06090057 CITY OF CUPERTINO ' ° "+^ `^"� ' °` '�' T`' ""8`"
FyUI LDING DIVISION PERMIT T ", "k8
BUILDING ADDRESS: T D ROOFING PER11I1,10.06090057
22633 WOODRIDGE CT
OWNER'S NAME: PERhllT ISSUE DATE
Ah YAU ROBERT 675 TULLY RD 09/11/2006
NE: SANITARY NO. CONTROL NO.
(408) 892-8872
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
oo LICENSED CONTRACTOR'S DECLARATION
mF 1 thereby affirm Nal 1 am licensed under provisions of Chapter 9(commencing Job Description
�Zry with Senian]UM)af Division 3ofthe Business and Professions Cade licemeir
�y inrallrort aerc t $.l Is REROOF- REMOVE WOOD SHAKE, REPLACE WITH COMP.
Z License Lk.p
�o one 75DECD%Cr PRESIDENTIAL TL CLASS A OR B
ARCHTIECTS LARATION
I undcrsunJ mY Plans shall W used as public mcards
iyU
Liccnud Professional
3
OWNER-BUILDER DEC.C....ON
i a C hereby.lion that 1 1. exempt from an Ne Contracm o Liccme Law for the
.p o following emon.permit
t ]consistent.L5,Business and Pmfessinns Cade:Any cisY m coumy
v, which rtquiru]a Penner re thealar,improve.h Permith,m t a sig any rwm ou
rat
.Z< prior mits issuance,atsarotorequires meapplicam for such permitmconse,signedstatement
;z thuWtsRaensed parsuanuo the Proaisiamarthc canuxmrY license law(Chapter Sq.Ft. Floor Area O D*m2000 M1 .
`I-$ (commencing with Section 7")of Division 3 of One Business and Pmfeasinns Code)or '
`t� that he is exempt therefrom and Be basis for IW alleged exemption.Any violation of
Section 1031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number cupaney Type
net dome Nsn five hundred dollars(5500). 34215071 . 00
1,u owrrm of llie property,army employees with wages m their mlecompensation,
will da the work and rhe raumurt is not inrendcd w.Bared Tarsale(Sec.]014,Business
rad Prornsims,Cada:The Camr= ^
ara L" ^se Saw does not apply on owner an or Required Inspections
property who builds m improve,thereon,and who does such work himself or through his
Own employers,provided that such improvements are not intended oroRerm forsaln.If. -
however.Ne Wilding.,improvement Is mid within one year of completion,the owner,
builder will have the korden of proving that he did mat build or improve(a,purpose of
meJ.
❑ h as owner of Ne properly,am emiurimly comraming with licensed contraction;he
consumer the Pruden(Sec.70x4,Business and Profesdons Cade:)The Contranors U.
came law dam not apply to an owner of property who Wilds or improves theeon,and
who contracts for such projects with a contractor(s)licensed internal In he Contractors
License Law.
❑I sm.tempt under See ,B&P C far the,rtman
Owner Dare
WORKER'S COMPENSATION DECLARATION
40 1 hereby affirm under penalty of perjury me of the following declarations:
❑I Mn.and will maintain a Cenifie.0 of Corneas to xl4inmrt for WmhrrsCompen-
sation,as Provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
!]B
lWI have and will maintain Workeru
Worker's Compensation Insurance, acquired by Secumn
O of the labor Code.for the perAi mune.of Be wort far which Nu permit u issued.
My Wmkch ompe sauoylommnccca icrand Policynumb'r�
Greeter, u. Polity RO
CERTIFlC PE EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need wr be completed if the permit is formic hundfud dollsn(SIM)
or less.)
I certify Nat in the performance of me work far which this Permit is issued.I shall am
employ any person in any mmmrm at to become subject in the Worka s''Compewdon ,
Laws of California.Dae
Applicant
NOTICE TO APPLICANT:If.after making does CeniOcae of Exemption,you should
become subject in the Workers Conformation provisions of me Labor Code,you must
.J 0forthwithfowith comply with each provisions or unit permit shall he daemon revoked.
z'� CONSTRUCTION LENDING AGENCY
[-a I Wrthy affirm that doom is a consVlKtion lending agency for the Performance of
(Yi me work for which this permit is issued(Sec.3097,Civ.C.)
