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06040125 (2) CITY OF CUPERTINO BUILDING DIV510N PERMIT £CONTRA GTOWINFORMATION, aUILDING ADDRESS: LOS GATOS ROOFING PERMrr N0.06040125 10730 ORLINE CT OWNER'S NAME: PERMTI ISSUE DATE WONG SUSANNE Y AND ANTHONY Y888 FAULSTICH CT 04/21/2006 ONE: SANITARY NO. CONTROL NO. (408) 298-9399 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECTPLUMB MECH l� O L! O ;op LICENSED CONTRACTOR'S DECLARATION mlicensed - Job Description 1 Icrtby affirm tat 1 am licen ed tanker provisions of Chapter 9(commencing P :i9 wit Secdon]O )cfDivision3aftc Buri ma Profmium Codo.v mylmarrecis rid inrallrorocaneer¢ D REMOVE EXISTING SHAKE ROOF. INSTALL 7/16" OSB in in lull TeaClaLk.p - o Dam coons err AND ROOFERS SELECT FELT. INSTALL PRESIDENTIAL T ARCHnEJ as CTS DECLARATunderstandshON SHINGLES 22 1 understand my plans all he uupublic o:cnrds aaU Licnmxd Pmfcuianal �' Oat I am exempt from m Ce Contractors ON 2 1 ..a affirm that i 1. exempt from am Canuaemh LLecn C Law for to 20 following mason.(Section Z Contract. Business;and improve. d000u Code:Any city or county <m0. which rtquimsnpermit reenms to alcor.improve,dcermi ti ore a sig anyned ommurt ?iA 1A y pnarmiscensed e.pursuant to the to applicant for Such Conueermitmfends,Lw(Cha mem EE < NalLICe(commencing pSRuanlladleofDivisiooftale acBuiemraRJYnxLaw(sCoca)9 Sq. F[. Floor Area /t/ 1 D t~$ (cat he ingwit Secuan]00dth Oiesisfron 3 of theeged ess assund mption. My vi Coca)of AM/ -. Jeal he u eumpa t appli end am bum f« bj alleged exemption.Any violation of .1Sector703L5 by vry red dollars (a pemth aubjecu dee epplicant m a civil pcnelry of APN Number O e Type not mom Nan five hoodoo dollars(5500). � y yP I,uowlter of Jon properiy,«mY ooPlaym wit wagmuteusok campensaJon, will aameumns aaaee:waonsommram is not,Licara Lawcloaffered forae a(See applyooincon Burnham359 Required Ins eC �ib, and ery,wh oro Cade The Contractors cad w1io law am cot apply hf an owner of q p con am who s.pro aimPtaw,ntImrove who amasuch worthimselredtrough his awnver.dom,provideddialvem Improvements wi art awl ou ofctor aroRertd for tele If. l however.Ne Wilding or improvement us colas,didn arm year of c prove for to owe of builder will have the Wracn of proving Wl k did n«build do improve far puryate of mleJ. ❑1,an owner of the property am ra clusivelY contracting wide licertxd cmntrvaoss in Conswct the project(Sec.7014.Bminm and Professions Cade:)Thin Conlrxmr's U. came Law does not apply to an owner of property who Wilds or improves termn,and who co m cla for inch projem wit amnVacmr(s)heenxd pUrstom an this ean4Ylara Liceme law. ❑1 Sm exempt under Sec. .B 6 P C far Nis myon Ow u Dam WORKERS COMPENSATION DECLARATION 1 bercby alarm under penally of perjury elm of Jm following dela sturc: Cj I hew,and will atermin a Ceelfieam of Cament m ulGimurt f«Warta.Compen. cation,u provided far by Secdan 3T(k3 of to Li WsCode.far Ne perferso nm of Ne wort for which his Permit is issued. 1 have and will maintain Worker"Compensation Inw..as myuima by Section 37W of Me lab«Code.far ton performantt of to wart fat which this permits Rmtrr4 My Warier K don N rums carrier and Polity number vis..:�Y..aa ��++ Grier. Policy Ne.:OO O 4-0.97- Z �� CERIIFICA OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE This xenon decd not lo completed ifft Permit Is fre e=hundred dallan(SIM) v tor less) 1 comfy that in to Mramsrce of to work for which tin permit is issued.1111111 not employ anymmen in any mannerx u in become subject IS to Wargo'Compenadan Laws of Caliromia.Data Applicant NOTICE TO APPLICANT:If,after making Nu CemiOcam of Exemption.Tau should became Subject m be Woi'mrS Campcmadon provisions of to Labor Code,you mute .J 0 faMwit Comply wit Such provisions or is Permit shall W aecmil muted. zgay CONSTRUCTION LENDING AGENCY [—� 1 herby affirm our tart u a construction Lending agency far to performance of E Jte work far which Jtis Permit is slued(Sec.3097,Civ.C.) �W Q Larder"Name = z Lenders Addrou U0 I rotary that I have lead to;it"licvian and sum that to Slow,information is I3. F Correa I agree in comply wit all city and county ordina es and arae laws mlaling to O V Wilding construction.and hereby autome mPmxnetiacs arts city to order upon lW ntionod purpo alowges judgru