . : 675 TULLY RD
CITY/STATE/ZIP . . . : SAN JOSE, CA 95111
TELEPHONE . . . . . . . . : (408) 892-8872
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 7, 000 . 00 137 . 16 0 . 00 137 . 16 0 . 00
BSEISMICRE VALUATION 7, 000 . 00 0 . 70 0 . 00 0 . 70 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 242 . 86 0 . 00 242 . 86 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- ---------------- ------------ ------------------
OTHER 242 . 86 VISA
TOTAL RECEIPT 242 . 86
•
CITY OF CUPERTINO
00 REROOF
• CUPERTINO PERMIT APPLICATION FORM
APN# L+ Date: I /
8 ,t q o �
Building Address:
lI foo 3 ode5� S rt n Cfi
Owner's Nam Phone#-
�� Ma CyoB ) aye. c; 6o1
Contractor: V O O (_ License#:
T D 1 `
Contact: I �S i N 0 0.N Cupertino Business License #:
d Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
O, Asphalt Shingles )j Asphalt Shingles
A Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Npmber of existing coverings ❑ Provide I.C.B.O. Report#
!7'ht To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: W
Ae -MaV V4 Wood S�t c� �4e . 7'
Residential Commercial ❑
Fire Zone: Yes ❑ No Rr Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: Type of Construction: r Occupancy group:
O %L - T-o o i
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
I 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 r/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.
MHomeowner's Name: ��+ 1�1 Q-
lob Site Address: 1 1 1'o eRt )J- l n G �
Roofing Company Name: D V00 n
Applicant's Signature: Date:
Greg Casteel •
Building Official
Revised 11/2/04