06080233 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONT'�+�RACTOR INFORMATION,
. �iuFhxEt'.'f"..,a.
BUILDING ADDRESS: PRINCIPLE ROOFING & PERMIT N0.06080233
1272 POPPY WY
OWNER'S NAME: PERMIT ISSUE DATE
EMILY CHANG 1700 NORTH IST STREET. #114 08/29/2006
NE:
SANITARY NO. CONTROL NO.
(408) 436-1681
ARCHffECT'ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0 0
loo
LICENSED CONTRACfOWSDECLARATION Job Description
m 1 bmcby affirm that 1 am licensed under pmvisimu of Chapter 9(Commencing
with Section 7000)of Division 3 ofihe Burnous and Professions Code,and my license is
in f.11fare.mdeft. REMOVE EXISTING WOOD SHAKE. INSTALL 1/2" OSB
Qy, u<anse aur ; Ue.a ;316 30T
-_o Dow _Contacts, aTwanurin reef— SHEATING & ASPHALT SHINGLES . CLASS A
ray ARCHITELTSDECLAR TION f
i a 1 understand my plans shall he used as public records
IyU
°�t, Limmcd Pmfessianal
OatN"m BUILDER DECLARATION
3 1 botchy.(Sere that 11. uempt from the Cantons Co e:Anne Law for the
S O following moon.(Benton 71131.3,Business and improve,
de am h.or Any city at county
1$w which its esu n permit re Construct,ills,improve,demolish,or repair any modem
.zY prior to its issuance.also requires theapplof for each Combermitmfikse,Law(Chapter
�<
that Ieislicensedpunuanttom provisionsof h Canis mr'sl rax aw(Chapm9 Sq.Ft. Floor Area Valuat$fl600
(commencing with Section 7000)of Division 3 of the Business and Professions Coca)or
that he is exempt therefrom and the basis for me alleged exa m rdon.Any violation of
Section 7031.3 by any applicant for a permit subjccu be applicant to a civil penalty of APN Number Occupancy Type
not mom thm Eve hundred dollars(5300} 3 6 619043 . 00
I,uown..of the prolsmsy.amy employees wire wagesuthev sole compcwtion,
will dome work.and me swctum is not intended or offered for sale(See.7054,Business
and pmfessiam Code Tat Centimeters License law does mot apply m an owner of Required Inspections
property who builds or improves thctmn,andwhodoessah work himselfor Waugh his
owes<mployces.proNded mawch impmvcmmu anot inwMed aro@rt Ma cr nL
l
. ra
however,me building or improvement i¢sold within oyea orcomvo-pleW owner
builder will have me burden of proving ren M Oitl not Wild w improve fa purpose of
sok.}
1,u mvner of the property am uelusively contracting wire BceesN m nbec urs to
construct the project.(Sec.7055.Business and Professions Code:)The Contractors Li. p
cense Law does not apply as an owner of p opcny who builds or improves daemon.and
who contras for such projects with a eantrai licensed pursuant to the Cornmetar's ((•�
License law.
❑ m Law.
laundo See .B&PC for Nu moan V
Owner Date
WORKER'S COMPENSATION DECLARATION
41 1 hereby afMn under penalty of perjury oat of the rollawing ddontiam:
1 bare and will maintain a Cenifina of Consent to ulf insure far Warkcrs Compcm
sazion, I vtdtl for by Section 3700 of the Labor Cads,far the performance of lM
wM which this permit is issued.
l base and will maintain Woraces Compcmatian Insurance,u banned by Section
37W of me Labor Codc,for the performance of the work for which mu permit is issued.
My Warkcrs Compensation Insurance Cartier and Policy nu�mpber/saae:
Carrier, YYiif'G�'�LIAJa) Policy No.:_a]I /8lS'-ZUl16
CERTIFlCATE OF aEM MON FROM WORKERS'
COMPENSATION INSURANCE -
(This if.need not he completed ifun, .it is faro.hundred dollars(SIM)
or leu)
I cenifv that in the perrotmance of the wank for which mer permit as issued.I shall not
employ any person in any manor so u it become subject o the Workers Compcmadon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject m on,Workers Compensation provisions of me Labor Codc,you mus
Qforthwith comply with such provisions or this permit shall he dccmed revoked.
z "" CONSTRUCTION LENDING AGENCY
[-+ I hem by aRrm Wtmert iso ILI ronswcleading agency,for the performanm of me work for which this permit is bound(SJ09'/,Civ.CJ
ILI
0. A Lender's Name
= z Lenders Add.
