06090144 CITY OP CUPERTINO "' '""'"
BUILDING DIVISION PERMITCONTRACTORINFORMATION
BUILDING ADORESS: OF ING PERMIT NQ 0 6 0 9 014 4
22653 WOODRIDGE CT
OWNER'S NAME: PERMIT LSITE DATE
lk KELLY DELEPINE 675 TULLY RD 09/19/2006
NE: SANITARY NO. CONTROL NO.
(408) 892-8872
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
O a LICENS Z r CONTRACnOR'S DECLARATION Job Description U C e .by affirm Nat I an licensed a provisions of Chapter 9(commencing P
jZtrr widmStion)qty)ofDivisionlafJ.Bu9nual essandRofcuiansCodo.andmylicense u REROOF- REMOVE WOOD SHAKE REPLACE WITH 50 YEAR
H in lull force araC ofr a
)n? License Class Lie.• � ) s
;moo Dak conlaemr COMP. 21 SQUARES/ CLASS A
2 rJ` ARCHfTECsDECLARATI
I w< 1 understand my plans shall be used
d v public rcwrJs !y�
o� Licensed Professional /
3 OWNER-BUILDER DECLARATION
<m I Mmhy a(Tim Nal 1 am exempt from one Commerat's License Law for Oe
C20 following mason.(Section]1131.5.Business and Professions Calc:Any city or County
<i lc which.quirts a permit in eonstrue4 alter,improve,demolish.or.pai,any structure
Pilaf O its lsmmeo,at. r..theapplieautfar such permit to file aligned statement
ESC that he4licensed pursuam10the provisions ofthoComrmon'sLicermLaw(charter 9 Sq.Ft. Floor Area - Value Ii O0
`h (commencing with Section 7()0))of Division 3 ofthe Businessland Professions Code)or
Nat he u exempt Jverefrorn and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applkant in a civil penalty of 3 APN�Ia lyl 0 0 Occupancy Type
nm mo.Nan five hundred dollars ISM 421
0 1,as owner of the projeny,in my employees with wages as their sole mripensadon,
willdothcwork,md NestmnWu enot intended or.111md tat SAO(Sec.Tlka,Busiest Required Inspections
and Professions Code:The Conuaedr's License Law does nm apply m in oewner of q P
me eny who builds i i d Oat such
the.anmW why amssmh work or offfor Waugh hu
ownver.the
eWiprovided pr mors improvementsasenot intended or offered the Curs R.
however,the Wilding or improvement is at he diinot yearofcornpvfortheower-
builder will have O<bothers of proving Nat he did rot build m improve for purpose of
save.).
❑1,as o nor of the pmpeny,am exclusively common&with licensed mnuanc on b
cakbuct the project(Sec.1044,Business and Professions Cade:)The Contractors U.
conal Law does not apply in an owner of property who builds or improves demon,and
who contracts for such projects witha conuxtar(s)licensed pursuant to the Conuacrors
License law.
❑lamenemptunder See ,B&PCfordismaxW
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby alfsrn under pc tidy of perjury cove of the fallowing Conjurations:
1 have and will mammon a Certificate of Consent to self-inaum for WorkersCompen-
salon,as provided for by Section 3700 of de labor Code,for the performance of de
work for which this permit is issued.
ban and will maintain Worker's Compensation Insurance,as required by Section
3 of the Labor Code,fa de peRormance of the work for whi< this permit is issued.
My Worker', ampexamonlpsuaneeca 'rand Policynumbci �C!T
Cartier. Zak k C Policy No.: SYL
CERTIFICA OF EXEMPTION FROM WO KERS'
COMPENSATION INSURANCE
(Thu section moil not M completed ifthe permit is for am hundred dollars(2100)
or less)
I certify dot in the pcfforrnance or the work for which this permit is issued.I All rot
employ any Nixon in any manner so as to become subject to un,WorkersCompensation
Laws of California.Date
Applicam
NOTICE TO APPLICANT:If.after making du Certificate of Exemption,you should
became subject be do Worker's Compensation provisions of Oc Ishnr Code,you must
.J ,2 loMwi th comply wish such provisions Or this permitsbail be deemed rcwkcd.
z O CONSTRUCTION LENDING AGENCY
[r Ihembyaffiom that them is.construction loodingagemy for the peroneci<ul
ori do mok for which this Permit is issued(Scc.3097,Civ.C.)
