03090049 (2) CITE OF CUPERTINOg "• '.
;r v BUI�mINCD1VISION PERMIT �CONTRACTnR+INkORMAh
BUILDING ADDRESS: LOS GATOS ROOFING PERMIT"°03090049
7A41 (-RT7.7T<T,ThTR DR
R'S NAME: 1771 SMITH AVE. PERMITUEDATE
HAN SUR- Ss03
PHONE: (408) 298-9399 SANITARY NO. CONTROL NO.
ARCHITECTMNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
IOp
LICENSED CONTRACTOR'S DECLARATION Job Description
E U I Mrcby elfirm'het I em licenseddanda,under provisions of Chapter 9(commencing p
v� with Section] 7of DivlsionJof Ne Buainesaod Professions Code.end mylicense ie
ii«11>c° LiYYE�Gd.�«�Iaapp D7B'J . REMOVE EXISTING SHAKE ROOF. INSTALL OSB AND 301
=pp D ARCHITELTSQECLARATION FEET. INSTALL PRESIDENTIAL SHINGLES BY CERTAIN
1 C 1 understand my plans shall M used as public records EED.
).0
Licensed Pmfeuiunel
OWNER-BUILDER DECLARATION
<I I herchy aamb'hat 1 am exempt from the Contractor's License Law for the
OO ralnwingmmon.(Sesd 7031.5,Business and Professions Code:Any city or county
3$r which requires a permit Io construct,almr,narrow,demolish,tor repair any s'n¢tum
-Zi
prior o its issuance,also requires the applicant for such permit to Elea signednawmen'
FFxx
that he is licensed punuan'm tM provisiom of she Contractor's Users Law(Chapter 9 Sq.Ft. Floor Area Valuation
tF (commencing with Section 7008)of Division 7 of the B usiness and Profusions Code)or
$ that M is exempt Ncrefrom and the buil for the alleged exemption.Any violation of $13000
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of APN Number Occupancy Type
not more Nan row hundred dollars($500). 36217042 . 00
P y yp
0 1,m owner of the property,m my employcm with wages u their sole compensation,
will do the work and Nuwctum is not intended oroRered for sale(Sec.7044,Business � p ®�
and Professions Code:The Conussa tors License Law does not apply an owner of Required Inspect) ■NA8i
property who build,or improves thereon,and whoduessuch work himself omhrough his
own employes,provided that uch improwmena are not imsedW oroRenl forule.If, 3055 — FRAME
however,the building or improvement is sold within one year of compledon,the owner- [ Q
builder will hove the human of proving that he did not wild or improve for purpose of 3 07 - INSULATION SEP :15
y [003
ml`')' 601 - ROOF TEAR OFF
❑I,ut wner the
the(Sec.7am W,
confessions with
e:iceu Crumbaectors i. 602 - ROOF PLYWOOD NAIL
cense La the es not (Sec.7044,Business and property
who Wilds
Code:)The Conuamor, rad BUILDING
whoa law dace not apply je ts owner of propery who builds or improves thereon,and 603 — ROOF BATTENS
who caramelsn
for projects with a contncmr(q pursuant licensed puut theContractorsLaw. 604 - ROOF IN-PROGRESS
0 l am exempt under sea ,B&P C far this moon -
Dew
WORKER'S COMPENSATION DECLARATION ' _
1 hereby affftm under penally of perjury one of Ne following declarations:
❑I haw and will maintain a Cenificate of Consent to sel6omum for Worker'sCampen-
sa0on, provided for mi Section of the Tabor Code.fm sheperformancc of the
woh _
for
which Nis permit is issued.
d. -
0 1 haw and will maintain Worker's Compensation Insurance.as required by Section
3700 of dw labor Code,for the performance of the work for which Nis permit is issued.
My Workers nm notion Imunnce carrier, d Policy numbenfmd
Co a alis,No.:27.7f OS
RTIFICA EO EXE ON FROM WORKERS'
COMPENSATION INSURANCE ,
CM11.0mn need no'M completed Rohe Permit is faro=hundred dollars($ial)
or it.)
I cattily Nat in the performance of the work for which this permit Is issued,I shall not
employ,any penan in any moneran u to became subject to IM Workeri Compemadon
Laws of California.Dem
Applium
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject ro the Wohers Compensation provisions of the Labor Code.you..It
70 forthwith comply with such provisions m this permit&hall M doomed tucked.
