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08060101 (2) CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRACTQR�INFURMATION BUILDING ADDRESS: PERMIT NO. .1.1.580 LAKE SPRING CT PRINCIPLE ROOFING & 08060101 OWNER'S NAME: l'ERMITLSSUE DATE PING MAK 10160 STERN AVE 06/13/2008 NE SANITARY NO. CONTROL NO. ARCHn-EC(ENGINEER: BUILDING PERMIT INFO REMOVE EXISTING WOOD SHAKE, BLDG ELECT PLUMB MECH O O O O SCO LICENSED CONTRACIVR'SDECLARATION —Job Description F 1 hucbY affirm i i 1 am licensed under and Piofess o t Code. 9(commencingis ^---••^- •^ --_ _ ., ., p nz1 with Section 7IXID)ofDivisian 3ofdte Buurry sand Prafeauav Code.and mylscnses in full fora and k,0 LiccnseC 3 Lic.• y216 �5 k, Da¢ t' Conuut. !!rg �� ARCHITECTI DECLARATION Y 1 unMwnd my Plana sIW I be used u public mentis of G G Licensed Professional 5 OWNER-BUILDER DECLARATION E 1 hereby aRrn that I am c nerept from the Contractors License Law for the y e o following reason(Section 7W I1 ,Butiness and Profusions Code:Any city ar mun.y K26!� which acquires a Permit m consumer•after,imprmc,demolish,«¢pair any swam Poor m its issuance,also Rquinsa tie applicant for such permit m rile a signed statement that he is licensed permans to the Provisions;of the Contracter's License Law(chapter 9 Sq.FL Floor Area Valuation %5S (commencing with Section 7lIlU)ofDivision 3 of the Business and Professions Codc)or e3— thus tie u exempt tnafrom and the basis for the alleged exemption.Any violadon of Section 7031.5 by any applicant for a permit subjects the applicant In a civil penalty of APN Number not mart than fnw hundred dollars($300). Occupancy Type ❑1,u aw«r of the property,ar my moploycu with wgu u rasa sole compensation, wiB do the wort and theswctum s.Untendedor offered forsalc(Sec.70N,Busnus and Processions Codse:The Contra ,I ansa Law dans an,apply to an owner of Required Inspections pto,crrywh t Wum«intProwadesmn,and wW noessuch w«k nimeeuor through his a wnemplaycu,pmvided Wtvchimpm mmuarttmtin¢Mcd«oRcredf«We.If. builder Ne Wilding u improvementg sold within ane yeas of completion,the o se of builder will have the burden of proving Nat W did net Wild«improve for pugnse of sale.). ❑1.as owner of tW preperY•am aGusvelY contracting with selected conurnon it consumer the project(Sec.7044,Business and Professions Cade:)Tae Coadmacmr's U. ave law does not apply,In an owner of property who Wilds or unprowu thereon,and, who ennvacts for such projedts with a m uracmr(s)licensed Pursuant to the Cunlracmrs License law. ❑lamuwptmdc See ,Bb.PC foe the mann Owner Dau WORKER'S COMPENSATION DECLARATION 40 I thereby affirm under pevlty of perjury one of the fallowing decluadons: I hew aad wBl mvntsin x Ce+tifimu of Cansem m self-ivurt f«Wargers ComRm uI ion,as red f«by Section 3700 of the LA.Code.f«the perlorma«e of the wart nmh this 9i,is issmd. - 1 save sand will maintain Warkces Compensation Insusaee,as acquired by Section 3700 of the tabor Cole,for the performanaofthe work,f«which this Permit is issued. ' My W.k .Com nsadon lnsunna carrier and Policy number are. Caner.afar' Z! ft•47✓l1 PolleyNo.: i7e"e 4— ZOoy CERTIFI TEOFEXEMPf10N FROM WORKERS' COMPENSATION INSURANCE rots section need rot W completed if the Permit Is f««m hundred dollars(5100) or less) I anify the.in the parfoonatee of the work for which this Permit n issued,I Nall rot employ say person in any manner so as to become subject tb IW W«kcrs'Compensedon Laws of Califorma.Dau Applicaut NOTICE TO APPLICANT':If,after making thin Certificate of Exemption,you should bosoms subject no the Warless Compcwdon ptaVlalons of the Labor Code,you most .J O fMW ed owuh camPly with such provisions or this Permit shall decreed!revoked. 'z y CONSTRUCTION LENDING AGENCY E•+"' L heteaY Niter that them is a cortstruction lending apse,for the Mofonnanauf C > the work for which ted Permit n named(Sec.3097,civ.c.) W Q Landers Name � 0, z lander,Address C.)Q I cranfY that I have mad this application arul state Nu the above information is [s. cortat 1 gree In comply with all City and county ordh ansa and state Ism mlatlng to Q Wilding construction.and hereby autharim mpmaenudvu ofthis city In enter upon de \ [A aWvcmcnuoond property for imMeuon purposes (We)agree he caw,indemnify and loop harmless the City of Cupertino against l•A liabilities,judgments.cow and,.pc.which may In any my scmc against said City V Z In"area«me of the granting of thus permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINTIssued by: Date SOURCE K4,ULAMONS. r o Signature of ApplianUConvactor Date Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding occ not some 0,halls hanrdous material as dclined by the Cupertino bluted Code.Chapter 9.12,and the Health sand Safety - Code,Section 83324)7 ❑Yea Na All roofs shall be inspected prior to any roofing material being installed. Will the applicaus nt ar future Wilding occupant e equipment or dcvl«s which If a roof is installed without first obtaining an inspection,I agree to remove emit haysrdov it conuminmu ayd fined by de Bay Area Air Quality Management all new materials for inspection. DisvicR ❑ ❑/ Yu Nu I haw read the hoar mater atenalsmquimmcnu under CluPter G95 of the Giiing ns Halthg:SafeyY Cade.mount, it my rrdcuwind uu.ifdc building docs not tsIcurrently have a tenant this it n my reaponubilitY m mtiry ase�upant of ma sip rtgofmr�ryn airn matte met prior to iasuame ora certtificate of Occupancy, Signature of Applicant Date Owner oraum�n,edagent �jrj� All roof coverings to be Class'W'or better CITY OF CUPERTINO • 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 36654034 . 00 DATE ISSUED. . . . . . . : 06/13/2008 RECEIPT # . . . . . . . . . : BS000005110 REFERENCE ID # . . . : 08060101 SITE ADDRESS . . . . . : 11580 LAKE SPRING CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : YING MAK ADDRESS . . . . . . . . . . : 11580 LAKE SPRING CT CITY/STATE/ZIP . . . : CUPERTINO, CA .95014-5120 RECEIVED FROM . . . . : DERECK LOI CONTRACTOR . . . . . . . : DERECK LOI LIC # 27564 COMPANY PRINCIPLE ROOFING & ADDRESS . . . . . . . . . . : 10160 STERN AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : (408) 898-7298 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ---- --- ---------- ---------- ---------- ---------- ----------- 1BSEISMICR VALUATION 5 , 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00 1REROOFRES SQ FEET 17 . 00 221 . 00 0 . 00 221 . 00 0 . 00 ---------- ---------- ---------- --- ------- TOTAL PERMIT 221 . 50 0 . 00 221 . 50 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 221 . 50 MASTER CARD --------------- TOTAL RECEIPT 221 . 50 VOICE ID DESCRIPTION ..VOICE ID DESCRIPTION -------- ---------------------------- - ------ ----- 7---------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF • CITY OF CUPERTINO REROOF ICUPEkTINO PERMIT APPLICATION APN # Date: Building Address: Fgo (i� tcb s pa`,v 6r Owner's Name: Phone #: Ytrl-r6r C400 446- 1 80.5 Contractor: RAN �� GG �z NG CnNsI �u�SON Phone #: Clg6,3 Fax #: Cupertino Business License #: Contractor License #: �7! 6 3 -0r Type of Roof Covering: Existing: Proposed: o Built-Up Roof ❑ uilt-Up roof ❑ asphalt Shingles u Asphalt Shingles d-Wood Shakes ❑ Wood Shakes o Wood Shingles o Wood Shingles ❑ Other (Specify) ❑ Other (Specify) _ Number of existing coverings ❑ Provide I.C.B.O. Report # o To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: IZC_ n ✓C,— S r:,r G, l✓poY� SHAD, n,yY1,1 1� 50—�(✓�S C•� 1�'�,� rs SHirrttLCr � liLdSS A 1 .�- Residential Commercial Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the there are any restrictions: ❑ application or if applicable, include in plan set & the sheet index. Valuation: ✓r-dwl w • I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature CITY OF CUPERTINO ill Sx-, REROOF ICUPEkTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BSEISMICO Seismic Commercial B 1REROOFRES Re-roof Residential B 1SFDWLROO]' 1BSEISMICRE Seismic Residential B 1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF 1BSEISMICRE Seismic Residential _ B 1BUSLIC Business License B • Community Development Department Building Division City of Cupertino 1 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: Job Site Address: Roofing Company Name: Applicant's Signature: Date:0�/3/o i • Greg Casteel Building Official . Revised 11/2/04 Community Development 10300 Torre Avenue EI Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 OUPEkTINO Building Department JOB ADDRESS: PERMIT # 1IF90 OWNER'S NAME: Yi u M 6 PHONE # GENERAL CONTRACTOR: v.;Nc ,�� ,,moo FAX # I am not using any subcontractors: o l o>? 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 C, Owner/Contractor Signature Date