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05070134 CITY OF CUPERTINO �' * *' � ' `"' : BUILDING DIVISION PERMIT C�NTRAGTOR INFORMATION - ,... BUILDING ADDRESS: R E ROOFING & CONSTRUCTIO PEpA11N1...g{'r,N 0.05070134 22018 MC CLELLAN RD OWNER'S NAME: PERMIT ISSUE DATE TONY CHONG 15230 CLYDELLE AVENUE 07/21/2005 OPINE: SANITARY NO, CONTROL NO. (408) 626-9320 ARCHITECrIENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description r� 1 boroby affirm Nal 1 am licensed under provisions of Chapter 9(mo meneing P -� with Section 7(08)-fl) 1.' n3ofa Business4p P fcuiun fpyl rad eryliecnuis in full Tome and c'm; I �,_I� REROOF-REMOVE EXISTING SHAKE/INSTALL i'y,_ Datc;C V 1 d 1/2" CDX 30LB ASTM FELE �yr�t I �y���\T�\ILE Dam Contrumr �11 ALJ 77 AR�Hf1ECfSDECLA 1 RNMED < 1 rax nJ my P, sh se uudu Pub' rds J U G 1 Licensed Professional OWNER-BUILDER DECLARATION r C I Wrotryso .(Sinn that 11. ucfrom tW Cssions o :A n c Law for du 3_ 200[ ip O following roomn.(Section RIJ 1.3,t'.Business'. and ws.di eau Gude:Any city m county vI Laim which its issa a p,mit b cnnsMe eller.impmsu thmoliih,or mash any suunum {1`((�}g.`p' Priors its issuance.c,mite otI.Me Me for mohpermiuoflcasigned Law(Chmment M < Hathe is mecing wit Puwam I.Me of Divionen oMae f the Business (Chapter Sq.Ft.Floor Area ggQ xFS ft,he it ngwith hmefom ittfDtems n3 but adl.gd errand Professions C-x)or .- Ihas he is eaunpt Hmcrt(rom and He bull for the alleged exemption.Any Wolation of Section 7031.5 by any applicant for a permit subjects He applicam to a civil penalty of APN Number Occupancy Type an, me M.five hundred doll.(M). 35608038 . 00 P y YP El I,mowneroftheryopeny.mmyemployceswiH"rAm h mlecompenudon, will do the work,and Hesuuctum is not intended ororered formic(Sec.7014.Business and liMfussiou CoxTu a :TCon cmes Licence,Law tro Law t apply in an owner or Required Inspections property who buildsorimproves Hereon,and who dmasuch work himulf or through his own employes,provided Hat such improvement art notinurWed oroRere i for sale.If, however.He building or improvement is mid within one year of completion,the manner, builder will have He burden of proving Has he did not build,improve for puryom of ale). ❑1,as owner of He property.am exclusively contracting with limosed contractors to contract He pmjcct(Sec.7014.Business and Professions Cox:)The Contractors Li- ce cs Law donot apply to in owner of properly who Wilds or improves themon,and contracts for such projects with a conoacmKs)li¢nud pursues m He Contractor's x Law. I am aempt ones Sec. .B A P C for this mason Owner Dau WORKERS COMPENSATION DECLARATION I bemby arum under penalty of perjury one of the following xclamtions: - ❑1 haw and will maintain a Cenifiau-f C-nsem m ulf-inseam for Worker's C-mpcn- s oral,as provided for by Section 3700 of He labor Codc,for He performance of the work for which His permit is isuea 1 have and will maintain Workers Compensation Insurance,as squired by Section of He Labor Cox,for He performance of He work for which this Permit is aimed. My Workee Compensumi mance artier and Policy no am: Cartier. i Policy No.:nn CERTIFICATEOF :EMMONFROMWORKERS' COMPENSATION INSURANCE (]Idsmainn need out becampleud if the permit is foronchundmd dollars(5100) or less.) 1 ceNfv Hat in He performance of He work for which His Permit is issued.I shall net employ any person in any manner m as in become subject in the WorlaKCompensation Laws of California.Date Applicant NOTICE TO APPLICANT:If,after making On Cenificau of Exemption,you should become subject to the Worker's Compensation previsions of He labor Chic,you most .,O foMwith comply with such provision or His Permit shall be themed m oked. z'" CONSTRUCTION LENDING AGENCY Ihereby affirm Hat Hirt is a conlru,ian lcndingagcney for He performance of 6i He work fm which this permit is issued(Sit.3097.Civ.CJ _ C(] leder,Name z Lenxr's Address U C) I certify that 1 have read His applicmion and suis Hat He abeve information is Fcorrect.1 apes 10 cemplY with all city and county ordinances and suis laws rdalmi,to, 0U Wilding convuNon.and hereby authorise representatives of His city to enter upon He �'[3.1 aWve-menti-nodpropertyils4og for ie peeuonpirch ma gy (We)agree to taw,indemnify and keep harmless the City of Cupenin.against rq liabilities,judgmentecoon and expcueswhich may In any way.ecus agalut mid City U ue"m of He gaming-(His pUe,rmit. APPLIC 1T U ERSTANDS A it L COMPLY WITH AL NON P01 Issued by: Date /7 SOUR EG A.Ns. Zl I o / 2 Re-roofs f Si of Appli_HAZARDCUS Dau \HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Hee Cupertor future building occupant gate or and M Health anmabrid u defined by Oc Cupertino Munici YCox.Chapter 9.U.and IW Health and Safety Code.Section 25532(.)