06060094 (2) CITY OF'CUPERTINO
BUILDING DIVISION PERMITC®NT7f2AC13QRN '0RMATIOPi.,,,�.
BUILDING ADDRESS: NEIGHBORS ROOFING AND GUT 7Lft p§T No'06060094
10407 COLBY AV
ER'S NAME: PERMIT ISSUE DATE
WONG 249 MOSELLE CT 6
PHONE: SANITARY NO. CONTROL N0.
(408) 629-7922
ARCNTfECrIENGINEER: BUILDING PERMIT INFO
BO EO PLUMS MECH
O
u0, LICENSED CONTRACTOR'S DECLARATION
0IObDCSCTI IIOn
1 heroby affirm Nn w
1 am IiconvE under provans of Chip.,9(mmmcu
ent p
with Section TOM)of DfrlsOn 3 of the Businen and Professions Code.sM my license is
ifall fan.andenect. TEAR OFF SHAKE ROOF .INSTALL 1/2" OSB AND
M Ljz Lla.Clast `" ue.9 ����'�� PRESIDENTIAL TL CLASS A
3�, Dao Contractor
ARCHIIEC,S DECLARATION
I understand my plans shall be used as public romrds
3yU
Apr' Liccmctl Profemional
3 OWNER-BUILDER DECLARATION
I kna y alErm Nm I am exempt from the Contractors license law far the
i.O O following mason.(Section IID 1.5,Business and Professions Code:My city or county
12P which acquires a Permit to contract shah narrow.demolish.Or repair any structure
_Z< Prior m i4 issuance.also requires the applicant for such permit to Olc a signed smemem
MAL he is licensed pursuant an tie provisions of the Cmanclor'e License law(Charon 9 Sq.Ft.Floor Area Valu4tiba.0 0 0
�$ (commencing with Section 7000)of Division 3 of W Busboy and Pro(eaalmla Cade)or
.. that M 4 asempt tMrtfrom and the basis for W alleged exemption.My violation of
Sermon 7031.5 by any appilem,fora permit subjects the applicant o a civil penally of3 pp[1 j�U p�ber � u cy Type
was mom Jun Rao hundred dollars(5500). 16 2 9 9 . 0 0
❑1.u owner of the Property,or my employer with wages at Jeb Ole compensation.
will do the work,and W sou tore 4 ret awarded or offered farsek(Sec.11M1,Businese t
Require
Nd Professional Cade:Tile Ossame sn'1 License Law ca ,net apply e an canner 0( n �oo(ts
proPenywle buildaarimprow&Ne com,and whodoessuchwarkhinuelfarthrough his u
own m.me ba,progded thnt weh lmPmsemenu in arm intended ma@rM for most- BUILDING how<ver,Ne bulldlnporimprovement is said within oro wv of compleJan,Wownery J�(�tf
builder will haw the burden of proving that k did rot Wik m haprow fm purycx of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed conuacon in
camtnsct tie project(Sec.7044.Business and Professions Cade:)The Commences LI-
ccnse raw does not apply to an Manor of property who builds or improves Wean,and
who cornets for such projea,with a canuantot(s)licensed pursuant to W Commences
Lkensa Law.
❑lam aemp,under See .B B P C for this reason
ter
Dae
WORKER'S COMPENSATION DECLARATION
I hereby air=under penalty of perjury ane of W fallowing declanlomor
1 haw and will maintain a CeniOsau of Consemto elf-instant fm WaJ¢Ys Compost,
salon,as pmvidcd for by Section 3700 of W Labor Code,for the performance of W
weak for which Nis permit 4 issued.
❑1 haw and will maintain Workers Compensation Insurance.u required by Section
37M of W Labor Code,for Ne performance ofthe work fm which this permit is Wood.
My Worker ,Cfampa tion insurance sinner and Policy number tie:y^,
Cartier.��Policy FROM
WO/E
k%4sin S Pf INSURANCE ORKER$s'
L'OMPENSATIONINSURANCE
missection need not le completed if W permit 4(wone hunthMdollan($100)
ar ins)
I certify that in W performance of W work per which this Permit 4 issued I shall rot
employ any person in any manuerse an in become subject to the Woricre CMmpemadon
laws o(Califorma.Data
Applicant
NOTICE TO APPLICANT.IL after making this Ceniftesu of Exemption.you should
become subject an the Worker's Compa n radon provWons of W Lahr Ca&yam mew
O O forthwith comply with such Provisions or this permit shall hw
e dcemed reked.