❑ Under',Nem
r7 Z lender's Address
U0 i coolly Oat I have mad this application anal sate Oat OC above itro matiun is
LL F" correct,lattice m comply with all city and county ordinances and sue laws Minting to
OU building construction.and hereby audarim Mprescmatives of this city to enter upon the
r4L1 procerly for inspection whichpur,Power,
F+ 0. (We)agree to ave,indemnify and keep harmless the City of Cupenino against
h liabilides.judgmcnts.cosss and expenses which may in any way accrue against said City
in
00
U? APPLICANTOUff. .1 Zran AND WILL COMPLY WITH ALL NON-POINT Issued by: DateSOURCE REGU
021, 9 /19 Re-roofs
Signvurt of App rpn AZARDOUS MA IALS DISCLOSURE Date Type of Roof
Willy In,Cupertino
um bPatC cupant uoreor handle hmalth and akriil
u de,Sec by tM Cupertino unicipal Cade.CTapkr 9.13,and Ore Health and Safety
Cole,Section 25533(x)7 All roofs shall be inspected prior to any roofing material being installed.
Yeti
Will the applicant or future building Occupant use equipment or devias which If a roof is installed without first obtaining an inspection,I agree to remove
emit henafdous air<onuminan s as JeOmd by de Bay All Air Quality Managcmcm all new materials for inspection.
District?
❑Ycs
I ban mail the hasardtmsmakriall requirements under Chapkr6.95 of do Caliror- 111 q
nix Heald&Sakty ado, bons 35505,35533 krill 5534.1 undemmnd Oaaifthe building V
Joys not Cur.ndy v k ant Nat it is my rtspomibility to notify Or cupeno nl W
.gai.mcna whiC m mm pilar to issumt¢arl Cervfieate feeenpaaey. Signature of Applicant Date
Owncrormthor ledagem Dak. All roof coverings to be Class "B"or better
CITY OF CUPERTINO
m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 34215073 . 00
DATE ISSUED. . . . . . . : 09/19/2006
RECEIPT # . . . . . . . . . : 36107
REFERENCE ID # . . . : 06090144
SITE ADDRESS . . . . . : 22653 WOODRIDGE CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : KELLY DELEPINE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : LESLIE HOANG
CONTRACTOR . . . . . . . : LESLIE HOANG LIC # 23155
COMPANY . . . . . . . . . . : T D ROOFING
ADDRESS . . . . . . . . . . : 675 TULLY RD
CITY/STATE/ZIP . . . : SAN JOSE, CA 95111
TELEPHONE . . . . . . . . : (408) 892-8872
•EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- - -- - - -- - - - ------------ -------- -- ---------- ---------- ---- - ----- ----------
BPERMFEE VALUATION 10 , 000 . 00 169 . 56 0 . 00 169 . 56 0 . 00
BSEISMICRE VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
---------- --- -- - -- -- ---- - ----- ---- - -----
TOTAL PERMIT 170 . 56 0 . 00 170 . 56 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- -- ---------- ------------------
OTHER 170 . 56 VISA
TOTAL RECEIPT 170 . 56
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
46UPERTINO
Building Department
JOB ADDRESS: PERMIT #
.2A6S3 WOo e C 0CCMc1 ' I ' f
OWNEWSNAME: ke( 1')e e inQ- PHONE # o$ 25,2 g
GENERAL CONTRACTOR D ro p � FAX #
I am not using any subcontractors: q l 9 O
Signature Date
Please check applicable subcontractors and complete the following information
21 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
•
Owner/Contractor Signature Date
aaoq 0144
CITY OF CUPERTINO
G REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# 54 ^ I JIO�J Date: 9l I e I oc�
Building Address: J
As 6 S 3 vJooc� tr; e C•f
Owner'sjj��?ame:Phone#:
I e,11D -( c ; ne �o$ 3 S ,2- r W
Contractor: 'lA J n License#: g S 53 I
Contact:'Ifn 1II Cupertino Business License #:
d7 LI VL FL J U.N
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles `K Asphalt Shingles
Wood Shakes ❑ Wood Shakes
Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
MT` To be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: II
1R- Ln o J e VV J J a a n la e. 7LR- ' 0.U W t
Residential ISI Commercial ❑ C O SS G(
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are any restrictions:
Cost of Project: Type of Construct Occupan grou
q $ o a est _ li o o 3
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
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: 4,(( y e h i 12
Job Site Address: b g 3
i
Roofing Company Name: Tba
Applicant's Signature: Date: 9 / 19101
Greg Casteel •
Building Official
Revised 11/2/04