06080252 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT '£CONTRACTOR INFORMATION�',
BUILDING ADDRESS: HELEN KIM 9FR"`F'No06080252
21179 OROGRANDE
OWNER'S NAME: PER.Mr ISSUE DATE
HELEN KIM 06
NE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0, LICENSED CONTRACTOR'S DECLARATION Job Description—p 1 hemby affirm Nat I am 1'uremN under provisions of Chapter 9(ammencing
:may withScetimil")of Divi.Jan3oftha Busimmand ProfessionsCode.andmyliccnrris
'a„ in full force and effect. RE-ROOF. TEAR OFF EXISTING AND REROOF WITH COMP
,q?
License Chu r C
Dae Cmun , SHINGLES 1/2” PLYWOOD AND 30LB FELT. CLASS A'
ARCHrTECTS DECLARATION
i ou I unda
ersnd my Plans dull be used az public records,
,0U
u.ou Licensed Professional
OWNER-BUILDER DECLARATION
<4 1 hemmy aRred that I am exempt from the Canractofs License Law far the
0 followingmason.(Snit.7ve LSBusinar.and ve.th Professions or Any city artcounty
i Q which requires a permit m construct,Jur,impmw,demolish,m repair any suucrum
.¢e prior to its issuance,also requires theapplieant for such permit to file a signedsutement
a Nat he a Banned pursuant in Provisions of the,Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valua[iQ�000
ft-$ (commrmng with SmAon 7000)of Division 3 of the Business and Professions Code)or
_ that he is exempt therefrom and One buts for the alleged exemption.Any violation of
Section 7031.5 by any applicant for permit a peit subjects Nqpe applicant to a civil penalty of 36217010 . 00
1eOccupancy Type
ore N
not man Rae hundred dollars fS500).
D I,u Moor of den property,or my employees with wages u their We Compensation,
will do the wade and theswctule is bar infrared of offered for sale(Sec.7060.Business Required Inspections'and Professions Code:The Cantrxctorf e License Law does ser apply to an owner of q
property wild,buildaofimprovu theleo0,and who re oriels work hoaealfart through his
awncmployms,provided that wen improwmanm are not mounded maRerM for We.If.
however,Ne building or improvement is mid within one year of completion,the owner-
builder will have tho human of proving that he did rot build or improve for purpose of
WuL
(]L as mane,of the property,aro ueluively coolant,with licensed com armrs to
cauvuci the project(Sec.7014,Budin and Profemser Code:)The ComnctuYs U.
came Law does not apply to an owner of Property who Wilds or impmws thereon.and
who contracts for such projects with a conuactor(s)licensed panuant ta the Contractor's
License law.
D l am cxcmptunder Sec. ,B At P C for this moon
Owner lJ cureO b
U
WOR 'S CO SATION DECLARATION
1 thereby Num under penalty of perjwy One of the fallowing declarations:
1 nave a ad will maintain a CiniRcate of Consent to self-insure far Waft,.CamN.-
satian,as provided for by Section 37M of the Isom Code.for the,performance of the,
work for which this permit is issued.
D 1 have and will maintain WorkcYs Compensation bmurma,as myuired by Section
37M a One labor Code.for the pcRormmce of de work for which this Permit is issued.
My Wmkcex Compensation 1...c artier and Pal icy number art:
Carrier. Palicy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This action need natnccampined if t e permit is fora..handled dollars(SIM)
at less.)
1 cattily Nat in Ne performanee of the work for which this Permit ts issued,I shill not
employ anypcnson in any mann. m cs bjW'.ft Workcrs'Cmu sadmion
Lawsof Califomia.Dae r �e�O rU S
APplianl ve
NOTICE TO APPLICANT:If,order g Nis COmficafr of Exemption,you should
become subject on IW WorkaS Compensation provtsiom of the Labor Came you mesa
.J 2 foMwltm comply with men provisions or this permit small W domed marked.
'Z O CONSTRUCTION LENDING AGENCY
I hcmh IBrn that dere is aconstructinn lcuri fmrlW
F hi gagemy perfartnaswle of
ai thoLa work for whim roma permit ts issued(Seu.3M7,Civ.C.7
DO Lander's Nauru
� z Lendeh Address
U Q 1 cmify that 1 have,rad Ws application and sue that Ne aWvc information u
jy corrett 1 agree to comply with all city and county ordinances and soon laws elating 10
t7U building conswnian and hemby authmim representatives of Nis city to enter upon the
r W shove-mcnuuncd pmpc costs
for inspection which s.
j-C (We)agree to sevc,indemnify and kap harmless Ne City of Cupertino against
N in Coiues,Judgmcnts,cutaandof this pewhich may in any way eccmc againstsald City
U 2 A APPLICANT-UNDERSTANDS
of IW Ranting of this permit.I L
^ APPLICANT_UNDE0.5TANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURFEREGUL ONS.