Z ti CONSTRUCTION LENDING AGENCY
1 herebyaX,m Net Nem is a construction lending agency tar the Performance of
x the work for which thu petmh Is issued(Sec.3M7,Civ.C.)
iLenderName
3 I z Lender's Address
J Qcertify Net P hew read this application and sow Net she show information is
correct.1 agree to comply with all city and county ordinances and saw Paws relating to
0U building construction,and hereby auNodn represenmives of Nis city to enter upon lM
1 above-mentioned property for Inspection purposes.
(We)agree as taw.indemnify aM keep humleu the City of Cupertino against
ti fq liabilities,judgments.eoaa and expenses which may in any way accrue against mid City
JZ in consequence of the granting of this permit.
^ APPLICANT UNDERSTANDS ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCEREG ATION
`d� Re-roofs
Sign an AFix canuconlacka Date
HAZARDOUS MATERIALS DISCLOSUR Type of Roof
Will thc applicant tar futon building uccupot store or hodlc hamdou material
Erred by de Cupertino Municipal Code,Chapter 9.11.and the Health and Safety
Section 25532(a)?
❑Yes �o All roofs shall be inspected prior to any roofing material being installed.
'
Will Can applicant or future building occupant tax equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit humorous air comamiamis u defined by the Bay Area Air Quality Management
District? all new materials for inspection.
❑Ya No
Ihave&Salet Nehuvtmtos;25505,2553 and nnis255 under CMpwr6.95ofdte Califo
ria Halm&Safety Cotk.Sadtua 25505,15773 and 25574.1 undersara lW if de Wilding
does not currently how a tenant,thn it is my responsibility to nadfy tMaaccupo'of the a
m mentowh' mu bcmci riortoissuanceoraccn_iEamofO,�o . ' nature ofApplic. Date
ave? All roof coverings to be Class"B" or better
term anulhortlL agent Dow g
I Community Development Department
Building Division
1• City of Cupertino 10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
CUPEkTINO
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.
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:
Job Site Address: / �%� ( ,/O//P �iJ CO
Roofing Company Name: ^U/S �T! TOS z6a n/d1 Cl
A plicanYs Signature: J Y1� Date:
• \�t/oSIAD�X�
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
• CITY OF CUPERTINO
Item 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 3
Sec : Twp : Rng: Sub: Elk: Lot :
APN . . . . . . . . : 36217042 . 00
DATE ISSUED. . . . . . . : 09/05/2003
RECEIPT #. . . . . . . . . : 23055
REFERENCE ID # . . . : 03090049
SITE ADDRESS . . . . . : 7843 CREEKLINE DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : HAN SUE-ON AND JAMES C
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4155
RECEIVED FROM . . . . : LOS GATOS ROOFING
CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481
COMPANY . . . . . . . . . . : LOS GATOS ROOFING
ADDRESS . . . . . . . . . . : 1771 SMITH AVE .
• CITY/STATE/ZIP SAN JOSE, CA 95112
TELEPHONE . (408) 298-9399
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
----- - - - - - ------------- -- ------ -- ---------- -- - ------- ------ ---- ----------
BPERMFEE VALUATION 13 , 000 . 00 187 . 00 0 . 00 187 . 00 0 . 00
BSEISMICRE VALUATION 13 , 000 . 00 1 . 30 0 . 00 1 . 30 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 188 . 30 0 . 00 188 . 30 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
------ ----------- ------------ ------------------
OTHER 188 . 30 VISA
TOTAL RECEIPT 188 . 30
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
--305-== FRAME ==307=== INSULATION=====_____________
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•
CITY OF CUPERTINO
REROOF
• CUPEkTINO PERMIT APPLICATION FORM
APN# Date:
3!62.-1 -7 -0-01/ Z- 3 03
Building Address:7943
Creel
Owner's Name: Phone#:
S yap �6s- opo�
Contractor: S S Phone#:D G License#:
U 0 '
Contact: Phone#: 99 Cupertino Business gicense#:
Type of Roof Covering: 7
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
Cl Other(Specify) '�er Other(Specify) 45 30'I" e#_
Number of existing coverings J ❑ Provide I.C.B.O.Report#
To be Removed fd Provide Mfgr. Installation Specs.S s
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: tow O
Residential Commercial(/❑ I
Fire Zone: Yes ❑ No Confirmed'with Planni De t. if
there are any restrictio
Cost of Project:, �_ Type of Construction: \ Occupancy group:
3006 e
Qty. if
Applib Fee ID Fee Description Fee Group
BPERMFEE Bid Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING