08090136 (2) CITY OF CUPERTINO
BUILMNCDIV.),SION PERMIT CzONTRAG7OI2INkU
BUILDING ADDRESS: PERMIT NO.
10280 S BLANEY AVE KNIGHT ROOFING SERVICES 08090136
OWNER'S NAME: PERMIT ISSUE DATE
LAU DAVID W MING ET AL 42035 OSGOOD RD 09/22/2008
IF)NE: (510) 438-9077 SANITARY NO. CONTROL NO.
ARCHITECT ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
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LICENSED CONIRACnOR'SDECLARATION lob Description
ue
C I rebr a?m Wl1 am ved pns lisunder ovisioof Chapter 9(commencing z1W nhh Sccuon]lM1U)ofDivision 3ofihe Businw tied Pmfetions Code,and mylicense is RE-RF T7 .0 SHK RF, INSTL SHETHNG& INSTL EAGLELIGHT
full foarme and effec -
Lleenw u: Z4 La..• LIGHTWT TL CLS A 29SQ
=� Da¢ Contractor
epp ARCHITECI'SDECLA TION
1 undcrsund my plansNall a used as Public Means,
?W U
6
L O r^ LWonsed Professional
OWNER-BUILDER DECLARATION
I hereby al Nn I am mmpt from the Convemrfs License Law for the
coo (.[Irwin,mason.(Section 703 1.3.Business and Prnfeadov Code:Any city or county
�.9 T which requires a permit m cmuvtct.filer.improve,demolish,or repair am summon
Z< prior In its issuance.also mluioes the applicant f0f Sueh permit In file a signed statement
gA that ebliccvcdpursvnitotheprovisiovoftheConvector'sLiccme❑w(Cluptor9 Sq.Ft. FloorArea Valuation
Y $ (eommncing with Section 7000)o(Divbion 3 ofthe Business mal Profeaiov Code)or $13340
y that he is esmpt urefrom and the hub for the alleged matinee.Any violation of
Section 7031.5 by am applicant for a Permit subjects the applicant to a civil penally of
Number
ort mom dam ft.a hundred dWlan(15M3 6 9 0 4 016 .,e Occupancy Type
0 1,as owrcr of nae property,or,my employees with wagon as their see compensation,
will do the work,and cite structure bact Wounded or oRemd fns sale(Sec.7064,Busimss
and Prof..to.Code:The Convener/s License law does out apply to an owmr of Requited Inspections
progeny who builds or improves therm.,and who does sued work himslf or thmugh his
ewa<mployec,Provided out such improvemrnu me not intended orof ercd for aWa B,
however.Ne building or improvement is mid within arc yesr of completion.the owner-
builder will have ere burden of proving that he did ml Wild or improve for purpose of
sa.j.
1,u owner of the property.am uGvively convening with licensed convectors W
mosencl the projen(Sec.7064.Business and Profudons Code:)The Contractor's Li-
a.Law doe at apply W an owner of interparty we Wilds or improves Memo.,and
who contracts for such projeeo wide a conamour(s)licensed punuant wthe eom etaes
License Law.
❑Lem vmpt under See ,B&PCforthismmen
Owner Data .
WORKERS COMPENSATION DECLARATION
I hereby alum under pcvity of perjury arc of ere follow.a,decimations:
I haw and will mainoin.Cmtifcam of Consent W s1f-Insure for Wo,kcfm Cents..
Galion,u pmvided for by Section 3700 of dee labor Code.for dee performance of the
wort for which this permit Is mmod.
1 ban and will maintain Worker's Competition Importance,as required by Session
3700 of the labor Code.for tie Performance of the wort Mr which[less permit as issued. .
My worysYvs ccoompeouuw esrarece artier and Policy number
Cartier.STA�5P Policy No.: 23F—(O
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(fhb scctlon reed not ecompleted ifte permit bforme huntrnd au0en($100)
or less)
I cuufy Not in dee performeam of tic work for which this Permit b bated.l"I not
employ any person in any smarter an as W bmomemb*l W 0c Workert Competialon
Laws of CaliromiL Dale
Appel.,
NOTICE TO APPLICANT:If.after making this ormil W of Exemption,you ,WW
become subject W tic Wohets Compensation provisions of Ne Labor Coda you must
.J z foMWide comply with each provisions or this permit Kali N mounted revoked.
z O CONSTRUCTION LENDING AGENCY
I hereby aRrm dean there is a cmuuoedon lending agency for the parammace of
ai the work fm which dais permit is named(Sm.3097,Civ.C.)
