06020023F�d
CITY OF CUPERTINO�'-'
r ,- �` r %,', °6 ``'
=CONTRACTOR INF�ORMATIO
BUILDING DIVISION PERMIT
BUILDING ADDRESS:
OLD COUNTRY ROOFING
PERMIT NG.06020023
1398 ROSEGARDEN LA
OWNER'S NAME:
FERMTT ISSUE DATE
CHRISTY CHOU
125-B GROBRIC CT
02/03/2006
NE:
SANITARY NO. CONTROL NO.
(707)864-5557
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
o
1 hereby affirm Nat I am licensed under provisions of Chapter 9 (commencing
with Section 7") of Division 3 of the Business and Professions Code, and my license is
in mB face and of qL�y 2 7 3
TEAR OFF SHAKES & RE -SHINGLE WITH COMP SHINGLES
LI.enR Lk. N
Das Convector
ARCHITECTS DECLARATION
I understand my plats shall, used u public records
/`w
� Y Qpg��}
Licensed Professional
OWNER-BUIMER DECLARATION
Ory j..
'4NIF�
I hereby affam Net I am exempt from the Contractors License Law for the
e/ly1'
fallowing moron. (Section 7W 1.5. Business and Pmfc aiom Cade: Any city or county
to enrsuuel Mur. Improve. dcmnlish, or repair any svucto.
I eft J
I� $12000
which requires a Permit
! pdormiuiuuauc,almmquimstWapplicanlforsuch permiuofilcasignedsutement
the the ConlraclOT'S Uucme Law 9
Sq. FC Floor Area
Valuation
Men he is licensed pursuant to provision of (Chapter
(cammcncing with Secuan70W)nf Division Jof the Busi^..•and Raresions Code)ser
1 Nat, is exempt therefrom and t, bus far MA alleged exemption. Any violation of
t
Section 7031.5 by my applicant for a permit subjccs the applicant to a civil penalty of
T
y Type
not mom dun five hundred dollars (5500).
_
❑ 1, As owner of Ne propeny, or my employe" with wages As their sale compensation,
will do the work, and the structure is not intended aOffemd tonal. (See. 7094. BusinW
Required Inspections
And Prfessiom Code: The Conuaclors U. law dote trot apply to an owner of
property who builds or improv themon. and who does such work hmeelf or duough his
own employees. provided that Such improvemcnu ail not intended oraRered forsale. If,
however, Ne building or improvement is mid within one year of completion. the owner.
Wilder will have But bum" of proving that, did vat Wild or improve for purpose of
sal..).
I, As Owner of dx pmpcny, am exclusively contracting with licensed contractors R
construct the project (See. 7044. Business and Professions Code:) The Contractors Li -
come law docs not apply to an owner of property,who Wilda or improv Burton, and
who contracts for such projects with a chemicals) licensed pursuant to the COnvacto's
License Law.
❑ I am exempt under Sec. ,B&PC for this mown
Owner Dart
WORKERS COMPENSATION DECLARATION
10 1 hereby affirm under penalty of perjury arc of ds following declaruiom:
I haw and will maintain a Certificate of Cement m self-insum for WorkcrsComber-
ution, as provided for by Section 3700 of the labor Code, for the performance of We
work for which this permit's issued.
1 have and will maintain Worker's Compensation houmnw, u required by Section
W of the LaWr Code. for mW peormse nm of the work for which this permit is issued.
My Work e�r�s Comeppemauon �y+m" rod Policy numla, Am:
linsu�rma
Cimler:_[t.tA'F i Y^"^ /"'Policy No.: /1 J 3 P/ /_
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
.
Aids men. recd not W completed if t, permit Is ("more hundred dollars (5100)
or "i)
I certify But in Inc performance Of the work for which this permit is iuu.d. I shall not
employ any Korea In my mMMfm at or become anbjecl to the Wmkxo Compensation
Laws of Califun da. Date
Applicant
NOTICE TO APPLICANT: If. after making this Certificate of Exemption. you should
become subject in the Worker's Compensation prwislom of t, IabIr Code, you most
forthwith comply with such provisions Or this p.amil shall, deemed reveled.
1
CONSTRUCTION LENDING AGENCY
I hemby alRrtn that Nem is a construction lending agency for the performance of
the work for which this permit is issued (Sec. 3097, Civ. C.)
lender's Name
leaders Add.
t 1 certify that 1 have mad this application and sate that the above information is
comma I agree to comply with all city and county ordinances and sok laws rdning m
Wilding anSYunidn, and hereby authorize repmsenuliws of this city to enter upon the
above-mentioned property for inspection purposes
(We) agile to eve, indemnify and keep harmless the City of Cupertino against
liabilifin judgmenu,coss and expenses which may in my way aceme against said City
%V�(Date
in consequence of Ne granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: 2/� d �'
SOURCE RE&UI,tWOC(S.
n Y/; `
/uactnr �r ` a
Re -roofs
SmgapYR of Appld[an nvactor Date,
te
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupant store orhandlc hmarmsus material
H defined by the Cupertino Municipal Cod.. Chapter 9.12, and d® Health and Safety
Gude. Section a25532(a)7 No
All roofs shall be inspected prior to any roofing material being installed.
