06090275 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMITT�RAC
BUIL.OING ADDRESS: D LLIOTT' S ROOFING CO Pa'IMITNO'06090275
10383 HENEY CREEK PL
OWNER'S NAME: PERMIT ISSUE DATE
CHIANG STEPHEN S AND CONNIE 2669 COIT DR 09/29/2006
E; SANITARY NO. CONTROL NO.
(408) 559-7327
ARCHITEC(7ENGMSER: BUILDING PERMIT INFO
BO EQ PLO MEOCH
laz LICENSED CONTRACTOR'S DECLARATION Job D05CrIpUOn
l 1 hereby alarm Nu I am licensed under pr a isiaw of Chapter 9(eomrecal mg
wi(III n]Of111)ofDivision3o(the BusinraandPro(csdauCass,admyliecwcu REROOF- REMOVE ALL SHAKES AND FLASHING, INSTALL
s�n mfull fern 7"of
;'q: Lleew`° _-3 I.a.a X3 -3 - 1/2" CDX, 30LB FELT, PRESIDENTIAL TL FIBERGLASS
efflDate AR HITiDDECLARA"ON CLASS A. 35 SQUARES
`W 7W7Wu I undersand my plans a1WI k used u public rtmrd,
cat; Licensed Pmfaaienal
5 OWNER-BUILDER DECLARATION
E I hereby alien that I me exempt Imre the Con°acme,License Law for Nc
C O o following mean.(Section 7031.3,Business and Profession Code:Any city or county
42 des which requires a permit to cons"m alma imponw,demolish,or repair any structure
prior m is Issuance,also requires Jen appliunl for such permit to file asigned statement
< Nat he ullecnuJ purstmt to the Provisions of the Contractor's Licela
nse w(Chapter 9 Sq.Ft.Floor Area Valuation
E 9 (commencing with Section 7000)of Division of the Bminessand Profusions Coca)or $16436
e — that k te attempt therefrom ad the basis for the alleged exemption.Any violation of
Swoon 7031.5 by airy applicant for a permit subjects the appllunt to a dvil penalty of APN Number Occupancy Type
an mart then An hundred dolmrs(ISM).
0 1.u o-xrcr of the Property,or my vapbym wW wages as their sole eompeeatlon,
will anddafaamesCde: ah CommmtmLMelo,.dos set
he 44.sus.of Required Inspections
J
and Profwh ons Care:The Cmmcmrs License law aces ret appy lf rt ometh is q P
popery who batiprovi ed domes thereon,and who dotsouchwok m alt oNacks bat
how a however.
the es,provided that such improwmma as mt eaMrd milled v,torula E,
however.Jrt and us or improvement b sold within on You of Wmplotim,the oss of
builder will have the burden of proving that k did ret dJm o improve far purpose of
ask.).
❑1,u ower of the property,am exclusivelynend contracting wW licensed canusstaa N
construct the project(Sea 7014,Business and property
whoProfessions Cade:)The Cmlruars LI-
caw whoclawaounotapplyus ean ithaofprogeny whosedpbuilds rtimprom thereon.ad. Q/
who cantata for such ryajeLa WIN a conuacar(o)licensed punwnt to the Contractor.
1 am taw.
0 /
lam exempt undo See ,Bk PC fns Nis moan
car Car—
as
ana
WORKERS COMPENSATION DECLARATION
1 hereby of ore under pertly of penfuy arm of the following declarmans
1 hamana will maintain a Centifiwa of Consent to self-alum far WorkersCompa-
ation,u providW far by Section 1]00 of the Labor Code.far Na perfomana of the
wart far which this Permit is iauea.
have ad will maintain Warkers Compensation Incomes,a required by Section
700 of Ne Iabo Code.far Ne performance of Ne wort far which this gena is Wood.
My Workers Tempa tall AInmrtwe wrier and Policy numher
ardertf/era�a• Us Su rw�vblky"a.: `L
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
ffhis it.mad maWcompleted If the pe.I,Is furore hundmddollam(SIM)
or lea.)
1 cer iy that in the performance ance of tin work for which this permit is leant,1 Noll tot
employ any person in my marcrso a a became subject to the WokerYCempensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,&Oct making this Certificate of Exemption,you should
become mom m the Worke s Compensation provisions of the lakr Code,you most _
2 forthwith comply with such Provisions o this permit shall W acenaa revoked.
zO CONSTRUCTION LENDING AGENCY
[—iI hereby arms Nat Noe is nswtk a eoction lending agency forperfurmarce of
E> the work fur which this permit Is issued(Sec.3097.Civ.C.)
