06090221CITY OF CUPERTINO^•'`.""�$''�'"+#
-
BUILDING DIVISION PERMITINFQRMr�TI9N:
a %a<•' .3. y ;`b�sd v«ii:d? W ..^1y''°,*'�&§,w x�k,. , iiytaw
BUILDING ADDRESS:
DOPING INC
PERMIT NO.O6O9OZ21
21220 GARDENA DR
OWNER'S NAME:
PERMIT ISSUE DATE
WILVIN LEE
3243 SYDNEY WAY
09/22/2006
NE:
SANITARY NO. CONTROL NO.
(510)889-9068
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BO EO PLO MO
p LICENSED CONTRACTOR'S DECLARATION
Job Description
rovisoes of Chapter 9 (commencing
1 booby alarm that i sm licamse l under provisoes e
p
with Section 70000) of Division 3afthc Business and ProRssiom Code.and my leen u
mre11forcean44171ea
REROOF- TEAR OFF WOOD SHAKE, INSTALL 7/16" OSB,
z Lime"mel ' _
AND ASPHALT SHINGLES CLASS A 33 SQUARES
Dem Conn
s l
VU T*SDECLector
ARCHITECTS DELLA
I undcntanJ my phos shall W used u public mcnNa
Licensed Pro@aional
OWNER -BUILDER DECLARATION
.riot Nm 1 am exempt from rime Commences law for the
1 herebyounce.
o -m Code: Any can or =my
mason. (Sadat 7071.5, Business and : Any c
Pi which requires a permit rs cnnWuct alar, improve. demolish, lir mpalr any stratum
which ma.&
-
y prior to its ismaac. also inquires the applicant for soh permit to ale a signed su emcm
of deen
he is licensed to the CoactaetU.. law chapter 9
Sq. Ft. Floor Area
ValuaC
potatoes pmvisba
potant
B (commencing with Section 7000) of Division 3 of de Business and Professions Code)or
— that W is exempt therefrom and the basis for the alleged remainder. My violation of
q}p7a��i /�,�Tyfj14y,��
Occupancy Type
Section 705 L5 by Hit' applicenl far a permit mbjec s the applicants to a dvil penalty of
on, mom dun 0w hundred dollen (37001.
3 L O Y V U U / T 0 0
❑ L as ewer of lha property, a my employea with wages a den wh compensa ou,
Required Inspections
will are
wlaoNrk,honot tsapply ,in Wof
isa
Guaranteesan aBmentorUr
and Pr fa Code: aa tOees Li aansa Law doo
property who, ampr tlhinlwW aoasuchwmk hBnef"rNrougd his
Own employ=, provided thatsuch imtimmemmu are notintr-a•"oroResN (wank If.
buNe buildingor Improvememiemllwithinm oarormmplec"gtheawm-
builda ilder will haw the buslm of proving Nal Ire did rot GdW or improve (a purpose of
see,).
❑ 1, as ower or the property, am exclusively comranial with licensed mntrect. to
construct the project (Sec. 70/x, Bminess sad professions Code) The Concourses LI-
crose Lew does not apply an an owner of property who Wilds or Improves thereon, and
who innate for such projects with a mntrvnarba licensed pmusui nt in the Commuters
Law
-
arnaemptundv5ee .BdtPCfmNumaven
0 lan
9/
war Data
WORKERS COMPENSA710N DECLARATION
I hereby trans under pemlty of perjury one of the fallowing denclantiom:
Q
I haw and will maintain a Cerdf cam of Come( an self -insure for Workee. Compen.
G
nation, as provided fa by Section 7700 of the Labor Code. roe the performance of the
work fa which this permit is issued.
❑ 1 have and will maintain Workers Compensation Insunna, as reining! by Section
3700af the lana Code, (a'perfa maf Ne wart far which this permit is heard.
=
My Work s ore mad" l nnennd Polirynumbcram:
Canner Policy No.:
CERTIFI TE OFEXEMPTON FROM W RKERS'
COMPENSATION INSURANCE
mus mien reed am W completed if the permit It foram hundred dollars ($100)
lir leas)
1 certify that in the performance or de work for which this parol, is based. I dull not
employ any person in any manmr m as to become subject in the Warkers' Compensation
Laws of Califnmia. Data
Applicant
NOTICE TO APPLICANT: If, after making this Ce tificam of Exemption, you should
become subject in the Workers Compensation provisions of an Laha Code, you mus
faMwiN comply with each provisions or NU Permit "I W anamcd anakcd.
CONSTRUCTION LENDING AGENCY
I Wmby alamn that Nee is a construction ending agency for the Nalomsnce of
the work for which this Permit is Issued (Sec. 3097, Civ. C'.)