property for inspectionxerms which ms. ,1 y (loc)agree to saw,,indemnify and keep harmless tW City of Cupertino against rA incoiuu,judc,of s,ewuand of this ponit. may in any way im«agafmueid City U z A PLICA nee of tc granting of to permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date �— Z/-YJ SOU REGU T9p y ^O� —S Z' SignatureSignatureof ApplicanVCanuacmr Dam Re-roofs HAUADOUS MATERIALS DISCLOSURE Type of Roof Will to applicant of fume building oecupant IInrc or handle laudations th and Saety u deli«a Section dim Cupertino Municipal Code.Chapter 9.12.and to Health and Safety Cause. Dy. All roofs shall be inspected prior to any roofing material being installed. 41 ❑Ym r�'u Will the applicant of to.Wilding amupanl us,cgaipmCnt or acvim which If a roof is installed without first obtaining an inspection,I agree to remove emit harardnus air Contaminated as dcloca by to Bay Arca Air Quality Management all new materials for inspection. Diseim? ❑Yon Nu I haw mal the harardms mamrialsreyuimmens undar Chaymrd.95 of to Caliar- niaHaltk SafclyCade,Sav«u 25505,25533 and 2553x.I nmtrsund derirtk Wilding dm rot Currently Ww a W tatiImy mapomibilily mdir the occupeot or to myuimmcnuw chmuvbemelno tmnaamaracerdrmamor0,27. Signature of Applicant Date Owner«autoriroa.,CarDam Dam All roof coverings to be Class "B"or better ' m, Community Development 10300 Torre Avenue Cupertino CA 95014 • Telephone(408) 777-3228 CITY Of Fax(408) 777-3333 •CUPERTINO Building Department JOB ADDS O �� PERMIT # ��((// 060 (/0j2S OWNER'S NAME: UOQ q JPHONE # Ypg GENERAL CONTRACTOR i u a o ;� " FAX # p _ I am not using any subcontractors: �� 0 6 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 O r%Contractor Signature at Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY Of Telephone: (408) 777-3228 • C PEkUrIN® 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 building4nnspector. 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-progiess 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. EWPORTANT: 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 in I understand and will coma12#" lwith the above stated policy.on re-roofing. Homeowner's Name: / &)(11/ 1 -__ __Job S:te_Address:_______,,_( o - - -.... 00 � Coin'-azi-Nam A plicant's Signature: Date: Greg teel • Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO OLm 1 of • 3 PERMIT RECEIPT OPERATOR: amyw COPY # 2 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 35922057 . 00 DATE ISSUED. . . . . . . : 04/21/2006 RECEIPT # . . . . . . . . . : 34089 REFERENCE ID # . . . : 06040125 SITE ADDRESS . . . . . : 10730 ORLINE CT SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : WONG SUSANNE Y AND ANTHONY Y ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4351 RECEIVED FROM . . . . : LOS GATOS ROOFING CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481 COMPANY . . . . . . . . . . : LOS GATOS ROOFING ADDRESS . . . . . . . . . . : 888 FAULSTICH CT 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 11, 000 . 00 180 . 36 0 . 00 180 . 36 0 . 00 BSEISMICRE VALUATION 11, 000 . 00 1 . 10 0 . 00 1 . 10 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 181 .46 0 . 00 181 .46 0 . 00 • CITY OF CL]PERTINO REROOF 0(00q 0 OF CUPER-TING PERMIT APPLICATION FORM • APN# jJ9 - -2- -03 7 Date: Building Address: 10170 Mine C Owner's Name: Phone#: Contractor: Cp Pho #: O License#: - X00 J0 Contact: �- Phone#: Cupertino Business Li�n e#: % Sairn� Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles Asphalt Shingles Wood Shakes ElWoodShales Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) -7 el S/3 Number of existing coverings 1 12 Provide LC.B.O.Rep u �. To be Removed ❑ Provide Mfg.Installation Specs. I Have Read, Understand and Will Com l With Cu ertino's Te Off Polic Job Desc 'ption: P-)�2�;yt /tr�� .Clio SeG�ei �1 ter, �P f4. _ 7�q/ J Residential f rxr Commercial Fire Zone: Yes ❑ No Uonfrrmed with Planning Det. there are any restrictions: LJ st of Pro ect: Type o Cons7ucti Occupancy group: ?, 3 0 k ;� Qty. if A licable Fee ID Fee Description Fee Grou BPERNIFEE Bldg Permit Fees BUILDING BENERGY Energ � BUH-DING IICRE _. — SeismicFeel2es._._._ BSEISMIGOlv1 -- - DING __ . Seismic@ommercia� __BUIL-DING _ — Plan Check FEE---- - - - B� DING Business License BUILDING