06050025 E
OF CUPERTINOLDING,DIVISION PERMIT CONT"CTOR INFORMATION ADDRESS: R E ROOFING & CONSTRUCTIO PE�No06050025
76 RAE LA
OWNER'S NAME: PERMIT ISSUE DATE
MINAE LEE 15230 CLYDELLE AVENUE 05/03/2006
IN NE:
SANITARY NO. CONTROL NO.
(408) 626-9320
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� 0 � 0
ioG escr
LICENSED CONTRACTOR'S DECLARATION Job Dl Iion
Vc 1 hereby affirm Out 1 am licensed on&,provisions of Chapter 9(commencing P
with Scstirr`i=)af n of 9udncatand Prefessiwu Code.. mylicenu is
nm0fnr aMerf REMOVE EXISTING 1 LAYER OF WOOD SHAKE, INSTALL
,n— License Class Lie.
-moo Dam Cony r 30LB ASTM FELT & LIGHT WEIGHT CONCRETE TILE
'££� ARCH ECTSUECAR EAGLEITE CLASS A OR B
f C-s 1 understand my p shall W used v Rub c scuds
>yU ���
e C H Licensed Professional
"',a g OWNER-BUILDER DECLARATION
I I W rchy...'res that 1 am nxempt from dm Contractors License Law for tW
°o following reason.(Section 7(D 1.5,Business and Pmfesdom Code:Any city or county
3 m which meet.a permit in construct alcor,impress.demollah,or repair my structure
prior m its issuance.also requires the.pplkant far such permit so Bk asiBneJsummcnt
INAAI< RD
thin he is licensed punuanttothe provisions of0.cmunnaur'sl.more. aw(chapter 9 Sq.Ft. Floor Area Valuation
monamencing with Section 70DO)of Division 3 of this Businces amt Proressiones Cods)or $17000
y that be,Is mmpt lMrefrom and the basis,for ds,alleged exemption.My violation of n
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of APN Number 4uuu Occupancy Type
not mom than Bw Waited dollars(5500).
❑1,as owner of Ne property,w my employees with wages u their role compenssJon,
will all,the work,and Ne swctum isnot laureled or offered fo..ae,(Sec.7614,Bud.
and professore Code The Cantsanors License Law doer.1 apply he an owner a
progeny who builds or improves thereon,and who doesauch work himulforthrough his
awn employees,provided that such improvements art notintentlel oroRered for sale.If.
however.the building or improvement is sold within one Year of completion,the owner,
butane will have We burden of proving dot M did nm Wild or improve for purp om of
sok.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to
commie,the project(See.7045,Business and Profusion Cade:)The Coatramors U.
come Law,dam not apply in an owns of property who Wilds,or improves dmmon,and
who contracts for such projeeu with a comminevor(s)licensed puruant in the Contractor's,
Lkenu Law.
0 1 am exempt under Sec .B d P C for this mason
owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby L firm under pmulty of perjury m s of the fallowing declarations
I ham and will maintain a Cmtificam of Consent to self-intim for Workers Compere
s,atlan,as provided for by Seetion 3700 of the labor Cade,for the performance of the
Coro or which this permit is issued.
1 haw and will maintain Workers Compensation Insurance,u lequired by section
3 of Ne tabor Codc,for the pciftrmanne of the work for which this permit is his
My ormkcess vC..olmpe�nsationfhstram.cacarrier and Policy number are: -
Carricr. .J I /L 1 C g'al"�1/ Polity No.:
CERf1�FICATE OF J EMF'r10N FROM WORKERS'
COMPENSATION INSURANCE a
(This maim need not be completed if the permit Is far one WndmddoBan($100)
or leu)
I certify that in the perfornmr se of the work for which this permit is Issued.I shall not
employ any person in any mamas as To become subject in the Workeri Compeesation
Laws of CaBfomia.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become aubjcet in Ne Workers Compensation provisions of the L.W,Code,you mtm
.JO forthwith comply with such provisions or this permitshall To declined rc
ded wked.
Z" CONSTRUCTION LENDING AGENCY
[—i I herebywhihmm Nat Nem is s ed(Section lending agency for the perfurmaoac of
VA tW work fur which this permit u L6UfA(Sec.1097,Civ.C.)