QLendar'sNam:
,
Lcndera Addie..
z
1 certify that 1 have read this application and sum Na the al information is
Fconch. I agree in comply with all city and county ordinances and sum laws relating rs
U Wilding construction, and hereby authorim repmaxnuciwa of this city to cnmr upon Ne
pcny far imcdan Pulex..
.hove-mcntioncd propc
WW
(We) agree to ave, indemnify and keep harmless the City of Cupenino agaiml
rn liabilities,judgments, coats and expenses which may in any way seems against said City
7 in conxqueae of the granting of this permit.
r1— APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SSOlgURC�S.
Re-roofs�✓
Type of Roof
�— 9 L
Na%moewr
aDude
AZARDOUS MATERIALS DISCLOSURE
Will the appleanl or pulmo building=.posts. or handle haasdous mamrial
as dented by the Cupertino Municipal Cade. Chapter 9.11. and the Health and Safety
Code, Sc01 I5573(a)7 GGGGGG
All roofs shall be inspected prior to any roofing material being installed.
❑Yes �No
If a roof is installed without first obtaining an inspection, I agree to remove
Will time applinnt or (arum Willing ampanl use eyuipmml or tesma which
emit heeudam alrcanumimn h0ad by the Bay Ara Air Quality Management
all new materials for inspection.
District
❑Ya a
I have read the haardms maerhm mphenums under Chapter 6.95 of the Calilm.
nice Hcoldm.38alm Cada $tttians25M5,15533 uu1255 4.l uMcr.und dwifNc building
does rot mentally oro a MML Nar It is my responsibility to no Ne oaupan, of dm
mquimm am whit mug he met primutisoance of a Cede- Ocmpan
Signature of Applicant Date
All roof coverings to be Class "B" or better
Dome r ma/ DU
aClOF
WUPEkTINO
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:` 07 -)�-i L
j� A (
PERMIT #
OWNER'S NAME: vl 1 I
PHONE # 2 — G 0
GENERAL CONTRACTOBI I A
FAX #
•
I am not using any subcontractors: � l J /2, Z��
Si a e 'Date
Please check aonlicable subcontractors and com Tete the followinR information:
Owner/ Contractor Signature
Date
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
&m 1 of 1
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 32640007.00
DATE ISSUED.......: 09/22/2006
RECEIPT 4.........: 36172
REFERENCE ID # ...: 06090221
SITE ADDRESS .....: 21220 GARDENA DR
SUBDIVISION ......
CITY .............: CUPERTINO
IMPACT AREA ......
OWNER ............:
ADDRESS ..........:
CITY/STATE/ZIP ...
RECEIVED FROM ....
CONTRACTOR .......:
COMPANY ..........:
ADDRESS ..........:
CITY/STATE/ZIP ...
TELEPHONE ........
•FEE ID UNIT
-----------------------
BPERMFEE VALUATION
BSEISMICRE VALUATION
TOTAL PERMIT :
WILVIN LEE
0
WINGS ROOFING
CHEA, WING LIC # 21240
WING'S ROOFING INC
3243 SYDNEY WAY
CASTRO VALLEY, CA 94546
(510)889-9068
OPERATOR: amyw
COPY # : 1
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
----------
10,000.00
----------
169.56
----------
0.00
----------
169.56
----------
0.00
10,000.00
1.00
0.00
1.00
0.00
----------
170.56
----------
0.00
----------
170.56
----------
0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------------------- ------------------
OTHER 170.56. VISA.
TOTAL RECEIPT 170.56
t
Ll
.'
E
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:
Job Site Address:
f�
Roofing Company Name: t/J I /l-q4
Applicant's Signature: Date:
Greg Casteel
Building Official
Revised 11/2/04
LVJ,Vq
I�fG.
0 axr
CUPEkTINO
0
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN # 32o .— 40 _
001
/
BUILDING
Date Z Z o
Building Address: I
BUILDING
BSEISMICRE
Owner's Name:
BUILDING
Phone #:
Contractor: I
I N L
License #:
Contact: 1' �I
BUILDING
Cupertino Business License #:
Business License
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
K Asphalt Shingles
X, Wood Shakes
LlWood Shakes
03 Wood Shingles
❑ Wood Shingles
Cl Other (Specify)
❑ Other (Specify)
Number of existing coverings 1
❑ Provide I.C.B.O. Report #
To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic
Job Description:
! &ke
��f/uo-- /
I
Yl�I
e
Residential
Commercial ❑
S(�t
lDpt.
Fire Zone: Yes ❑ NoConfirmed
with Planning if
there are any restrictions: IJ
Cost of Project: g40.0
Type of C truction:
Occypancy oup:
Qty. if
Annticable
Fee ID
Fee Description
Fee Group
BPERMFEE
Bldg Permit Fees
BUILDING
BENERGY
Energy
BUILDING
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING