08030121 CITY OF CUPERTINO
BUI!uDINCDIVBSION PERMIT _� a «xasacs " 0PERP1'
k
BUILfI�c��D�REPART AVE SHADOWFAX ROOFING 08030121
OWNER'S NAME: PERMIT ISSUE DAM
WU QIURONG AND YU NI 1366 SANTA FE DR 03/21/2008
NE: (408) 265-2490 SANITARY NO. CONTROL NO.
ARCHMECT/ENGINEER: BUILDING PERMIT INFO
BLDG EIFCT PLUMB MECH
0 0 0 0
o o LICENSED CONTRACTORS DECLARATION lob Description
e F 1 hereby arm Nat 1 sm limmeed under provisions of Chapter 9(commencing
nSj nl with Suiten 7000)ofDivisien 3 Ofde Business and PrOrcuicn Cado,etd my license is RE-ROOF,RMV EXSTNG SHAKE,RPLC W/40YRCMP CLS A
6y n full fore.end effact
� 5 License 1 s Lic.R 'Z 27SQ
e Dam Conuacmr W
,Ell
ARCHRELTS DECLARATION
I I undamand my plass shall taunted as public recoils
k LL LiOurad Pmfculonal -
ym OWNER-BUILDER DECLARATION
iI Ieroby M.that I me camps from the Ctut ram's License law for the -
p O fOlbwing moon.(Section 7111I.3.Business ad Profusion Code:Any city Or county
$ which acqubes a permit W..L a@e Improve,demolish,or per,any Mae. -
_Zj, prior m its intense,also acquires to applicant forsuch permit to file a signed aummens
< thus W is licensed pursuant M to provisions of the Contractor's License law(Chapw 9 Sq.Ft.Floor Area $7947 Valuation
s
9 (commencing with Station 700M of Division 3 of the Businesend Professions Code)or
Nat he Is comps thmfrom and the bub for the alleged assumption.My vlolNon of
Section 7031.3 by any appllunt fp a permit sebjecu the APPlmat to a civil party of Number Occupancy Type
at more thea five hundred dollars,(5300). 36925012 .'l7'l1'
01,uownerofDiepmpmy.vermywployeuwithmguuth knlcmmpe don,
ad��w N coadke The co actoes m LA dOul`an,a( to a,,.a,a Required Inspections
property who boldsorimproves deacon,ad who doessuchwork hWuelforduough his
awn wnployee,provided that such impammal,w not intended.remote el for RkL If.
however.the building or Mprovemmu Is aid within arc yeti of compmuon.the caner-
Wilder MB have the burden of paving that M did at Wild or improve for purpose or
tele.).
❑1.as Owner of use property,am exclusively canoeing with licensed camscton to
conawet the project(See.70th,Business and Prefeetiaa Code:)The Con rscter'a W-
time law,does ons apply m an Ower or pause,who builds or Impact.demon,ad
who central,for such projects with a conuumr(s)licensed puraans to the Comesaah
L iceva Law.
❑Inmc.mptades See .BRPCforthis.
OwnerDae
WORKERS COMPENSAOON DECLARATION
I hereby ailuro under peaky of pedury ore Olden following Eecla udow:
1 ham ad will mainWn s Cer ifium of Comsat to calf-laum fur Worker's COmpen-
mlun,a provided for by Sidon 3700 of the Labor Code.for the perfomta a of the
work for which this permit is issued.
❑1 have ad will mainWn Workers Compensation Inmrutce,u acquired by Section
3700 of the Labour Code,for the per(ermace of W wart for which this permit b lamed.
My Workers Compensation lamace amu and Polley number em:
cairn r9y�glfb/!cr(� PolicyNo.: ave* 'AldZSa
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(nslseeNu need not becomplemd Ude permit is foruehtndned dOBan($100) ,
or mu)
1.unify met in the performance of the work for which this Permit is land.I shall na
employ any punch in any manero as On buena object to tie WOrken'COmpemadon
Laws of Califernil.TWO
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Esmond...you sham
become subject to the Workers Compensation provisam;of W labra Code,you most
0 Mcomply mply with such Prevision or this person shall bmW
e deerewind.z0 CONS ucnON LENDING AGENCY
E4 I hereby affirm dust then I..comanin t lending agency fm the pMamana of
CL> de wart for which this permit b issued(Scc.3097.CW.C.)