CONSTRUCTION LENDING AGENCY
F.r 1 hereby slRrm that Wrt ls&mnstructinn knding agency for W perfom,anceof
I�7 the murk for which this permit is issued(Sec.3097,CW.C.) '
W A Lender's Name
7 Z Lander',Add=
V Q 1 awry that I haw read this application and tau this W&bow Information 4
D.F correct.l agroe to comply with all city and county andimmems and sate laws relating to
QV chbuilding construction,and hereby authorinemposenutivesofthis city ocmarupon do
r ow-mentioned pmperly for insrcetion purposes.
1:6 (We)agree On saw.indemnify AM kap harmless me City of Columna against
lF.r h liabilities,judpmen4,emu and espemm which may in any my sense gWmL said City
t.3 7 in conaguenee of the grana ng of this permit.
rte- APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC GULATIONS.LvZS/ jj
Z�2'y Re-roofs �Z---
Sigmture of Appliant'Con4acor Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will W applies or forum building oavpantsose orMndle hamdow,mauri d
deOnM by W Cupertino Municipal Code.Chapter 9.12,and W Health and Safety
e,Sectors 25532(.)7
❑Yea �Na All roofs shall be inspected prior to any roofing material being installed.
Will me appliesm or future building occupant usa equipment Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air conuminmu a dcOnod by W Bay Area Air Quality Management all new materials for inspection.
DWct7
r'7Yas kNNu
I haw read W haaardaa materials tequirtmems under Chapter 6.95ofthe Califor-
meHealokSafctyCode,Sections 25505.25533 and x5534.1 undermso Jut lfW building
Jam net currently hew•onana,land It 4 my responsibility o sadly W occupant of W
nNuiromcnu nm be matPrtMo iss; f,cenineatcoraaapanoy. Signature of Applicant Date
Owner or authorized epees /I[ /� � Dace All roof coverings to be Class"B"or better
' 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: W (7Vt W
Job Site Address: (0 ND l-- ' l A z C�V-
Roofing Company Name::ae h hh Iry S YO Q � Vl �
Applicant's Signature: !21"/ �. Date:
• Greg Casteel
Building Official
Revised 11/2/04
• CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 31629019 . 00
DATE ISSUED. . . . . . . : 06/13/2006
RECEIPT # . . . . . . . . . : 34816
REFERENCE ID # . . . : 06060094
SITE ADDRESS . . . . . : 10407 COLBY AV
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WONG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : NEIGHBORS ROOFING
CONTRACTOR . . . . . . . : ROBERTO LOPEZ LIC # 27063
COMPANY . . . . . . . . . . : NEIGHBORS ROOFING AND GUTTERS
ADDRESS . . . . . . . . . . : 249 MOSELLE CT
CITY/STATE/ZIP . . . : SAN JOSE, CA 95119
• TELEPHONE . . . . . . . . : (408) 629-7922
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 11, 000 . 00 180 . 36 0 . 00 180 . 36 0 . 00
BSEISMICRE VALUATION 11, 000 . 00 1 . 10 0 . 00 1 . 10 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 181 .46 0 . 00 181 .46 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 181 .46 1137
TOTAL RECEIPT 181 .46
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
1CITY OF Fax(408)777-3333
PEkTINO
Building Department
JOB ADDRESS: PERMIT #
D off- V- O 06� dQQ `9
OWNER'S NAME: WoPHONE # o4— V �L-Z 3 S
GENERAL CONTRACTOR rooFAX # Co 2 22
I am not using any subcontractors: Zz 2 e Z —13
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 Rock
Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# �9 Date:
Building Address:
10 V.
Owner's Name: Phone#:
Contractor: License#:
S 1
8,0S`o
Contact: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles it Asphalt Shingles
St Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings Z ❑ Provide I.C.B.O. Report#
Ok Tobe Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: /
CCJ.Y 0 � S G Y,Op� )rs/AI( /dt C oS 2 dt
Residential ® Commercial ❑
Fire Zone: Yes ❑ No P Confirmed with Planning Dept. if
there are any restrictions: U
Cost of Project: Type of Construction: Occupancy group:
11, d2Oa
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
•