06080031 CITY OF CUPERTINO 'U51
BUILDING DIVISION PERMIT ��ONTRACTORINFO,,RMATIO,N
SUEMINGADORMS: LOSj�GATOS ROOFING --n-ND06080031
21824 STEVENS CREEK BLVD
OWNER'S NAME: PERMIT ISSUE DATE
CHONG 888 FAULSTICH CT 2006
E: SANITARY NO. CONTROL NO.
(408) 298-9399
ARCHITECf7ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
10, LICENSED CONTRACTOR'S DECLARATION Job Description
%wF 1 Mrcby arfim Nn 1 am five, under provisions of Chapmr 9(commencing P
:Z,Tj with Secuon]g10)of Division Sof NCBuvncssand Rofuafom Code.and mYliccaccis
At inrmllromeaneer�ect�,, Voon17 �, REMOVE EXISTING 2 LAYERS OF ROOFING. INSTALL OS
i'q_ Do,nseclssca�Lk.x ROOFERS SELECT FELT. INSTALL 40 YEAR CERTAINTEE
ih sO.j' Uam V'i�/�C fTECTS DECLContinuumARATION
iCe Iunderstand myplans shall hcused Aspublic records LANDMARK PLUS SHINGLES . CLASS A
t.0
y Licensed Professional
g OWNER-BUILDER DECLARATION
<f 1 hereby atrou Nat I em eaemp,from the Comae oes License law for the
p O following mason.(Section 713 1.5,Business and Professions Coale:My city or county
which recut.A permit to mosuam,aim,.impmw,demmtah,An roped,any urucmre
-iiprior In is issuance.also equim the applicant for men permit to Cite a signed statement
Natheis Rccnsedpumanito epmNsiomofmc Con=toesUmmetaw(Chapter9 Sq. Ft. Floor Area Valuation
[�O (commencing with Section 7000)of Division 3 Ar0w Business And Profusions Code)or $5'20'2
that M is exempt therefrom and the basis for the alleged eamption.My violation of
Section 7031.5 by any Applicant for A permit subjects the applium to A civil penalty of APN Number Occupancy Type
not mare Nan floc hundred dollars(SSW).
1,As Ownm of the poi or my employees with wages as Nck anic compmszdnn,
an
will do the Amk, d 0. .came is no,intended or offered Business
sale(Sec.7061.BusircRequired Inspections
and Profevdans Cada The ConuacmYs ndAdm Law does.1 Apply lf,t r ugh is q P
Own enywho Wadamimpmvu N,rtprove sold AM
chwet nimmlredthrough his
own cur,the employees, or i Natswh improvements art not intended araffemplecired forsalothe ow.
Ir.
howevrs,the building eor impmwm,nt u sold within ane year ofimpromfor the owner.
will low dm Maden of pmvinB Nat k did rot MuW or improve for PUTom of
sok.). A.
coiat Or
the sec.7 •.Buclusi ad conbatvng with:)Tho Cmnoacaoe U-
Ce
, \
come La the project(Sec.7014.weer of and nywho onsWilds
Cade:)pm C therecon, nd y
cense Law does not apply w an owner of Prcoaq.who Wilds ar improv Nenwn,and
w W ne,Lacs for such projems with a canvacaar(s)licensed pursuant w IW COnmacwYs /
Lkehhse LJW. /b
❑ I am eump,an&,See ,B k P C for this mason
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affsrm under pointy,of perjury oro of the(allowing dularstiant -
1 have and will maintain a Cenificase of Consent to self-insum for WartcYs Compcm
scion,As provided for by Section 3](10 of the labor Code.for dm peAomams of the
work for which this permit is issued. ..
1 boa and will maintain Worleces Compensation Insurance,ns im ied by Section
3700 ofhW Labor Code,for to Performance ofthe weric for which this Permit is issued. '
My Worout, CC nsali Insumn cortins end Policy number are:
Cartier. T MN Policy No.:
CE KATE OF.....FROM WORKERS'
COMPENSATION INSURANCE
(fhuscNm aced not be completed If the Permit is foram hundred dollar((5100)
car Icas.)
I certify than in dm penformams of the work for which this permit is issued.I shall not
employ any person in any manner so As to become subject to the Workers'Compensatlon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Cenificam of Exemption,you should
become subject in the Worker's Compensation provisions of the labor Cade,you most
.Jz ranhwith comply with such Provisions or NU Permit shall W drmmcd revoked.
z'O CONSTRUCTION LENDING AGENCY
t-h IMreby affirm that Nee is a consmuction lending agency for the performance of
<Yi > Nc work for which this permit Is issued(Sec.3097,Civ.C.)