W�Q Lender's Name
7 Lenders Addrrss
U Q 1 certify that 1 have read this application and sate Nu Ne above information is
(~' coucsu.1 agree to comply with all city ad county ordeameo and sate laws relating to
QU building construction,and hemby authorize rapmxmatives of this city to cater upon the
4[1 above-mcntiuwd pmpery for impaction purcxs
C (We)agree to ave,indemnify ad keep hornless the City of Cuperino against
ti liabilitiw.judgments,eon antl ailuro which msY it ay wsy occruc ogolwt aid City
V? mc...quen"of the garde[of Nu permit
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
Signuurt ofApplicaOr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or forum building ocupent store errltomaterial
rideRnd by We Cupertino Municipal
the
Ham
pal Cotte,Chapter 9.12.ma the HealthaJ Safety
Cade.Section 2553x(,)7 All roofs shall be inspected prior to any roofing material being installed.
Yw �N
Will 0m applicant or futurebuildingoccupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit huardow air mnuminanm ex defined by the Bay Am Air Quality Muugcmenl
Mortal? inspection.811 new m8teC181S for SPCCt10TI.
0Yw Nu
C
Lhow mMthe hvaAaumaterials 05.2553 i ad 2553 nJcraaparG95 efNe Wilding '9
nu HwlNkSafmyCada Scctiou25505s myrend25S34.1an notify =up building
taw oat currtntl sow tewnt N u u my responsibility a notify the onager of the
g ne,Iorna he p armiaaacaence0ifpvy y ignature of Applicant Dale
8)9(� a i �7i� O[/7 All roof coverings to be Class "B" or better
mer or am o et
at Dole'
CITY OF CUPERTINO
!m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 34248025 . 00
DATE ISSUED. . . . . . . : 09/29/2006
RECEIPT # . . . . . . . . . : 36259
REFERENCE ID # . . . : 06090275
SITE ADDRESS . . . . . : 10383 HENEY CREEK PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : CHIANG STEPHEN S AND CONNIE
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : DAN ELLIOT ROOFING
CONTRACTOR . . . . . . . : DAN ELLIOTT LIC # 21466
COMPANY . . . . . . . . . . : DAN ELLIOTT' S ROOFING CO
ADDRESS . . . . . . . . . . : 2669 COIT DR
CITY/STATE/ZIP . . . : SAN JOSE, CA 95124
TELEPHONE . . . . . . . . : (408) 559-7327
'FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
------- --- ------------- ---------- ---------- ---------- ------- --- ----------
BPERMFEE VALUATION 17, 000 . 00 245 . 16 0 . 00 245 . 16 0 . 00
BSEISMICRE VALUATION 17, 000 . 00 1 . 70 0 . 00 1 . 70 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 246 . 86 0 . 00 246 . 86 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
--------- -------- ------------ ------------------
CHECK 246 . 86 12686
TOTAL RECEIPT 246 . 86
•
Community Development Department
Building Division
City of Cupertino
• 10300 Torre Avenue
Telephone: (408)777-3228
0
CUPEkT1N0
Building Department Fax: (408)777-3333
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.follow'mg.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 iequired.
..6. An _roofin which is.applied without first obtauun an inspection,
Y g � PP.• . . g:,,
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'plyiaood nail-inspectionand 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: .0 \\�(`S, CL'tlu 11
job Site Address: )0363 N-QY�V(eN T
C�`eQk aco, Cy'PffCtIMQ
Roofing Company Name: �Am G��ioT�S „oo�'hq Co'r��LtN�
Applicant's Signature: Date:
• Greg Casteel
Building Official
Revised 11/2/04 :
Printnd nn Rnnw:,nti Pnnnr - ..
or
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CFax(408)777-3333
un , NG
BDU' : Det artrnent
JOB ADDRESS: PERMIT#
03 3 N C
OWNER'S NAME: -�N1Ys, C �R PHONE # t(og �cl -i32?
GENERAL CONTRACTOR �j t' Ca FAX It o0, SSq 3 b
I am not using any subcontractors: Q_2g-O
Signa t Date
Please check a licable subcontractors and com le— ollowin 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 0.
Septic Tank ?' a
Sheet Metal
Sheet Rock
T'
er/Contra ' o gnature
Date
CITY OF CUPERTINO 0,J0C 'W5
REROOF
CUPERTINO PERMIT APPLICATION FORM
•
APN#
O� Date:
31-1�2- 4 6 OP-6
Building Address: I
A)3 F 3 Me t7 ae e C 4
Owner's Name: Phone#:
MT 1_ Mr4, C�tan 10,50— —` 1-39
Contractor: t Phone#: License#:
` )&-t t 4 s ." (o a8- S'SA- 13ZL (0113 3g C-3q
Contact: (J Phone#: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof 11 1 i
❑ Asphalt Shingles ® Asphalt Shingles
® Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles 1
C, Other(Specify) ❑ Other(Specify) Ji
Number of existing coverings_Q rrP ❑ Provide I.C.B.O.Report#_A SS M 1)301 g
6 To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: . p.4-ZaSb no)5., %4k)l .0 RDx, nsia i'3c
'Irn4all s '
Residential Commercial ❑ ..: 35 SQ
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are an restrictions: IJ
Cost of Project: Type of Construction: Occupancy group:
Ib q 23 SaMR- V" Sin a I g-2
Qty. if
A licable 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
•