06090221 (2) CITY OF CUPERTINO a* xxaa*a {" +r�-'- "�"•'', $''�'°sa' ' -
ilUILDING .RAC
DIVISION PERMIT CO . - TOR�INFQR1VIr�TIQN:
ii<2? r'°,*'�& iL,ytaz'
BUILDING ADDRESS: DOPING INC PERMIT NO.06090221
21220 GARDENA DR
OWNER'S NAME: PERMIT ISSUE DATE
WILVIN LEE 3243 SYDNEY WAY 09/22/2006
NE: SANITARY NO. CONTROL NO.
(510) 889-9068
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BO EO PLO MO
GC LICENSED CONTRACTOR'S DECLARATION Job Description
i 1 hereby same that i sm licensed under pmvi-man of Chapter 9(mmmamoeg p
with Section 70)(a).(Divlaion 3afthe Earinw and Professions Code.'ed my license in
mrallfureeandgffeer. REROOF- TEAR OFF WOOD SHAKE, INSTALL 7/1611 OSB,
License Class - Lie.# AND ASPHALT SHINGLES CLASS A 33 SQUARES
Dem Co
mummer s r
ARCHTEC7rS DECL.A
i 1 udde "my plans shall heated m public records
I6F
.O In
Licensed PN(CVlaOal
3
OWNER-BUILDER OE CLARAT
1 nam sRirtn the(1 am exempt from rile Canine enc Co License law for the
O o
follow at reamn.(Sadao 7(171.3,Rescue and professions Code:Any city or county
$Pi which requires a permit to cmlmucL alar,improve.demolish,or repair any stereos
Z y prior to its issuance.also inquires the applicant for such permit to Ole a signed statement
that he is licensed potatoes to the pmvisiona of Na Conoactlel U..Law(Chapter 9 Sq.Ft.Floor Area Valuer[
(commencing with Section 7000)of Division 7 of the Buono and Professions Code)or
$ that he is exempt therefrom and the bills An,the alleged eaanpdon.My violation of q}p7a��i/�,�Tyfj14y,��
Section 70315 by at0'applimnt fora permll mbjem the applicant ter,ciM pemity ar 3 L O Y V U U / T 0 0 Occupancy Type
ons mom dun Ow humlm9 dallun($5001.
❑Luawmrofthe popcny.orroyemployem with waimm deb wk eampemadon,
wit do Newark and Ne heCom Raged Licandm awdo not
apply in a4,Bmena Required Inspections
and Property
what
aN Cada:mpr CanVmmra LIRAS[ ons dam oat apply f rt owner of l p
propertywho ,proviimprowsthimpranlwho aoessuciewmk hkaffmcr Nrougd his
awn employ=,provided Nn inch improvemmuart notinteMel oroResN(w a,ie If.
builder Nebuildingor Impsovememin ert!withinm oar or mparmfrthesue of
builds will haw the burls or proving Nat k did rot GdW or improve for purpose a(
sale.).
❑1,as owner or the property..calmmuniY...unaing with licensed mna,nem N
construct Ne project(Sec.70",Bsinea aced profession Code)That Concourses Ll.
came:Lew does not apply to an owner of property who builds or Improves Nem en,and
who mmmcta for such projects with a comae cu s)licensed personal in the Cantsmers
lanlaw.
0 aIatmempt undo See .BdtPCfm Nu reamn 9/
73700of
.1 Data
WORKERS COMPENSA710N DECLARATION
I hereby LEirm under pera ty of perjury are of dm fallowing decisntiam: Q
I haw and will maintain,Califscata of Come(a self-imam for Worime.Compen. G
um,as provided for by Second 7700 of the Labor Code.Tor the performance of the
rk for which Nis permit is issued.
1 ban and will maintain Workers Compensation InsunnR,a reining!by Section
Ne labs Code,(a' perfm serf Na work farwhich this permit is Legend.
Work s oat nado I lance rrieraodPnkirymmberare:
rtier Policy No.:
CERTIR TE OFEXEMPTON FROM W RKERS'
COMPENSATION INSURANCE
(7lds mien need ambo completed if the permit It forme,hundred do0sre($100)
lir bons)
1 certify that In the performance of de work for which this parol,is based.I dull not
employ any person in any manner m as to become subject in the WarkerY Compensation
Laws of Califomia.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject in the Workers Compensation provisions W the lahm Code,you moa
.,O rorlhWlN s comply with each mandmor NU Permit")In,dammed rewkcd.