Lenders Name
.7 ,2 Lenders Address
V Q 1 cc dify that 1 have fund Nis application sort shim that the than information is
U, F coned.1 agree in comply with all city and county ordinances and seam laws Misting to
0O building construction,and hereby authorise representatives or this city to enter upon the
C ahovomentioned
.a.c. for insPccumn purposes.
(We)agree m save,indemnify and keep harmless doe City a(Cupertino against
E'tI,iZ incoival judgmcnhog and expcnseswhich may in my way attmc against said City
V z in eonugoence o[doeg nn of Nis permit.
^ APPLICANT UNDE ST S AND WILL COMPLY WITH ALL PION-P INT Issued by: Date
SOURCE REGULA q�ll �04
Signatufu mf Appl an✓Con Re-roofs
RDOU Dow
HAZARDOUS MA ALS DISCLOSURE Type of Roof
Will the a Contadot metro Wilding ettmpmt rmrt or natwm na alth ad Safety u dented by me Cupertino Municipal Cade,Chapter 9.13,and doe Health and Safety
Cade'pyti 25532(')' Na All roofs shall be inspected prior to any roofing material being installed.
will the applicant or alum Wilding..Pon,sex cquipmcnt or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emh h..afdam air emiumiants m dcIII d by the Bay Area Air Quality Management all new materials for inspection.
District'
❑Yes Nu
I have read the hzaardous maerialsrcquiamenu under Chaperb.95 oldie Califor.
.i.He C carom 25505,25533 md25534.1undcnund heeflW building
Jon not curemly Its emit Nat it u my responsihility m notifyddJrrreee arvp t of da
equirtmcnts wine u t to iamance mfa Cenifieae Auto Try 6 Signature of Applicant Date
Owner or oummind agent t4 In
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 . . . . . . . . : 34215071 . 00
DATE ISSUED. . . . . . . : 09/11/2006
RECEIPT # . . . . . . . . . : 35970
REFERENCE ID # . . . : 06090057
SITE ADDRESS . . . . . : 22633 WOODRIDGE CT
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : YAU ROBERT
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : TD ROOFING
CONTRACTOR . . . . . . . : LESLIE HOANG LIC # 23155
COMPANY . . . . . . . . . . : T D ROOFING
ADDRESS . . . . . . . . . . : 675 TULLY RD
CITY/STATE/ZIP . . . : SAN JOSE, CA 95111
TELEPHONE . . . . . . . . : (408) 892-8872
•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 AMOUNT NUMBER
------- ------- --- ---------- -- -------- - - --------
OTHER 192 . 36 VISA
TOTAL RECEIPT 192 . 36
•
K Community Development
f' 10300 Torre Avenue' F't' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: PERMIT #
J.x 6 15 W o o f ri d R- C-f
OWNER'S NAME: k;; bQ-T-t Q.%.k PHONE # %lo$ ZLS S &" I
GENERAL CONTRACTOR T n M O fi K 01 FAX #
I am not using any subcontractors: 9 / tl 0 t
Signature Date
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
Tile
•
er on a ature Date
t
OWI 0U5-1
CITY OF CUPERTINO
a(Lb' REROOF
_1.
CUPEkTINO PERMIT APPLICATION FORM
APN# � Date:
Building Address:
2,1633 Woo�r . d Q Cfi
Owner's Name: Phone#:
RZ D fieri ati q,00 2SS" - 8 5 9 f
Contractor: o r N License#: g S
i D
Contact: 'L Dcw t 0.to
Cupertino Business License #:
c,� ilU
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Q Asphalt Shingles Al Asphalt Shingles
A Wood Shakes ❑ Wood Shakes
Cl Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
X1 To be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
�eMQV* vvooa sha.� he �� �,cR
Residential 1PCommercial ❑ r
Fire Zone: Yes ❑ No IVConfirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Constru ton: Occupancy group:
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: R o h e of
Job Site Address: '.1 'I G 3 3 V\J Si P CA
Roofing Company Name: 1 aar3
Applicant's Signature: Date: 9 lit 'U C
i
Greg Casteel •
Building Official
Revised 11/2/04