06030087 (2) CITYFCUPERTINO
BUILDING DIVISION PERMIT O CTUR�iNk'URMr1TION:,-'
Ms ; aYn
BUILDING ADDRESS: PERMIT NO.
WOODS ROOFING 06030087
O "r.:GARDENA DR PERMIT ISSUE DASH
NE: SANITARY NO LNO.
ARCHITECTIENGINEER: - —5 0 7 6 BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
l� l�
iZp LICENSED CONTRACTORS DECLARATION JobDescri tion
i 1 hereby&M m that l am licensed under provisions of Chapkr 9(comminuting P
r with Seedon 7").DivisioOn 3 of the Business an nfetuont Code,t ylicense it
""d
force and a '�
13C Data Y G ' O SHAKES . REST T' OSB ADD 50 YR COMP SHINGLE
i ARCedl be ttse DECLARATION CLASS' A � ALE®
1 undersand my plain dull he uuA u puhlie rtcnrN
iO
h
Licensed Professional
'S Oat I am exempt
DECLARATION
Commoner
,
I hereby.(Stu that i 1. .Bumps Item the Conuamoo License law for the KyyL ?� 2006
j o following mann.(Section 71171.5.Business and Improve.
ds io i Code:Any city or County J(I}�(��7W L
S jxi whlrM1 its i ms n permit re cowmcL der.ntfor such
demNuh.ri repair any thoelmoc
ned atement
:y pdorm it,iensedpalm mqulme theapplicantof far cork Permit miensrile a,aw(Cha mem
o
that hetscCansed pursuant loth.pmvldsio of BUConu.nm'tumnxelace.Code)or
Sq.Ft.Floor AT Valuation
c$ (Commencing with Secllon7000)o(DiNsion3 oflboeged mu pton.M Preference.Cndc)err yS 1375
that he t,naemPt durtfrom and it,but,fm the alleged exemption My vlolallw of
Section 7031.5 by any applicant for a permit subjects the applicant to•civil penalty of APN Numbe0 '111 1%=::OCCupancy Type
nm more dun Rve M1undred dolt,n(f50oL
❑I.uawm of ore PmputY,amy employee with Cogen thetr mkcomRmdan,
will do the work,and the strecthm isnot intended or offered for tak(See.70th,Business Required Inspections
and Profedn ^ n oCode:The Dormouse. . e Law does rot apply an ower of tl P
pmpmy who builds or improves thereon,and who docs such Cork himself or dew{M1 his
own employees.prodded that such improvements are reminmeded m offered fm Use.If.
ltowvu.the Wilding or improvement it mid within oro year of eompledon,me ower.
Wilder will have the When of proving that has did not Wild or improve for purpose of
sale.).
❑1.as owoer of the property,am ucluively commaing with limned wnlr =ld
contract me pmjee(See.701.Business and Profrniun Code:)The GnOacuds LI-
Came Law does not appy to an ower of property who bull&or improve dmmon,and,
who contract,for such pmjecu with a conuacmr(s)licensed pursuant m the ContrseloM1
License law.
❑Iamexemptunder Sec. ,B&PCforthlsmuon
Ower Dau
WORKERS COMPENSATION DECLARATION
1 hereby aTom under prtulty or perjury one of the following declarations:
Ohaw and will maintain t Certificates of Centocor m self-Inure fm Worker'sComfeeo-
n.a provided fee by Secdon 3700 of the Labor Code,for the pedmarmem of the
work for which this permit is issued.
1 have and will maintain Worker's Compensation lnmranm,a required by Section
of the labor Code,for the performance of the work for which this permit is issued.
My Worker's omPe tiw1 rancecatrierand PalicynumbLmam: r�
Grtier. V� Policy No.:26S-ots f ff
CER FICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Tblssectlon need not be completed Ems permb Isfmooe hundred dollars({100)
or lea)
I certify that in the performance of thc work for which this permit is Issued.I shall not
employ any person in my member an as in become abject to the Workets'Compeasation
Laws of Celifomia.Date
Applicant
NOTICE TO APPLICANT:If,after making this CenlOcak or Exemption,you mould
become subject in the Worker.Compensation provisions of the Isbw Code,you must
,Z roanwith Comply with such provision or this permit hall W deemed Invoked.