UJA Lenders Name
Z Lender's Add.
fJ 1 ahtify Nat 1 haw read Nis application and sum Out the mow information is
Ly F correct I agree to comply with all city and county ordinances and sum laws aiming to
O V building eonsuuction.and hereby aurhorne rcprucnutivcs or Nu city to enter upon do
r L32 ahove-memimn<d propcny for inspection purposes.
F fY (We)age,to save,indemnify and keep harmless the City of Cupcnino against
eri balodoo.judgmens,coss andexpemu which may in any way accme against said City
J ri in
nequence of Ne gaming of this Permit /
s, APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �� `� U>
SOUR EGUL) O
_ �— Re-roofs
Shgnawreo APPls Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dm applicant or future building Occup intswrc or handle haumons material
As defined by the Cupcatino Municipal Cade.Chapter 9.12.and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
41El Y. Pm
Will the applicant or future Wilding Occupant tie component Or devices which If a roof is installed without first obtaining an inspection,I agree t0 remove
AM haxardou air contaminants as defined by the Bay Area Air Quality Managcmcn, all new materials for inspection.
Dismict? IV
0Yca I Nu
1 have read the ha7ardas materials e"wem,nu undo Chapmr 6.95ofdm Califor.
nu Hui"SafetyCOde.Secdau25305.25533 and 25534.1 unMrsund thatifthe huildfng
dors rot cumntly haw A imam.Nat it k my elimoubility to notily the mcmpant of the
requircmens which
( Ipdo,w iasmnce ora ccnircme Or CcmPancy. Signature of Applicant Date
All roof coverings to be Class "B"or better
Owner tar mflimivcd agent Dam' g
CITY OF CUPERTINO
�m 2 of 2 PERMIT RECEIPT OPERATOR: zmyw
COPY #Sec : Twp: Rng: Sub: Blk:' Lot :
APN . . . . . . . . : 35716009 . 00
DATE ISSUED. . . . . . . : 08/04/2006
RECEIPT # . . . . . . . . . : 35522
REFERENCE ID # . . . : 06080031
SITE ADDRESS . . . . . : 21824 STEVENS CREEK BLVD
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : CHONG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : LOS GATOS ROOFING
CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481
COMPANY . . . . . . . . . . : LOS GATOS ROOFING
ADDRESS . . . . . . . . . . : 888 FAULSTICH CT
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 298-9399
*EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- - - - - --- ---------- ---------- ---- - -- -- - ---------- - - - ------ -
BPERMFEE VALUATION 6 , 000 . 00 126 . 36 0 . 00 126 . 36 0 . 00
BSEISMICRE VALUATION 6 , 000 . 00 0 . 60 0 . 00 0 . 60 0 . 00
------ ---- -- ------ -------- - - ------ ----
TOTAL PERMIT : 126 . 96 0 . 00 126 . 96 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- -- -------------- ----------- - -------- ----------
CHECK 253 . 92 1768
TOTAL RECEIPT 253 . 92
•
!fll
Community Development
k 130 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
4§UPERTINO
Building Department
JOB ADDRESS: PERMIT #
Z-/82 Cj $ L,� &/C &4G / 060 ,F0691
OWNER'S NAME: PHONE # `10S &CI Y 9 3
GENERAL CONTRACTOR: FAX # 2 -9 3
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinginformation:
60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
AM 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
Owner/Contractor Signature Date
Community Development Department
Building Division
. " '
City of Cupertino
10300 Torre Avenue
TCITY OF Telephone: (408)777-3228
UPEkTINO 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: 1-7
y / _ /�
Job Site Address: / 7�UL`�h $ �/ �(.� 4
Roofing Company Name: 40JJ (T oS 16 Q7 — 1
Applicant's Signature: /// �' /�L � Date:
• Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO e I�
GTITbF REROOF I
CUPEI� TINO PERMIT APPLICATION FORM
APN# .25 7— lL ` 00 ' / Date: .71 1 1 16 C.
Building Address:
Owner's /anPhone#/ D� � /c_
Contractor: Dn Cl
Phone :
License#.*
L'--s &fiOS .29Gq39q )Q
v,-7
Contact: Phone#: Cupertino Business License#:
0 25 ' - 99 23ygl
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles X Asphalt Shingles qO �ka�
❑ Wood Shakes ❑ Wood Shakes
Wood Shingles ❑ Wood Shingles
❑ Other(Specify) �& Other(Specify) I b,, O S J3
Number of existing coverings 2 ❑ Provide I.C.B.O.Report#
To be Removed ❑ Provide Mfgr.Installation Specs. 5
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job DesAcriRtippn:�
Residential Commercial ❑ _
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Proje t: _ Type o Construc on: Occu ancy group:
OZ r�
S vo Y n � 4
Qty. if
Applicable Fee 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
•