0.0 Lamor'.Name
7 z Lcndaes Address -
f,J Q 1 mnify that I have read W.application and sale Nat tic man information is
mmcl.I agree W comply with all city and county ordinance,aIle sou laws testing W
.O building mnstrcuon,and hereby mthori ,topes carom of this city W enter upon the
Ill shovetle jurnedpmpeur for amemlon which may
t„�y I%)agree to save,indemnify and amp,harmlo w the City of Cupertino against
fA incoreajuda of the mong of this Permit. may Warty waY acme agminstseid City
V z in PLICA ace of the among of this permit. /
`-' APPLICANT UNDERSTANDS AND WILL PLY WRHA NON-POINT Issued by: Date
S.
SOURCE REGUTATI
stgnuma.rnppuaanUCern
7z 2, Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Unite Type of Roof -
WIII lite applicant or future Wilding mcupmtatort orhandle haeardo a maWrial
u defmad by Oto Cupertino Municipal Code.Chapter 9.11,and cite Nashua and Safety
ewe,section M32(.)?
❑Yes p All roofs shall be inspected prior to any roofing material being installed.
�No
wet the. licant or r.Mrre building«m If a roof is installed without first obtaining an inspection,I agree to remove
PP , pant ver equipment or devices which g p
O�cr us air conominma u defired by the Bay Area Air Quality Mmagcmc.I all new materials for inspection.
❑Yat �Nu
I haw Ica[tee haraNwa1mauriab mquimmums under Chapter 6.95 of the Califor.
rets Health k Safety Code,SecGmu 25505,25533 and 25534.lmdeessnd that ifthc Wilding
dors ret cum.u,ban a Mason.19,It' y mepoviCilily W notify to pini of dee
mquimmeno w h mute aE pet iuvltce of a Caruftcn,of i y.
.�//// G Zl✓ Signature ofA (cant Date
owner armtt Dow All roof coverings to be Class'/?.,'or better
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36904016 . 00
DATE ISSUED. . . . . . . : 09/22/2008
RECEIPT # . . . . . . . . . : BS000006144
REFERENCE ID # . . . : 08090136
SITE ADDRESS . . . . . : 10280 S BLANEY AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LAU DAVID W MING ET AL
ADDRESS . . . . . . . . . . : 10280 S BLANEY AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-3191
RECEIVED FROM . . . . : GREG KNIGHT
CONTRACTOR . . . . . . . : DAVID RICE LIC # 27646
COMPANY . . . . . . . . . . : KNIGHT ROOFING SERVICES
ADDRESS . . . . . . . . . . : 42035 OSGOOD RD
CITY/STATE/ZIP . . . : FREMONT, CA 9.4539
TELEPHONE . . . . . . . . : (510) 438-9077
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 13 , 340. 00 1 . 40 0 . 00 1 .40 0 . 00
1REROOFRES SQ FEET 29 . 00 377 . 00 0 . 00 377 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 378 .40 0 . 00 378 . 40 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 378:40 AMEX
TOTAL RECEIPT 378.40
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
0 C)
CITY OF CUPERTINO
a
REROOF
• il
cUPEVINo PERMIT APPLICATION
APN# C) O Date: Z .
Building Address: (P
10280 South Blaney Ave .
Owner's Name: Phone #:
David Lau 408 996 0128
Contractor: Phone #:
Knight Roofing Services 510 438 9077
Fax#: 510 438 0604
Cupertino Business License #: Contractor License #:
27646 844108
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) Other(Specify) Lightweight :Tile
Number of existing coverings a Provide I.C.B.O. Report# ER 1647
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:
Tear off shake roofing.
Install Sheathing.
Install Eaglelight Lightweight Tile C
Residential x Commercial
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are nny restrictions: ❑
Valuation:
13 , 340
I Have Read Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
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 Raid 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.
Homeowners Name: David Lau
Job Site Address: 10280 South Blaney Ave
Roofing Company Name:
Applicant's Signature: Date: G Z L
• Greg Casteel
Building Official
Revised 11/2/04
vbv CITY OF CUPERTINO
REROOF
O
• CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
2� 0 1RER00FRES Re-roof Residential B 1SFDWLR00F
1BSEISMICRE Seismic Residential B
1REROOFMRES Re-roof Multi-FamilyB
1 MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
•
Community Development
sa
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CVOF Fax(408)777-3333
_S�UPEQTINO
Building De artment
JOB ADDRESS: PERMIT #
v S- "C- 40 cv
OWNER'S NAME: &AA PHONE #&c J
GENERAL CONTRACTOR: N,� Rooar v FAX#
I am not using any subcontractors: 4 LL
SignaKre ate
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 Rock
Tile
Owne ontractor Signature Date