08020049 CITY OF CUPERTINOOryx
DUILDINGDIVISION PERNIIT �a,#�4 � � Y '•�a*, ''*
._..'u QL�£
BUILDING ADDRESS: PERMIT NO.
10435 IMPERIAL AVE M & S ROOFING CO. 08020049
ER'S NAME: PERMIT "CEDATE
CHEN JUI-HSIN AND HUOY-JIUAN Y 208 COPCO LN 02 08/2008
PHONE: SANITARY NO. CONTROL NO.
ARCHITECfIENGINEER: BUILDING PERMIT INFO
REMOVE EXISTING WOODSHAKE, BO EO PLTfqgTftbh 09B SHE
UMB MECH O
0, LICENSED CONTRACTOR'S DECLARATION .. Job Description
rd 0p!� I hereby affirm the,I an licensed under provisions of Chapter 9(commencing - ^^•-^ -^ ^^^^ ^- -
naE with Section 7000)ofDividon 3 ofde Business and Prolasons Code,and my licence is
fay intuit forte aM cff p 2 f g
Crab Uoc..Clans Lk.k
DnIC CAnlfacbr
B
'` ARCHITECTS DECLAR TI s
1 undersand my Plans shall W used as public accords
DyU
a0 Licensed PNfaaelapal
50 OWNER-BUILDER DECLARATION
m
COO hereby.(Sero that 11. exempt farm the Canons Co License Law for the
COO O following mean.(Section 703 1.5,Businer.and Pe. riluw Cade:Any city or county
e 9�i which requires n permit re cnawct,alter.improve.h Permit
t fie a sig any alamue
priwmis issumce,also requires the appliamfor soch permitmfileasigucd wsemem
�< that he if licensed pursecnt to the provisions of the Conusav's LlWan Law(Chapter 91 R000r Area Valuation
a (commencing with Section 7000)of Division 3 of the Business ad Profession Code)or
Nal he u exempt therefrom and the buts far the allegedexempd...Any violatian of
Section 7031.3 by aoy appliant fm s thb a permit mbpae applicant a civil penalty of APN Number Occupancy Type
nut mere then five hundred dollen(5300), p y yp
❑I,u.war of Ne pbputy,or my employm with wagex u timir wk mmp mdm.
Will de the work.ad the IVYQYn H not intended or offend Tarsale(Sec.7044.BwInW
and Professions Carlo:The Coaaecbr'a License Law dm not apply b an owner of Required Inspections
property who builds c r improv thmmn,end who docs such work himsel f ar though his
Man employer,provided that such Improvements as not intended proffered fvale.if.
howev,the building or improvement usold within one year of compledon,the owner.
builder all have the buden of proving that W did mat Wild or improve for purpose of
ssk.):
❑I,u awasr of the property am exclusively contracting with licensed canuacbrs an
construct the Project(Sec.7044.Business am Professions Cade:)The Cotnctor'a U.
ceae law dm not apply to an owner of property who Wilda or improv Neaten,and
who Warrants for such pajects with a aontncuf(s)licensed pursuant b the Contractor's
License Law.
❑I oro exempt under Sec ,B&P C fm Nis mason
v Dam
WORKER'S COMPENSATION DECLARATION
I hereby aRum under pemlty of perjury one of the following declaedons:
❑l haveand will mmmaht•Cer fneamcf Consent b self-ensue fns Warkeb Compm.
cation,u provided for by Section 3700 of the labo Code,for the performance of the
work far which this permit is issued.
❑i have and will..law.Wmi afs CaatpensNaa I..,as retained by Sectio
3700 ofthm LaWr Code.far the pedormucc ofthe wart for which this Permit is isswd. '
My Worker's Competent..haunnce arrim end Policy number sac:
Carie,.-5T-fTo 7—Vµ,Policy No.:/S"l 7/ 7c
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Ills action coed maraccomphaad Irdm permit Isforooc hundred dollen($100)
ar lora)
1 mniry that in the performance or the wock for which this Permll is issued.I shall net
employ any person in my mamerb as to become subject to the Workers'Compensation
Laws of Califomin Date
Applicant
NOTICE TO APPLICANT:If.after making this CeNEca a of Exemption,you should
become subject b the Worked Compcnp4on previsions of the labor Code,you most
,J O forthwith comply with such provisions a this Permit shall W deemed molted.
,zr i CONSTRUCTION LENDING AGENCY
[-r 1hemby.M.that there is.consmctinn lending agency far the part..of
LYi > the work for which this Permit is issued(Sec.3097,Civ.C.)
GQ Lender's Name
z lander'.Add.
V Q 1 merely that I Mw mad this application and sate that the aWve information is
Is. cmmcL 1 ogee b comply with all city ted county oNiamm and sole ewe elating an
-0 Wilding construction.and hereby uNadse representatives of this city to cater upon the
�+a above-mmdoned property fns fico n rail Purposes
(� (We)agate to ave,indemnify and keep humless the City of Cuparim against
Fr h liabilhiu,judgmmu,mass ad eapeaa which may in my way xeCaw against said City
U in consequence of the grouting of this Permit. _ c- Off"
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date O - y
SOURCE REGULAMON
�4/tie z�—'e- Re-roofs
Signuueo limn onRDOU Dem /
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant a IWtve building occupant sero or handle huaAow mantis
de11nod by the Cupertino Mum.* I Cade.Chapter 9A2,and the Haldr and Safety
scN z 53z(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Ye, o
ww the appfimmt or Ice building occupant cab eyvipmenl v devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit Wa daa air commainams;u defined by the Bay Area Air Quality Management all new materials-for inspection.
District?
❑Ya u
Ihave ead Ch.hvndWsm5505. mquieme5534.1 ndeapmr6.93afthe Calding
rias nolm&randyy Cade.Smvons I1ditit 3373md 23334.1 uMcnsM thuifthebui ft he
dm not cwentiY hove a tenet,that it u my responsibility b WtiIY the omuPmt of tite
equimmenuwhkhmwtWmetpiarmimummofa Cmtifeamor0cWpmcy. Signature Of Applicant Date
!!i� All roof coverings to be Class"B"or better
Owner or authorized agent Data
• CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: -Lot:
APN . . . . . . . . : 35719102 . 00
DATE ISSUED. . . . . . . : 02/08/2008
RECEIPT #. . . . . . . . . : BS000003889
REFERENCE ID # . . . : 08020049
SITE ADDRESS . . . . . : 10435 IMPERIAL AVE
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : CHEN JUI-HSIN AND HUOY-JIUAN Y
ADDRESS . . . . . . . . . . : 10435 IMPERIAL AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5931
RECEIVED FROM . . . . : SAFET KRAJINIC
CONTRACTOR . . . . . . . : MIRSAD KRAJWIC LIC # 28360
COMPANY . . . . . . . . . . : M & S ROOFING CO.
ADDRESS . . . . . . . . . . : 208 COPCO LN
CITY/STATE/ZIP . . . : SAN JOSE, CA 95123
• TELEPHONE . . . . . . . . : (408) 314-0870
FEE ID UNIT QUANTITY `AMOUNT' PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- -- ----------
1BSEISMICR VALUATION 10, 900. 00 1 .10 0. 00 1.10 0. 00
1REROOFRES SQ FEET 34 . 00 442 .00 0. 00 442 . 00 0. 00
------ ---------- ---------- ----------
TOTAL PERMIT 443 .10 0. 00 443 .10 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 443 . 10 VISA
---------------
TOTAL RECEIPT 443 .10
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ------------------ --------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
605 FINAL REROOF
•
CITY OF CUPERTINO
affla
REROOF
� CUPER INO PERMIT APPLICATION
APN# Date:
Building Address:
1043S 1 /-1P ;A AV
Owner's Name: Phone #:
Contractor: Phone #:C1. ev 3 jh _ a
7
Fax #:
Cupertino Business License #: Contractor License #:
3COa1 8o (2/z3
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )4 Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report #
A To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:
Residential 0 Commercial El
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: ❑
Valuation: on
• I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
CITY OF CUPERTINO
REROOF
•CUPWOTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
IBSEISMICO Seismic Commercial B
3 1REROOFRES Re-roof Residential B 1SFDWLR00F
1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roofMulti-FamilyB 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: _Z� u I - /-F 5 /i✓ G H c/y
Job Site Address: / 113 S 1 /9 L �K ✓t
Roofing Company Name: r i><
Applicant's Signature: S� C Date:
•
Greg Casteel
Building Official
Revised 11/2/04
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS: PERMIT #
.� yr \ 20DLt
O R' NAME: Z L4 _ /cs ii cbe z-iI c PHONE # Zs - z
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: `tom A:f- 2—
Signature Date
Please check apphcable subcontractors and complete the following information:
60 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