? ❑Yes Ne All roofs shall be inspected prior to any roofing material being installed. Will the.applicant or future Wilding If a roof is installed without first obtainingan inspection,I agree to remove PP g«cm pant um or dcvias which P it haiardnu air mnuminst u Dimic,7 toed by du Bay Area Air Quality Mamgcmcm all new materials for inspection. ❑Ycx Nu Ihave mmlthehvardousm 5505, 53 i an255 unxr CbapmrbMto(tW Califon ( I I0 nim @Safny Codc.S,don 25505,21537 and 25574.1 understand Matilda,Wilding / ms note ly h am.Hat it t my msponibilitY b nmifY de auupmt of du mgmi not ngg�yy�typ` of.Cemnamnfoempan�r�y-_�' tureofpppFicant Date I U 7 Own,.r amhoriud a Dau All roof coverings to be Class"B"or better CITY OF CUPERTINO 1 of 2 PERMIT RECEIPT OPERATOR: suem COPY # 3 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35608038.00 DATE ISSUED. . . . . . . : 07/21/2005 RECEIPT #. . . . . . . . . : 30470 REFERENCE ID # . . . : 05070134 SITE ADDRESS . . . . . : 22018 MC CLELLAN RD SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER TONY CHONG ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4060 RECEIVED FROM . . . . : R E ROOFING/CONST CONTRACTOR . . . . . . . : PROCTOR, PAUL LIC # 20615 COMPANY R E ROOFING 6 CONSTRUCTION INC ADDRESS 15230 CLYDELLE AVENUE CITY/STATE/ZIP . . . : SAN JOSE, CA 95124 TELEPHONE . . . . . . . . : (408)626-9320 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL _____ _____________ ---------- BPERMFEE VALUATION 19, 000.00 266.76 0.00 266.76 0.00 BSEISMICRE VALUATION 19,000.00 1.90 0.00 1.90 0.00 ---------- ---------- TOTAL PERMIT 268.66 0.00 268.66 0.00 • s Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 `UPERTINO Building De artment JOB ADDRESS: 220 ( (!, C�k1, AA- j 1p1`v, PERMIT# 7 O - U ( 2 OWNER'S NAME: U h1 PHONE # L4 U�- (L Z6 -I Ct 32- GENERAL CONTRACTOR: p FAX# 0 I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following ' 0 tion: 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 ' e r/Contr or Signature Date Community Development Department Building Division {,),t City of Cupertino 10300 Torre Avenue • Telephone: (408) 777-3228 CITY OF Fax: (408) 777-3333 CUPEkTINO 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 compl with the above stated policy on re-roofing. Homeowner's , 1 (/ - p �, Job Site Address: �20� 8 b��, u✓ i Roofing Com y e: - �% UCJ F l 1�1(( �II trnf C��(Zl C�� N` Nf Applicant's ignatu Date: l2� • Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper CITY OF CUPERTINO aun OF RE ROO F •CUPERTINO PERMIT APPLICATION FORM APN # / 68-0 3 Date: Building Address: 22 0I r, KL L Cru-,-,w Owner's Name: �/uy boy - Phone #: Contractor r Phone #: License #: 1 � 1Z��N w u - (�26 - c1316 7 2 Z 519 Contact:/ Phone #: Cupertino Business License#: (0t5 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles Wood Shakes El Wood Shakes ❑ Wood Shingles ❑ Wood Shingles /�L Lq-[t W a f1 EI Other(Specify) Other(Specify) ( 5S G YL4 I I I t'� Number of existing coverings Provide I.C.B.O. Report# IQ-:?)o 26S?6 Q7 To be Removed ❑\ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Com 1 With Cu ertino's Tear Off Polic Job Description: 11F,eM0vt"I (f k4,rlN(t% ( 111 tq Yt_ OY— PJM A_z tNe7-T LL N '12-l' GDx + TNt Via LA41iwtl I ' Residential Commercial Fire Zone: Yes ❑ No Confirmed with Planning D, t. if there are any restrictions: U Cost of Pro=Ject , � VD Type of Construction: Occupancy group: X3. 25 Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEEBld Permit Fees BUILDING BENERGY Ener BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING