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08010079CITY OF CUPERTINO T/�7 7 ,� y •,;., �.y�g7i '7•;}�a, BUILDINC'DIVISION' PERMIT � - 0_8! 9a $�5 veer L.H BUILDING ADDRESS: 22585 SALEM AVE MEDRANO'S CONSTRUCTION R NO. PEAM0TNO. 9 OWNER'S NAME: PERMIT ISSUE DAM JANE CHUEH 1227 REESE ST 01/14/2008 NE SANITARY NO. CON -MOL NO. ARCHnECTPENGINEER: BUILDING PERMIT INFO RE -ROOF, 25 SQ, CLASS A BLDG PLUMB MD" GD O j LICENSED CONTRACTOR'S DECLARATION I thereby affirm that I am IIxnsN under pmvitiom of Chapter 9 (commencing Job Description with Seaon700D)ofDiv',ion 3ofthe Badwan nd PrafeudrmsC and my license i, ce In fall farold effect e .cense Cl lY.g Dam Conlrcter CHITELTS DECLARATIO C IunMnand my p.ns siWlbeusedapublic torn Licensed Pmfcuionel OWNER -BUILDER DECLARATION g 1 betohy a1Brm n I em mucin from Nc ConuanCc Liana taw far Un o Do ag mons. (Sadat 71131.5, Business and oli Code: Any city Of County which improve. m a which rolalma , permft to enmweL alms improve, demal.h, or repair any structure far ,ah permittoftk adguduucmal amen, ° pdotoiu iuuana,,luantin Novislac the INOWisnamsd Pursuant lO the Of t thouCaucasian'sBusinssswanselaw(Chapm9 Sq. Ft. Floor Area Valuation t (comm is compNSeNon Tang of Division 3 of than Budnemand Profen Com) or io .campy . that thetofrom and ate aper[ for but, for Any vi of d.ged uemant be Section 7031J by anyapplicantdollfaapemllsubjau the appl.anito,civll penslb err in l penalty wt moa than Bw hundred dollars (5.100). APN Number Occupancy Type 0 L Na owner of die Property, or my wploycu with wagns as Heir ain eompntadon, will do the work and destruction, I, mulatemied or offered fonsale(Sa. 70th, Budin, and PrefmdOns Cade The Contractors Llan¢ Law dao on, apply to an owner of Required Inspections property who build, or impar., thertom, and who dae„uch work himulf err QmmSh h. - own employees. provided that each dmpro.mau pee not intended aronemd farads. if, however. the Wilding w imp avemat is sold within arc your of comp.tion, the owner. Wilda will haw the burden of proving thus be did not Mid or improve for purpose of ale.). 0 I, u mamen of rW property, am exclusively conuuUng with nerved cemocTos in cauman the protect (Sec 70x. Business and Profeulans Cade:) The Caoanora U. Mass taw dope not apply in an owner of properly who Wilds or Improver mamon, and who anucl, for such Psejsou with a conuacter(,) licensed punaanl to the Contractors Liters taw. 0 lams,emptunaasee ,B&PCrad.reuon Owner Date W ORKERI COMPENSATION DECLARATION 1 hereby ,farm under Penalty of perjury one often fallowing decbaflam, Taw Nfim and will maintain a Cemaf Comerl on ulf-Im ou for WorkeesCmnpen- pe provided far by Session 3700 of than labor Code, for Ne psdamarce of the work for which this permit. bound. 0 1 haw and will maintain Workers Compensation Imoana, u minima by Secva 3700 of Ne tabs Code, fa mam the Nolare of the was, For which this permit. issued. My Workeeic Pe fadon In was 'er and Paltry number am 09 S �. Carder, Policy No.: CE FICA EXEMPTION FRO W 11KERS COMPENSATION INSURANCE (nds scudmm mad not be Completed if the permit is far Came hundred dollars ($100) or leu) 1 sonify that in the perfomaneo of Ne work fm which this permit IN issued, ) shill not cmPiay anY Peron in any manors a m became subject m Nn Woken' CmnpcmNon Law, of California. Data Applicant NOTICE TO APPLICANT: If, after making this Certificate of Esemption, You should become subject m Ne Workers Compensation provisions of the labor Conn. You nun faMwim amply with such provisions as this permit,hdl be domed rtwWd. CONSTRUCTION LENDING AGENCY 1 hereby LiBron Nus Nem. a amauam lending agency for sew performance of But wok fur which this permit Is toad (Sec. 3097, Civ. C) Lender's Name ' Leaders Address I certify that 1 haw mad this application and tote thou the above Information. cermet I ,gtoe to comply with all city Nd County ordinances and seem lava totaling in ' Wilding Convect.., and hereby eallorian rtpmsenutive, of this City to enter upon the drove-matiamd propeny fm inspection purpamL (we) asses to a., indemnify ped trop harmless 0n City of Cupcnina against li,bilide,,judgmcnu,com ad Cape which may In Nymyaccmcagdnsl sold City I. cc of Ne granting of N. L I APPUCAPLICA)UNDERSTANDS ILL COMPLY WITH ALL NO -P01 SOUR GU ONS. Issued by: Date / RC -roofs Sigaat of Ap UCantnnor D, HAZARDOUS MATERIALS DISCLOSURE Type of Roof WAIN ppncantstMuni land. Con. ! NN MunicipalChanluoeo Hardonsmaterisi by the Cupertino Munciryl Cah, Chapter 9.1; aM Ne HeaIN and Safety un. Sed code, season 25532(.)T ❑Yns All roofs shall be inspected prior to any roofing material being installed. win the.pp0aant err aldose wmm�g oaap,m am agaipmat or de„a, .teen If a roof is installed without first obtaining an inspection, I agree to remove hoardnan sir a erns n,nu as influent by the Bay Arta Air Quality Management all new materials for inspection. rinT j GYns �K I have mal the hasaNausmatcdalsmquiemenu under Chapmrb.93 ofthe Califor. /f f nia Haith&Safely Cade. Saaau x5505, 25533,y�fs 25 d.I undo Land than, if the Wilding U O docs at cmsentiy have nL that it u m m(' ml .y m atirY do acupanu or the / mqudmmenuwh.bm WmeI or r erukweerg racy. Signatu of plieant Date All roof coverings to be Class "B” or better Owner or,umod pent fl Dam is 2 ITEMS OF 2 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 34212102.00 DATE ISSUED.......: 01/14/2008 RECEIPT #.........: BS000003683 REFERENCE ID # ...: 08010079 SITE ADDRESS .....: 22585 SALEM AVE SUBDIVISION ....... CITY .............: CUPERTINO IMPACT AREA ....... OWNER JANE CHUEH ADDRESS ..........: 22585 SALEM AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: MEDRANO'S CONSTRCT CONTRACTOR .......: JORGE MEDRANO LIC # 29445 COMPANY ..........: MEDRANO'S CONSTRUCTION ADDRESS ..........: 1227 REESE ST CITY/STATE/ZIP ...: REDWOOD CITY, CA 94061 TELEPHONE ........: (650) 906-4780 FEE ID UNIT ---------- QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ------------- 1BSEISMICR VALUATION ---------- 15,000.00 ---------- 1.50 ---------- 0.00 ---------- 1.50 ---------- 0.00 1REROOFRES SQ FEET 25.00 325.00 0.00 325.00 0.00 TOTAL PERMIT ---------- 326.50 ---------- 0.00 ---------- 326.50 ---------- 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : AMOUNT --------------- 326.50 --------------- 326.50 VOICE ID DESCRIPTION -------- ---------------------------- 601 ROOF TEAR OFF 603 ROOF BATTENS 605 FINAL REROOF REFERENCE NUMBER -------------------- #2751 VOICE ID DESCRIPTION --- -------------------- 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS lr� - arr of ®CUPERTINO C ?Of ooq i CITY OF CUPERTINO REROOF PERMIT APPLICATION APN # & � / AI (0,;�. Do Date: Building Address: Sv �m � Owner's Name:. I �n� S�e� Phone #: C6 -45D �160�3 Contractor: c Phone tb Fax #: Cupertino Business License#: �� y C tracto��ense Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles )< Asphalt Shingles Ar 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: Residential Commercial ❑ Fire Zone: Yes ❑ No Confirmed with Planning Dept. if there are any restrictions: ❑ Valuation: r I Have Read, Understand and Signature . with Cupertino's Tear -Off Policy: CITY OF CUPERTINO REROOF OT OF ®CUPERTINO FEE SCHEDULE Number of Squares Fee ID Fee Description Fee Group Permit Type IREROOFCOM Re -roof Commercial B 1COMMLROOF 1BSEISMICO Seismic Commercial B IREROOFRES Re -roof Residential B 1SFDWLR00F 1BSEISMICRE Seismic Residential B 1RER00FMRES Re-roofMulti-FamilyB 1MFDWLROOF 1BSEISMICRE Seismic Residential B I BUSLIC . Business License B 0 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 state olicy on re -roofing. bo Homeowner's Name: �� l �L p Job Site Address: Roofing Company Applicant's Signat Greg Casteel Building Official Revised 11/2/04 7 a CITY OF CUPEkTINO E JOB ADDRESS:,,, OWNER'S NAME: CONTRACTOR: I am not using any subcontractors: Buil 0 (e, Please check applicable subcontractors Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 • to01 PERMIT # ova PHONE FAX # the followin¢ information Date • 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 j Sheet Metal j Sheet Rock j Tile fL/Conactor Signature