06080114 CITY OF CUPERTINO �SIa,� s WT1A) +('°+A °" "777z "1_1_19,"�� "�T"-
•BUILDING DIVISION PEyvylaT COA\:'RUMOR��,dti��'•O w ��g
BUILDINGADDRESS: s AMERICA' S ROOFING PERMIT"'.06080114
Z.524 ORANGE 13LD_qSL)M_DR____
OWNER'S NAME: PERMIT ISSUE DATE
CHU YORN 1650 S
NE: SANITARY N0. CONTROL NO.
(408) 661-6501
BfELECT P
PERMITINFO
ARCHER/PNGINEER:
BLDGMECH
TTO O O
O g LICENSED CONTRACTOR'S DECLARATION lob Description
u� 1 hereby affirm that I am Iteensed under provisions of Chapter 9(tommdndng
.,� with Saction 7")a DivWan 3 of the Basin—and Profmalum Code.and my licenset&
infull(arteand. Q �1 �2 ^y�I� REMOVE 1 ROOF INSTALL 7 16" OSB 30LB 50 YEAR
,qz uemnmCl ` Conn _k_ CLASS A
Dato -Connector
ARCHITECTS DECLARATION
1 understood my plain Mall he used as public retards
'C.
' Licensed Pmfmsianal
s OWNER-BUILDER DECLARATION
p 1 hereby allied on I em exempt from the fesnmmah Liemnu Lew for the
i a O following re+aan.(Saito construct,
Business and Professions Cede:Any city or county
3$� which re9ultea a permit w enmtruc4 atm(,impmve,demnilah,or repair any Wuclure
prior us its issuance.also requimede applicant forsuch permil On Ok a signed swememValuate
e o Ihu he is Ikempursu
cd pursuant an We praviabm of ave Contractor's License law(Chapter 9 Sq.Ft. Floor Area P 0 0 0
$ (cammeming with Sedan 7000)W Division 3 ofthe BusineuuM Profealtns Code)Or
that he is exempt therefrom and the but&for the illegcd exampilon My viola0un of
Sudan 7031.5 by any applimm for a permit subjects the applicant w a civil penalty of APN Number Occupancy Type
not mom than five hundred dollars($500). 36611067 . 00
0 L as owner of the property,or my employes with wages as their sot&compensation,
will do the work and the =to.is not intended or f..d for aelo(See 7041.Business Required Inspections
and Professions Cade:The Contractor's License Law does not apply w u owner of 9 P
property,who builds m improves ilereon,and who doesaah work himself or through his
own employees provided that Such improvements are tut Intended araffered for We.IL
hawewr,the building or Improvement is told within arc year of completion.the owner.
builder will haw the harden of proving that k did and build Or improve fm purpose of
Sale.).
0 I.Sa mover a the property,am exGusively convening with licensed contraewn w
construct Ne projen(Sec.7044,Business std Professions Code)The Cmuuwr's L(-
came Law does not pply in an owner of progeny who builds of improves themon,and
who contracts for such projects with a eonvachuh)licensed pursuant in the Coothual 's
License law.
O l ons exempt under Sea ,B&PC fm this roast.
Owntr Data
WORKERS COMPENSATION DECLARATION
1
may
IR uMer penalty of perjury.oOc of the following declarations
I ham and w01 milnain a Cu ifimm of Convent w self-insure fm WarkeYSCompcn-
Sailon,u provided pe
or by SeNon 3700 of the labra Cade,for Ne performa�of Ne
ooh for which Nis permit is WOcd,
0 1 haw and will maintain Wmkees Campemathm Insurance,as inquired by Section
37W of Ne labor Code.far the performance of the work for which this permit is smad.
My WarIme C pe cation mSa ata artiv and Policy number art:
Cartier. c Policy No.:
CSMIFICA XEMPnON MOM WORKERS'
COMPENSATION INSURANCE
(This senion need not ha completed iliac permit Is form hundred dollars($101)
or lam.)