L ^� ° Re-roofs
Signamto of^RpllEanUC ser Data -
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will tmcapplicam or future Wilding occupantscam orhandle hma basmaterial
as deRned by the Cupertino Municipal Codc,Chapter 9.13,and the Health and Safety
Cade.Satires 15532(,)7 All roofs shall be inspected nor to an roofing material beim
❑Yes g'�,a P P � Y g g installed.
Will the applicant or future Wilding occupant um equipment or&0.which If a roof is installed without first obtaining an inspection,I agree to remove
mit havardnus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Disrin7
Dy. 12R.
In ove mad Ne haaadousmawrialsequimments under Chaper6.95 mf the Califor-
nialN..10ISafety Code,Swu=nM5.25533am125534.1undcrsanrtheifde Wilding
docs not Currently have a tenant,dm it u my responsibility to nouly the occupant of de
require mcntaw IWm¢pdarm issuance of a CcnlOcato or Caiam
�'/ 3%6 Signature of Applicant Date
Owner of adWoaCdagent —an, All roof coverings to be Class"B" or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
46UPERTINO
Building Department
JOB ADDRESS: PERMIT#
-,7-((-7q 6 v O S-O 2-S �—
OWNER'S NAME: PHONE # 5) 2?0 - Q( ,46S-
GENERAL
46JGENERAL CONTRACTOR 09 FAX #
I am not using any subcontractors:_ _C 3-i/0
G
Signature Date
Please check applicable subcontractors and complete the following ' ormation:
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
6
Owner% ontractor Signature Date
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent,spouse or child) will perform:
• A. All the work authorized by this permit
B. _ A portion of the work.
C. None of the work
If B or C is checked, complete 2 or 3below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
vc au usu:�.�
• 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information reverse side). /
Property Owner's Si; nature: �� rc, J Date:
Job Address IIW L990�71J3�L Cceper';m o G/} c/�ul� Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
•
City of Cupertino Building Department
CITY OF 10300 Torre Avenue•
C 1 I P E kT I N O Phone: (408)777-3228
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit. Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself, you
may protect vourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do you-Town work,with the exception of various trades that you plan to subcontract, you
should be aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work
(including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
If you are an employer,you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding,federal social
security taxes,workers' compensation insurance,disability insurance costs,and unemployment compensation•
contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your
obligations under state law,contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor, only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit,erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters: The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department,
City of Cupertino •
Printed on Recycled Paper
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36217010 . 00
DATE ISSUED. . . . . . . : 08/30/2006
RECEIPT # . . . . . . . . . : 35835
REFERENCE ID # . . . : 06080252
SITE ADDRESS . . . . . : 21179 OROGRANDE PL
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : HELEN KIM
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : JASON KIM
CONTRACTOR . . . . . . . : LIC # *OWNER*
COMPANY . . . . . . . . . . : HELEN KIM
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE . . . . . . . . :
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- - - - ---------- ---------- ------ - - -- ---- ------ ---------- ----------
BPERMFEE VALUATION 5, 000 . 00 115 . 56 0 . 00 115 . 56 0 . 00
BSEISMICRE VALUATION 5, 000 . 00 0 . 50 0 . 00 0 . 50 0 . 00
---'------- ---------- --- - ------ --------- -
TOTAL PERMIT 116 . 06 0 . 00 116 . 06 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------ - - ----
CHECK 116 . 06 4143
TOTAL RECEIPT 116 . 06
•
CITY OF CUPERTINO wa252L
Cu REROOF
cilyor
• CUPERTINO PERMIT APPLICATION FORM
APN# �(Q2_ �1-DID Date: - 30 D
Building Address:
/i-�17 oX N)qf L
Owner's Nam�:� �^ Phone /
E vt 1m
Contractor: / n License#:
Contact: ! IJ Cupertino Business License #:
`�aSOv1 C�
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
@ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles �r I
❑ Other(Specify) 13Other(Specify) CD
Number of existing coverings ClProvide I.C.B.O. Repo I /
❑ To be Rein oved ❑ Provide Mfgr. histalla ion Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
• Job Description: �� f�� 05•x,
�e wv{:�� Fewer D 1 d f? e
Residential .® Commercial ❑ 1
l2 s'r�GG rl uia�c'- lbs re(-l-.
Fire Zone: Yes ❑ No '4 Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
000
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
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 Qaid before another inspection can tie 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 Iabove stated policy on re-roofing.
Homeowner's Name: Rd" '!1/yn
Job Site Address:�7�� OP�O� �L L u '//�� U S l
Roofing Company Name:
Applicant's Signatury� !tip Date: �� v
Greg Casteel •
Building Official
Revised 11/2/04