U O 1 certify that I have read this application aM show this the above information is -
Ly coram.I agree to comply with all city and county ordinances and suite laws mladng to
U building construction,and hemby aumorim rcprescmatives of this city to enter upon the
0. ahovomenumetlpmpeny for imanms purposes.
(We)agate to save,indemnify and kmD harmless the City of Cupertino against
UZ inconsequedgmcns,cossmd expcmes which they in any way acrncagainIIsaO City
U z APPLIC NTeof late UNDERSTANDS Aranfing of ns Permit.
ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE EGULATIONS.
06 Re-roofs 92,
��----
Signature:a ApplicmUCoDani
S MATERIALSDISCLOSUREType of Roof
Will deapplicant or future building ac Capt store or and hanAaanmaterial
u dsOned by quiupertino Mum 1 Codc.Chapter 9.13,and the Mea1N and Safely
cads.SCY.zss32(a)7 All roofs shall be inspected prior to any roofing material being installed.
41 ❑Yes Nu
Will the applicant or forum building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit harardnm air mnhominanta u fired by the Bay Area Air Quality Management all new materials for inspection.
District?
[3 Yes
I have read In,hvaNcws macrialsrcquiremcrosundr Chapmrd.95 of lM Caliber.
-is Hwim&Safety Cad,sections 35505,25533 and75S35.l undcrsund thaif da building .t
671does not currently ham a meant.mat it a my responsibility to notify the occupant of Ne
mquiremcnta which must be met prions ismance of a CcniOcauto/Occupmcy.f S1gnalUre Of Applicant Date
�i�o/
owner or.amariand,g<ntF Dam I All roof coverings to be Class n$rr or better
Community Development
id,
0 Torre Avenue
Its
C10p rtinno CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
4§UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
4 2 lT2 ra 9-0 Zr:3 7
OWNER'S NAME: « Cr lam PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: �� t _ ?) g ju C
Signature Date
Please check applicable 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
• d 2-L_y 4� 3Y Ly O6
Owner/Contractor Signature Date
CITY OF CUPERTINO
om 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36619043 . 00
DATE ISSUED. . . . . . . : 08/29/2006
RECEIPT # . . . . . . . . . : 35809
REFERENCE ID # . . . : 06080233
SITE ADDRESS . . . . . : 1272 POPPY WY
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER EMILY CHANG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : PRINCIPLE ROOFING
CONTRACTOR DERECK LOI LIC # 27564
COMPANY PRINCIPLE ROOFING &
ADDRESS 1700 NORTH 1ST STREET, #154
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE (408) 436-1681
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- -- ------- ------------- - - -------- -- - --- --- ----------
---------- - ---------
BPERMFEE VALUATION 8, 000 . 00 147 . 96 0 . 00 147 . 96 0 . 00
BSEISMICRE VALUATION 8 , 000 . 00 0 . 80 0 . 00 0 . 80 0 . 00
TOTAL PERMIT
148 . 76 0 . 00 148 . 76 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
------ - - - --- ----- ---------- -- --------- ---------
OTHER 148 . 76 MC
TOTAL RECEIPT 148 . 76
•
CITY OF CUPERTINO
Suw_
REROOF
• CUPERTINO PERMIT APPLICATION FORM
APN# -2 19 ^,rVVL( Date: p,P/19 0 6
Building Address: 1
12 -72
Owner's Name: Phone#:
c4Ud) 666 - 860 '
Contractor: License#:
Contact: Cupertino Business Li ense #:
26G� ltii` .�U
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑/Built-Up roof
❑/Asphalt Shingles � Asphalt Shingles
l3' Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ 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: 1 it
U /Z 7
lerttitOvi:/G'�77; Nor '^fid° u t�H,adGC, .�NSf7tL(, asl3 S�C¢1-Tta�r/(r F+S #Ai S
Residential Commercial ❑
Fire Zone: Yes O No Confirmed with Planning De I. if
there are any restrictions: u
Cost o� �� Type of Construction: Occupancy group:
i
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Emrgy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
•
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 fust 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: 12 .72-
Roofing
7LRoofing Company Name: N�� �� j�co.✓SY��2c�n�
Applicant's Signature: Date: 69 aJf o6
Greg Casteel •
Building Official
Revised 11/2/04