0 Lenders Name
,z Lenders Address
fJ t—
correct
cerdfy that I ham sad this Oppression and sum that ft Above Information is
Dr t— 1 agree to comply with all city ad county Ordnance,and solaw ac
le lating In
.0 building construction.and hereby athoudn representatives Of this city to amr upon the
W Now-mendmted property for inspection purpoos
(We)agree to an.indemnify ad kap hamrmn the City Of Cupmino agalut
I..'�fn Ilabilidu,lWgmcvu.caste adespenses which may in ay way wane Maim and City
U Inanee rff OlthegMrobWIL _�I )
APPLICAUNDERSTAANDND;AND
WILL COMPLY WITH ALL NON-POINT Issued by: Date
SoUggotGULA31ONS.
2C�P_
09_' Re-roofs
uta or liven le
AZARDORDOUS MATERIALS DISCLOSURE Type of Roof
WIII theCupentoofuni building neapatstoac Or handlewu
hatlomaterial
u definedthe Cupeby NM
vo Municipal Code.Chapter 9.11.and the Health ad Safety
Cam.SeWu 2T531(a)T All roofs shall be inspected prior to any roofing material being installed.
Yes
Wiil the opuses Or f'ummbubnilding occuFam um equipment ver deAca which If a roof is installed without first obtaining an inspection,I agree to remove
hk it husdnu air cuumunu u mde irdcOd by Bay Am.Air Quality Ma ncm.nt all new materials for inspection.
dcR
❑Yu u
I ham mad due b adea mamdals immenuumYr Clwpur6.91 Orden Califon
out Hinds@S9myCcde,Smion 15305.25333 am125534.1 undcmad thatlfde building
dos on curmndy hew a uneraLvdtat It is my reepomibility to tmufy de temp fit of Ne
req nu winch mea enc 'Ormisu .Certificate Of Signature of Applicant Date
a fl
I ver at 3e again Dam. All roof coverings to be Class'J�."or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36925012 .:00
DATE ISSUED. . . . . . . : 03/21/2008
RECEIPT # . . . . . . . . . : BS000004227
REFERENCE ID # . . . : 08030121
SITE ADDRESS . . . . . : 10460 RAMPART AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WU QIURONG AND YU NI
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4525
RECEIVED FROM . . . . : SHADOWFAX ROOFING
CONTRACTOR . . . . . . . : JERRY SHAFFER LIC # 27342
COMPANY . . . . . . . . . . : SHADOWFAX ROOFING
ADDRESS . . . . . . . . . . : 1366 SANTA FE DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95118
TELEPHONE . . . . . . . . : (408) 265-2490
• FEE IO UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 7, 947 . 00 0. 80 0. 00 0. 80 0. 00
1REROOFRES SQ FEET 27 . 00 351 . 00 0. 00 351 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 351 . 80 0. 00 351.80 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 351. 80 #6791
---------------
TOTAL RECEIPT 351. 80
VOICE ID DESCRIPTION VOICE ID DESCRIPTION '
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
605 FINAL REROOF
•
CITY OF CUPERTINO
alo ,
REROOF
•CUPEII;TINO PERMIT APPLICATION
APN # Date:
Building Address:
/D Q
Owner's Name: Phho/ne #:
Contractor: Phone #:
S/ wl�0?, /` UDT` ` Fax #:
Cupertino Business License #: VContractor License #:
gq y�,
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles pO Asphalt Shingles
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.
Job Description:
iDS
kcsidentialCtSj., Commercial
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: ❑
Valuation:
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
•
Si ature
�. CITY OF CUPERTINO
REROOF
�CUPERTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
1REROOFRES Re-roof Residential B 1SFDWLR00F
/ 1BSEISMICRE Seismic Residential B
1RER0,0FMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
All
1BUSLIC Business License B
•
Community Development Department
1 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: / /,�,E
Job Site Address:
Roofing Company Name: I�B fL Ti
Applicant's Signature: Date:
• Greg Casteel
Building Official
Revised 11/2/04
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
St
CITY OF Fax(408) 777-3333
SCUPERTINO
Building De artment
JOB ADDRESS: � PERMIT #
OWNER'S NAME: PHONE # OS- t7- 91—,-5a
GENERAL CONTRACTOR: u, FAX #
I am not using any subcontractors: Z D�,-'
Signatur ate
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
er/Co ctor Signature 16ate