O
Vl CONSTRUCTION LENDING AGENCY
I hereby affmn that dere Is a conaructin r lending agency fm dmc Performance of
7
the work for which cols permit is issued(Sec.3097,Civ.C.)
Qlender's Name
Z Leader's Mdmcs
Q I cool that I have reed this application and sun fast the above information B
^'. Corrrd 1 agree m comply will dl Illy and coumy oNiw¢ca and We law re1Nn{0
SVS building construction,and hereby aumodx repreunutimof this city to enter upon the
W a1mve-mentioned property for WrI cdon purieuseL
gy (We)agree to save,indemnify and keep harmless the City of Cupertino against
fq Ilabllide,Judgments.cotts and expenses whish corp in any wyamoesgainl midCity
in cweequence df me ming of N' per
APPLICANT U STA L COMP WI7F�AL NON-POINT Issued by: Date T—f
SOURCER
�� of Re-roofs
Signed.of Appli_ _
HAZARDOUS MATERIALS DISCLOSURE Oak Type of Roof
Will the applicant or fu um Wilding decupantttom whstdle luurdous makrid
U defined by the Cupertino Municipal Code,Chapter 9.11.and the Health and Safely
Code.Section 25531()7 ' All roofs shall be inspected prior to any roofing material being installed.
C]Y. WNo
Will the applicant or future building Occupant tau equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
haramous air cwnminanta as dcBOcd by the Bay Arta Air Quality Management all new materials for inspection.
icIT
❑Ye RN.
Ihave mal thelwardwamakridsrequirements under Chapter 6.95 of the Glifor.
rale Hulth&Safely Codc,S mu25305.25533 S3/.lunticrstsnd mulf me building
don not currently hero a 4 the it IbililY ti(Y dmf ace set of time
reyulmwour Ochi hue meal mi f y Signature of Appli rat Date
All roof coverings to be Class"B"or better
Owner or eau lborined tgem Da¢
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 32643035.00
DATE ISSUED. . . . . . . : 03/16/2006
RECEIPT #. . . . . . . . . : 33601
REFERENCE ID # . . . : 06030087
SITE ADDRESS . . . . . : 21251 GARDENA DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : H.K. GOSTA KNOHNGNGAN
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-1619
RECEIVED FROM . . . . : BONITA JENKINS
CONTRACTOR . . . . . . . : WOOD, LAWRENCE E LIC # 20810
COMPANY . . . . . . . . . . : WOODS ROOFING
ADDRESS . . . . . . . . . . : 2179 STONE AVENUE STE 22
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (831) 637-5576
SEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
______ _____________ __________ __________ __________ __________ __________
BPERMFEE VALUATION 14,000.00 212.76 0.00 212 .76 0.00
BSEISMICRE VALUATION 14,000.00 1.40 0.00 1.40 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 214 .16 0.00 214 .16 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ _______________--_
OTHER 214.16 VISA
TOTAL RECEIPT 214 .16
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
•CUPEkTINO
Building De artment.
JOB ADDRESS: �12 S GOA let, �� PERMIT #
2yo SL?
OWNER'S NAME: H•K. G5 e4c, PHONE # - Z o -/Z / Z
GENERAL CONTRACTOR: 01 `s - FAX#
I am not using any subcontractorsLN'04's Ms
ignature 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 Contract 'r Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF TelephFax: (OS)777-3
�UPE(�TINO
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: /9 /� d1 O Ca Fi✓r'o^� _�
tl
job Site Address: ;2/Z S,
Roofing Company Name: (�/0—trcP s titi
Applicant's Signature: �. Date: a1/le b 6
• Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO p?8�+
' REROOF
CUPEf�TINO PERMIT APPLICATION FORM
APN# 39b, 4s, 03S Date:
Building Address:
2/' Z-5-
Owner's
Owner's Name: Phone#:
- K G 730-12-12-
Contractor:
3v-/z/zContractor: Phonef f License #:
�06rd _T yob 6Uo-0ko3 32- 5 / 3 /
Contact: Phone#: Cupertino Business License#:
Zo 5-/J
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ')2( Asphalt Shingles
V Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: 7—/, S'-4-44t�Q D g A. "d So9
�"
Residential"IZ Commercial ❑
Fire Zone: Yes ❑ No g Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Project: Type of Construction: Occupancgroup:
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
•