VA
Q Lcrtticrs Nmnc
=z lenders Address
C)Q 1 certify Nat I have lead this application are .in that thc above information is
ly F^ cones.1 agree to comply wit all city and county ordinances and sum laws mlating to
O V building construction.and hereby authariar npmxrn0tivesar this city to come upon tlm
W aWve-mentioned propery for inspection purposes
F 04 (we)agmc m save,indemnify and keep harmless Ne City of Cupertino agal
en liabilities,judgencnts.costs andexpceses which may in my
ynaccste agaimt im
sail Ciry
V z in eomrgmoec of the ranting of Nu permit
A PLI NT UND AND`ND WI COMPH ALL Np p� Issued by: Date S—�. D 4
SOURCE ULA710N . _ (L I I
ISi�m ser ApplicmUcantract r am Re-roofs C
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dm applicant or future Wiltlin Mae.
in hvaNaus mamrial
as defined by the Cupertino Mon es ode,t]upmr 9.12.and the Health and Safety
cntle.Otion zss3z(a>+ All roofs shall be inspected prior to any roofing material being installed.
MY. No
If a roof is installed without first obtainingan inspection,I agree to remove
Will theapplicant o Tuturt building wcupam use eyvipmenl or devices which P g
emit hi.mmus air counters.ants m dc0nctl by the,Bay Area Air Quality Management all new materials for inspection.
District
0 Yea
I r�ad.thah mumamria menu under Chaper 6.95 of the Cable,
ria FicaW cry Code.& 'o(u 35505.25533 534.I undcnwd Nu ifdm Wilding
Jaei cwt u n y�Iwve mnmtVltT t it k m¢rmpo bilitY a notify dee aaupmt n(
myuim cuts 1 t emelp r rp CLC ma/Ocapmry Signature of Applicant Date
owns.nr.wnarirrl,g<at/ DareAll roof coverings to be Class"B"or better
CITY OF CUPERTINO
am 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 35607028 . 00
DATE ISSUED. . . . . . . : 05/03/2006
RECEIPT 4 . . . . . . . . . : 34226
REFERENCE ID # . . . : 06050025
SITE ADDRESS . . . . . : 22076 RAE LA
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : MINAE LEE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4031
RECEIVED FROM . . . . : RE ROOFING & CONST.
CONTRACTOR . . . . . . . : PROCTOR, PAUL LIC # 20615
COMPANY R E ROOFING & 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 17, 000 . 00 245 . 16 0 . 00 245 . 16 0 . 00
BSEISMICRE VALUATION 17, 000 . 00 1 . 70 0 . 00 1 . 70 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 246 . 86 0 . 00 246 . 86 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
--- -------------- ------------ --- ---- -----------
CHECK 246 . 86 9958
TOTAL RECEIPT 246 . 86
•
. Community Development
e 10300 Torre Avenue
k✓" Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
WUPERTINO
Building Department
JOB ADDRESS: 2-20(o �At N� PERMIT # Ol _ /1 V/�` 0 .2
OWNER'S NAME: i_. PHONE # L4 0 ! l( '2-Gl �275-
GENERAL CONTRACTOR: 5 FAX #
I am not using any subco tractors: `�
Si tune Date
Please check applicable subcontractors an �lete 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
' e
r/Con e or Signature Date
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: W hl:
Job Site Address:
Roofing Comme: �� F u LD IJ 5 tZcn.CiTI `rf C
Applicant's Date:5 -3 oho
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO 0(.005oo2.5
REROOF
• CUPEkTINO PERMIT APPLICATION FORM
APN# 55u-- 01— O,�_tl Date:
Building Address:
Owner's Name: Phone#:
Contractor: License#:
� ,DoY-)hl - `� (�Js�r�fn.c.+IoN � 15 �
Contact: / , Cupertino Business License
J/ #:
sl)I c, �C��1Z � o(D 1�
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) 12r, Other(Specify) L-r V`�T• 1 Ll-,�
Number of existing coverings 'RProvide 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 Polic
Job Description: - (,�tive �,XI S fwI L-A/401,_ * WoJI) k Ny(�I {_ i� r4
f wF atm t c " ` I �"
Residential Conuner6ial ❑ (S
Fire Zone: Yes ❑ NoConfirmed with Planning DMt. if
there are any restrictions: u
Cost of Project: 17 vv Type of Construction: Occupancy group:uob , v ti -3
Qty. if
ApplicableFee 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
•