Will thea liemlor future WBdia acct
pp [ pool use equipment or which
If a roof is installed without first obtainingan inspection, I agree to remove
P
UI us air contaminants u defined by the Bay Ama Air Quality Management
Mann
all new materials for inspection.
District'
Disvim?
❑Yex nN
ba7wdus requirementsunderChrsund.95o
til& road! thode,Suoms
aut25under Chepandthatoft, Calwithin,
lJ �I
Act H"Ith&Bron Ce 2550als
25305.2553 the Califon
�/
dars not cunendy hoe a tenant Net it is. my respmuibilay m notify de occupant of the
/JG%� _ /—
^� O
requirements mus rinrmaaa a f.comicam.foca y
Signature of Applicant Date
Z � 06
All roof coverings to be Class "B" or better
g
Owner ser
am prized a[enl ate
CITY OF CUPERTINO
1 Of 1 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Elk: Lot:
APN ........: 36617038.00
DATE ISSUED.......: 02/03/2006
RECEIPT #.........: 33074
REFERENCE ID # ...: 06020023
SITE ADDRESS .....: 1398 ROSEGARDEN LA
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: CHRISTY CHOU
ADDRESS ..........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014
OPERATOR: bethe
COPY # : 2
METHOD OF PAYMENT
-----------------
OTHER
TOTAL RECEIPT :
•
AMOUNT NUMBER
------------ ------------------
192.36 VISA
192.36
RECEIVED FROM ....:
BONITA JENKINS
CONTRACTOR .......:
FOLK, DIETER LIC # 20389
COMPANY ..........:
OLD COUNTRY ROOFING
ADDRESS ..........:
125-B GROBRIC CT
CITY/STATE/ZIP ...:
SUISUN, CA 94585
TELEPHONE ........:
(707)864-5557
-
•
FEE ID
----------
UNIT QUANTITY
-----------------------
AMOUNT PD -TO -DT
----------
THIS REC
NEW BAL
BPERMFEE
VALUATION 12,000.00
-,---------
191.16 0.00
----------
191.16
-____----_
0.00
BSEISMICRE
VALUATION 12,000.00
1.20 0.00
----------
1.20
0.00
TOTAL PERMIT
----------
192.36 0.00
----------
192.36
----------
0.00
METHOD OF PAYMENT
-----------------
OTHER
TOTAL RECEIPT :
•
AMOUNT NUMBER
------------ ------------------
192.36 VISA
192.36
•
0
:S
•
JAN-30are
-2006 13 � 21
CUPEkTIINO
OLD COUNTRY ROOFING
4087828301 P.05
Community Development
10300 Torre Rve=
Cupecdno CA 95014
Tekpbone (408) 777.3W
Fax (408) 777-3333
Building Department
FE>?.1vKrr # a i7 U 2, v o Z?
CN asTy GIadU NIONE # 9forT
RACTC RvO L—J C A ti N-rrz-t r`AX # 440 )" -- �Z
I &ln,not usznS any subcontractors:
r I.X® oG
Sigreure Dote
please check ovlicable subennkactors and conlriete the foLowine tr'ormadon;
"LJSC:0Nr'RA'roT
BUSINESS NAME I BUSINESS LICENSE
J C mcl< Re Nfillv.,�rk
I
Fzdslting
—�
_Cement
L-lectrical
r
Excavation '
Fencing
I_._._�
.Flooring: Cazpet;r�
i
_ _
_
L :nolc• m / Wood
Glass / Glazing
I
Heati�
�!
=Lnsulation _
dscapin
-
r---
Ort:'u'nental Sheet Men �
lllo°�nti �^
P,ladtering _
Ptumbtng � �
Roofing
pleta.i
Sher; Rock _ - �-i—
`__ TUe
�-
Own er/COntracttlr Signature
l 3o% 6
Date
IV
TOTAL P.e5
1
CITY OF
UPEkTINO
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:
Job Site Address: / 3 g
Roofing Company Name: Xo( eyz c ,1
Applicant's Signature: - Date:0 6
• Greg Casteel
Building Official
Revised 11/2/04
Printed an Recycled Paper
CITY of
CUPER,TINO
41
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN #-3 6 _ J7- 0 3
a
Date: Q
BENERGY
Ener
BUILDING
Building Address:
Seismic Fee Res
Owner' N e: p
BSEISMICOM
Phone #:
Contracto :
Phone #:
License #:
p;P
4(8 7 g z. 4-300
62-2--23 1
Contact: /
Phone #:�
Cupertino Business License #:
0
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
'dL Asphalt Shingles
Asphalt Shingles
Wood Shakes
❑ Wood Shakes
�i 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:
ob Description: T -/,p SX—vf,,
Z4-"/ oS B
GtGPG7O 5-0 a -
(„ (� n to • >� v
Residential ;6 Commercial ❑
Fire Zone: Yes ❑ No [3�_,
Confirmed with Planning Dept. if
there are any restrictions: 15
Cost of Project: o. Type of Construction: Occupancy group:
/z/000
Qty. if
Applicable
Fee ID
Fee l7Pcrrintinn
BPERMFEE
BldgPermit Fees
BUILDING
BENERGY
Ener
BUILDING
/ BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING
0