I cemly that In the pafartmncu of the work for which Nis permit is issued,l shall not
employ any person in any menOcrw bcgOLne sub�'ajO w the Workdn'Cadpensadon
LAWS of Califoroi Data 1
Applicant 7
NOTICE TO APPLICANT:If.after making this Cenifume of Exemption,you should
become Subject,w the woheYs Com m adom pmvisiam of thd tabu Code,you most
Z foMwian comply with such provisions or Nis permit shall be demand!revoked.
ZO CONSTRUCTION LENDING AGENCY
[-t Ihereby M.that them is construction lending agency for the performance of
C> Sane woks for which this permit la issued(Sec.LMT,C+.C.)
W�A Lendn's Namc '
] z Landefs Address
U Q I cuufy that I haw read this applicmau and state this the above Information is
cored I agree to comply with all city and county ordinances and sate laws relating to
.J U Wilding conxtruedon,and hereby amhorm representatives of this city no cater upon the
Cn ahovo-mcnuoOcdpropery for i expenses
purpowhich m.
(We)agree to Saw.indemnify and keep harmless the City of Cupertino against
tU Z inconsequarac meth costs grouting espcnsesmitch may in any wyacenm against said City
U Z A APPLICANT
of dte UNDERSTANDS
of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS,
(C,-r-- 6 a 6 Re-roofs
Signature ofAWlimm/Caamm or Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building aaupsat port orhandle haurdou materw
as defied by dte Cupertino Municipal Cade.Chapter 9.13,am the Health and Safety
code.Sudan 355334)± 9�6 All roofs shall be inspected prior to any roofing material being installed.
0 Y.
Will the applicant or future building Occupant use equipment car deviate which If a roof is installed without first obtaining an inspection,I agree to remove
mil huWnus air contmommtt u Med by Ne Bay Ama Air Quality Management all new materials for inspection.
District]
0 yin
1 hew lead the heowdua maerhb requircmcw under ChapW 6.95 of the Califor-
uhHmlth&SactYCodc.Senions 35505,35533 and 35534.1 undersand u nifthe Wilding
dam not currently haw a tenant,haat it IS my responsibility to notify thin acumen,of the
requireme icmmIpriortossuanceoca
�uEcmeifaCcsdfmratuka .V L I Signature of Applicant Date
C
Owner us authorircd agcnl Dpb, All roof coverings to be Class °Bin or better
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 comp rth the above stated policy on re-roofing.
Homeowner's Name: Iy ck
Job Site Address: S Z Ll ! id4 C 13 it, 5�2w,A„ r
Roofing Company Name: YvI� er C,4j 9 � yl
Applicant's Signature: �� Date: 6
• Greg Casteel
Building Official
Revised 11/2/04
Community Development
10300 Torre Avenue
acm
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
#UPERTINO
Building De artment
JOB DDRESS: PERMIT #
SZLI of pl , 60
OWNER'S NAME: v, PHONE #
GENERAL CONTRACTOR ct:CA14 ED,-I- k I FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36611067 . 00
DATE ISSUED. . . . . . . : 08/16/2006
RECEIPT 4 . . . . . . . . . : 35648
REFERENCE ID # . . . : 06080114
SITE ADDRESS . . . . . : 7524 ORANGE BLOSSOM DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : CHU YORN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : AMERICA' S ROOFING
CONTRACTOR . . . . . . . : CHRIS CASTILLO LIC # 27100
COMPANY . . . . . . . . . . : AMERICA' S ROOFING
ADDRESS . . . . . . . . . . : 1650 S . 7TH ST.
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 661-6501
•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
---------- ---------- ---------- ----------
TOTAL PERMIT 137 . 86 0 . 00 137 . 86 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------
CHECK 137 . 86 340
TOTAL RECEIPT 137 . 86
•
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# / I '
Building Address: UC �v 1
51H to >0
Owner's N P} d#:
Coactor: t License
Contact: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 9iAsphalt Shingles
,Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) O Other(Specify)
Number of existing coverings ❑ 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 Policy:
Job Description• �3 1
561
Residential 71 Commercial ❑ G6_%
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Pro'ect: Type f Constructio . Occupant group:
ova e_r .� i
Qty. if
Applicable 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
•