'�.r` CONSTRUCION LENDINGAGENCY
[+ IbusrNY SRimI Na Nee u a construction lending agency for the perfurrearxs of
a ti
the work for which this Permit is issued(Sec.3197,Civ.C.) '
Q Lender's Name
0.
0.z Imnda
ers Addm
U Q 1 certify that 1 haw read this application W sum Na the seem information in
U,F comm.I agree in comply with all city and county ordinates and sum laws relating in
C) building construction,and hereby authorim repmsemaiwa of this city to cnmr upon Ne
.have-mcndoncd propcapc
y far imctian purposes.
WW
(We)agree to an,indemnify and keep harrolms the City of Cupertino against
,.w rn liabilities,judgments,coats and expenses which may in any way accts against said City
C)7 In conmqueme of the groedng of this permit.
e1— APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: eau Date
SOURCE ppLA ONS.
N l -��— 9 Ll Re-roofs �✓
Signmu onummr
AZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ibu applicant err Range building=.posts.or handle hsallos mamrial
as dented by the Cupertino Municipal Cade.Chapter 9.11.and the Health and Safety
Cade,Sc01 I3
373(a)7 GGGGGG All roofs shall be inspected prior to any roofing material being installed.
❑Yin �No
Will thn applicoet or(atom Willing aspens use eyoipmmt or deviser which If a roof is installed without first obtaining an inspection,I agree to remove
..it hmsrdes air contamimnh0rod by the Bay Arm Air Quality Management all new materials for inspection.
District?
❑Ys o
I have read the haardns mmol.1s,mi0remcnu u.dm Chapmr6.95 of Nc Calilm.
lila HColNSs 5afeI Caa$tttiensd25305,15533uu125534.luMcraunddwifdlc building
dean rot Carmody On a MMM Nat It is my responsibility to no de oecupoe,of dm
mquimm whit mug buMet prior at smance0 aGerdf- Ocmpm Signature of Applicant Date
owmgr ,m a/ Dow- All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
aClOF Fax(408)777-3333
WUPEkTINO
Building De artment
JOB ADDRESS: ` 07 -2�4
_ J� I L PERMIT #
A ( Q (ED 2�L
OWNER'S NAME: vl 1'n4 PHONE# 2 — G v
GENERAL CONTRACTORY I A I S FAX # /
I am not using any subcontractors: r gla �P 2
Si a Datteo
Please check applicable subcontractors and com Tete the followinginformation:
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
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32640007 . 00
DATE ISSUED. . . . . . . : 09/22/2006
RECEIPT 4 . . . . . . . . . : 36172
REFERENCE ID # . . . : 06090221
SITE ADDRESS . . . . . : 21220 GARDENA DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : WILVIN LEE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : WINGS ROOFING
CONTRACTOR . . . . . . . : CHEA, WING LIC # 21240
COMPANY . . . . . . . . . . : WING' S ROOFING INC
ADDRESS . . . . . . . . . . : 3243 SYDNEY WAY
CITY/STATE/ZIP . . . : CASTRO VALLEY, CA 94546
TELEPHONE . . . . . . . . : (510) 889-9068
•FEE 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
t
•
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: �V,
Job Site Address: 672 1
Roofing Company Name: t/J i rtq _ R," (N
Applicant's Signature: J�— Date: ��b6
• Greg Casteel
Building Official
Revised 11/2/04
pry
CITY OF CUPERTINO a6w
Z
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# ao 4.0- 001 Date
3 I
Building Address: I
Owner's Name: Phone#:
Contractor: I N L License#:
I
Contact: 1' �I Cupertino Business License #:
i/U._ Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles K Asphalt Shingles
X, Wood Shakes LlWood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 1 ❑ Provide I.C.B.O. Report#
To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply Withi Cu ertino's Tear Off Policy.. f /
Job Description: —f/u �i1�0� �/)pt�e Yl� ���,�� ° S g GvrYl �S 1tit' SGiI e
Residential Commercial ❑ S(�t
Fire Zone: Yes ❑ NoConfirmed with Planning lDpt. if
there are any restrictions: IJ
Cost of Project: q 0-0 Type of C truction: Occypancy oup:
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