06040125 CITY OF CUPERTINO
BUILDING DIV510N PERMIT £CONTRA GTOWINFORMATION,
aUILDING ADDRESS: LOS GATOS ROOFING PERMrr N0.06040125
10730 ORLINE CT
OWNER'S NAME: PERMTI ISSUE DATE
WONG SUSANNE Y AND ANTHONY Y888 FAULSTICH CT 04/21/2006
ONE:
SANITARY NO. CONTROL NO.
(408) 298-9399
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECTPLUMB MECH
l� O L! O
;op LICENSED CONTRACTOR'S DECLARATION
mlicensed
- Job Description
1 Icrtby affirm tat 1 am licen ed tanker provisions of Chapter 9(commencing P
:i9 wit Secdon]O )cfDivision3aftc Buri ma Profmium Codo.v mylmarrecis
rid inrallrorocaneer¢ D REMOVE EXISTING SHAKE ROOF. INSTALL 7/16" OSB
in in lull TeaClaLk.p
- o Dam coons err AND ROOFERS SELECT FELT. INSTALL PRESIDENTIAL T
ARCHnEJ as
CTS DECLARATunderstandshON SHINGLES
22 1 understand my plans all he uupublic o:cnrds
aaU
Licnmxd Pmfcuianal �'
Oat I am exempt
from
m Ce Contractors
ON
2 1 ..a affirm that i 1. exempt from am Canuaemh LLecn C Law for to
20 following mason.(Section Z Contract.
Business;and improve.
d000u Code:Any city or county
<m0. which rtquimsnpermit reenms to alcor.improve,dcermi ti ore a sig anyned ommurt
°iA 1A
y pnarmiscensed e.pursuant to the to applicant for Such Conueermitmfends,Lw(Cha mem
EE < NalLICe(commencing
pSRuanlladleofDivisiooftale acBuiemraRJYnxLaw(sCoca)9 Sq. F[. Floor Area /t/ 1 D
t~$ (cat he
ingwit Secuan]00dth Oiesisfron 3 of theeged ess assund mption.
My vi Coca)of AM/
-. Jeal he u eumpa t appli end am bum f« bj alleged exemption.Any violation of
.1Sector703L5 by vry red dollars
(a pemth aubjecu dee epplicant m a civil pcnelry of APN Number O e Type
not mom Nan five hoodoo dollars(5500). � y yP
I,uowlter of Jon properiy,«mY ooPlaym wit wagmuteusok campensaJon,
will aameumns aaaee:waonsommram is not,Licara Lawcloaffered forae a(See applyooincon Burnham359 Required Ins eC �ib,
and ery,wh oro Cade The Contractors cad w1io law am cot apply hf an owner of q p
con am who s.pro aimPtaw,ntImrove who amasuch worthimselredtrough his
awnver.dom,provideddialvem Improvements wi art awl ou ofctor aroRertd for tele If.
l
however.Ne Wilding or improvement us colas,didn arm year of c prove for
to owe of
builder will have the Wracn of proving Wl k did n«build do improve far puryate of
mleJ.
❑1,an owner of the property am ra clusivelY contracting wide licertxd cmntrvaoss in
Conswct the project(Sec.7014.Bminm and Professions Cade:)Thin Conlrxmr's U.
came Law does not apply to an owner of property who Wilds or improves termn,and
who co m cla for inch projem wit amnVacmr(s)heenxd pUrstom an this ean4Ylara
Liceme law.
❑1 Sm exempt under Sec. .B 6 P C far Nis myon
Ow u Dam
WORKERS COMPENSATION DECLARATION
1 bercby alarm under penally of perjury elm of Jm following dela sturc:
Cj I hew,and will atermin a Ceelfieam of Cament m ulGimurt f«Warta.Compen.
cation,u provided far by Secdan 3T(k3 of to Li WsCode.far Ne perferso nm of Ne
wort for which his Permit is issued.
1 have and will maintain Worker"Compensation Inw..as myuima by Section
37W of Me lab«Code.far ton performantt of to wart fat which this permits Rmtrr4
My Warier K don N rums carrier and Polity number vis..:�Y..aa ��++
Grier. Policy Ne.:OO O 4-0.97- Z ��
CERIIFICA OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
This xenon decd not lo completed ifft Permit Is fre e=hundred dallan(SIM) v
tor less)
1 comfy that in to Mramsrce of to work for which tin permit is issued.1111111 not
employ anymmen in any mannerx u in become subject IS to Wargo'Compenadan
Laws of Caliromia.Data
Applicant
NOTICE TO APPLICANT:If,after making Nu CemiOcam of Exemption.Tau should
became Subject m be Woi'mrS Campcmadon provisions of to Labor Code,you mute
.J 0 faMwit Comply wit Such provisions or is Permit shall W aecmil muted.
zgay CONSTRUCTION LENDING AGENCY
[—� 1 herby affirm our tart u a construction Lending agency far to performance of
E
Jte work far which Jtis Permit is slued(Sec.3097,Civ.C.)
�W Q
Larder"Name
= z Lenders Addrou
U0 I rotary that I have lead to;it"licvian and sum that to Slow,information is
I3. F Correa I agree in comply wit all city and county ordina es and arae laws mlaling to
O V Wilding construction.and hereby autome mPmxnetiacs arts city to order upon lW
ntionod
purpo
alowges judgru property for inspectionxerms which ms.
,1 y (loc)agree to saw,,indemnify and keep harmless tW City of Cupertino against
rA incoiuu,judc,of s,ewuand of this ponit. may in any way im«agafmueid City
U z A PLICA nee of tc granting of to permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �— Z/-YJ
SOU REGU T9p y ^O� —S
Z'
SignatureSignatureof ApplicanVCanuacmr Dam Re-roofs
HAUADOUS MATERIALS DISCLOSURE Type of Roof
Will to applicant of fume building oecupant IInrc or handle laudations th and Saety
u deli«a Section
dim Cupertino Municipal Code.Chapter 9.12.and to Health and Safety
Cause. Dy.
All roofs shall be inspected prior to any roofing material being installed.
41 ❑Ym r�'u
Will the applicant of to.Wilding amupanl us,cgaipmCnt or acvim which If a roof is installed without first obtaining an inspection,I agree to remove
emit harardnus air Contaminated as dcloca by to Bay Arca Air Quality Management all new materials for inspection.
Diseim?
❑Yon Nu
I haw mal the harardms mamrialsreyuimmens undar Chaymrd.95 of to Caliar-
niaHaltk SafclyCade,Sav«u 25505,25533 and 2553x.I nmtrsund derirtk Wilding
dm rot Currently Ww a W tatiImy mapomibilily mdir the occupeot or to
myuimmcnuw chmuvbemelno tmnaamaracerdrmamor0,27. Signature of Applicant Date
Owner«autoriroa.,CarDam Dam All roof coverings to be Class "B"or better
'
m, Community Development
10300 Torre Avenue
Cupertino CA 95014
• Telephone(408) 777-3228
CITY Of Fax(408) 777-3333
•CUPERTINO
Building Department
JOB ADDS O �� PERMIT #
��((// 060 (/0j2S
OWNER'S NAME: UOQ q JPHONE # Ypg
GENERAL CONTRACTOR i u a o ;� " FAX # p _
I am not using any subcontractors: �� 0 6
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
O r%Contractor Signature at
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY Of Telephone: (408) 777-3228
• C PEkUrIN® 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 building4nnspector. 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-progiess 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.
EWPORTANT:
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 in
I understand and will coma12#"
lwith the above stated policy.on re-roofing.
Homeowner's Name: / &)(11/ 1
-__ __Job S:te_Address:_______,,_( o
- - -....
00 � Coin'-azi-Nam
A plicant's Signature: Date:
Greg teel
• Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
OLm 1 of • 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35922057 . 00
DATE ISSUED. . . . . . . : 04/21/2006
RECEIPT # . . . . . . . . . : 34089
REFERENCE ID # . . . : 06040125
SITE ADDRESS . . . . . : 10730 ORLINE CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WONG SUSANNE Y AND ANTHONY Y
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4351
RECEIVED FROM . . . . : LOS GATOS ROOFING
CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481
COMPANY . . . . . . . . . . : LOS GATOS ROOFING
ADDRESS . . . . . . . . . . : 888 FAULSTICH CT
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 298-9399
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 11, 000 . 00 180 . 36 0 . 00 180 . 36 0 . 00
BSEISMICRE VALUATION 11, 000 . 00 1 . 10 0 . 00 1 . 10 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 181 .46 0 . 00 181 .46 0 . 00
•
CITY OF CL]PERTINO
REROOF 0(00q 0
OF
CUPER-TING PERMIT APPLICATION FORM
• APN#
jJ9 - -2- -03 7 Date:
Building Address:
10170 Mine C
Owner's Name: Phone#:
Contractor: Cp Pho #: O License#:
- X00 J0
Contact: �- Phone#: Cupertino Business Li�n e#:
% Sairn�
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
Wood Shakes ElWoodShales
Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify) -7 el S/3
Number of existing coverings 1 12 Provide LC.B.O.Rep u
�. To be Removed ❑ Provide Mfg.Installation Specs.
I Have Read, Understand and Will Com l With Cu ertino's Te Off Polic
Job Desc 'ption: P-)�2�;yt
/tr�� .Clio SeG�ei �1 ter, �P f4. _ 7�q/ J
Residential f rxr
Commercial
Fire Zone: Yes ❑ No
Uonfrrmed with Planning Det.
there are any restrictions: LJ
st of Pro ect: Type o Cons7ucti Occupancy group:
?, 3 0 k ;�
Qty. if
A licable Fee ID Fee Description Fee Grou
BPERNIFEE Bldg Permit Fees BUILDING
BENERGY Energ
�
BUH-DING IICRE _. —
SeismicFeel2es._._._
BSEISMIGOlv1 -- - DING __ .
Seismic@ommercia� __BUIL-DING
_ —
Plan Check FEE----
- - -
B� DING
Business License BUILDING