04070176 (2) CITY OF CUPERTINO CdN ` � , Q INFO �
( BUILDING DIVISION PERMIT , ,
BUILDINGADDRESS: STEPHEN HI4CKMAN ROOFING, 2 �!MITNO04070176
1R72.5 TILSON. AVE OWNER'S NAME: PERMIT ISSUE DATE
Alk PAUL KAO
SANITARY NO. CONTROL NO.
NE:
(408) 266-6359
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG EO PLUMB MEOCH
ITIft
uO0 LICENSED CONTRACTOR'S DECLARATION pl
I hereby from that I am licensed under provisions of Chapter 9(commencing
with Section](g107Of0iv'IOn theBalineasandprofcssiona Code,andmyliceeaeis
^
Mot in lull for���pprr��d erreaL yt REROO/sF
�g� I.icenMC Clasg,r Lie lf�� D[',N AUG ors 2004
Convenor /� S „y�J
QW A HTrECI'S DEG ON'
1 understand my Plain shell W useJ u public records BUILDING
3aU
Gr^ LicemdPnJcssimnal
3 barOWNER-BUILDER DECc Conti DN
qy 1 homey ofriee Not 1 am excmm from Nc Contractors License Law for the
which lm mason. emit t Ronstr t,al•er. and improve.
de ivas Cole:Any city ns county
.22 which requires a Permit m construct,alms imPmve,dcmOlLth,m repot,any nmcwm innon
FZi prior a its iumnce.alw requires tWapplieant rmsuch Permit I.Man signed stsemcnt
F � thetheislicensed pmmemmthe prevision offtCommunesLimnmlAw(Chapter 9 Sq.Ft. Floor Area Valuation
(commencing with Section 7")of Division 3 of Ne Enrolment and Profusions Code)or
Wthat in,is exempt therefrom and the basis for the alleged eamption.Any violation of
Section 7031.5 by any appbcant for a permit subjects the applmanrm a civil Penalty of 3-ATNalUfaTber00 Occupancy Type
Me,morn Nan five hundred dollar($5001.
❑1,as Owner of the properly,or my employees with wages as theirmic compenu0on.
will do the work.and the avucture is not intended or offered for sale(See.70".Business Required Inspections
and Professions Code:The Convectors Liam Law dean not apply a an owner of q p
property who Wilda orterproves Iherton.and whodoussuch work himself or through his
own cmpmycea,provided that such improvements art not Inen ed orafferad for We.If.
however.Ne building or improvement is sold within one year of completion,Ne ownM-
builder will have she burden of proving that he did not Wild or improve for purpose of
We.).
❑h u owner of Jin property,am exclusively contracting with licensed camracen e
maswn the project(Sec.7(56,Business and Profusions Code:)The Contmceri U.
cert taw docs not apply to an owner of property who Wilda or improves thereon,and
who contracts for such projects with a mmracter(l)licensed pursuant in Ne ComracmYs
License taw.
❑I am exempt under See ,B&P C for this won
Owner Data
WORKER'S COMPENSATION DECLARATION
10 1 hereby affirm under penalty of perjury,ore of the following declarations:
I have and will meintoo aC,ol of Consent to self-msua for WarkeraCompcn-
mWe".m provided for by Section 370D of the Labor Code,for me performance Of the
work for which Nis permit is issued.
711 have and will maintain Workers Compensation Insurance,at required by Section
3700 of Ne tabor Cade,for me perfor cof the work for which this permit is Issued.
My Worlme,..CCynmp,,namstio. rmunn 'mend Palic numMrare: p
CERTIFICATE
RRu 0PoIi
r� C TIFIC OMP MON KERS'
COMPENSATION INSURANCE
(Thissection need not W completed if tW permit Is for one hundred dollars($1018
or less.)
I coldly that In the performance of the work for which this permit is issued,l Mall nut
employ any person in any manner m m to become subject a the WOrkeri Cmmpensa0on
Laws of California.Data
Applicant
NOTICE TO APPLICANT.If.eller making this Cenifcam of Exemption,YOU Should
become subject 0 the Worker's Compensation previsions of the Labor Coll you must
.,O forthwith comply with such provisions or this permit shall W deemed mulled.
z CONSTRUCTION LENDING AGENCY
14 1 homby of firm that there I,.conatructlnn lending agency,for the porfwmmex of
gk 7 me work for which Nis permit 0 imuod(Sec.3037,ON.C.)
ul Q Landers Name
2 Lender',Add.,
U 1 amity that 1 ham mad this application and seem that the above information is
W catmcL 1 agree a comply with all city and county oNinaneea and soon law,relating e
O V Wilding construction,and hereby aurboriarepresentatives ofthis city aenter upon The
>.CT] shove-mentioned property for inspection pulpows 42
F 6r (We)agree a aaa,indemnify and keep harmless the City of Cupertino against
fA liabilities,judgments,costs and expenses which may in any way accrue against mid City
L)z s Permit.
in
eUSTANDS.A
tNERe swung of tND WILL COMPLY WITH ALL NON-POINT Iss ed by: [
SO ACE R ATIO S.
e-roofs
Signmurc pl' 0 cater Dam
RDOUS MATERIALS DISCLOSURE Type Of ROOF
Will to t or future Wilding occupmt am or handle hvasdom material
m defined by the Cupertino Municipal Code,Chapter 9.11.and de Health and Safety
tale.Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑yee
Will tW applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit a/erdom air contaminants as defined by the Bay Arta Air Quality Management all new materials for inspection.
Disvin?
❑yu
reIbave and JmarSeenuxma
lie HraihCOtlo Secmm255ri05a.ls25re533 and
2n5534.It MCerborm th95 iffWNc Wilding
Y{//
Jon trot c Jy have a IenanL Nat it u my responsibility to notify Ne occupant of Ne
require etch m renprio issuanaofaCcnifeaeofoccas ancy Signature 0 plicant -Date I
er ora ori a gent c All roof coverings to be Class "B"or better
Community Development
v„
10300 Torre Avenue
Cupertino CA 95014
J'
r, Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRES* PERMIT# DyQ
g`72S Ti/6ar� !h �.4
OWNER'S N PHO
GENERAL CONTRA FAX#
5�7-00 er.�, // A nKorc J?r Eins� c, 4�U8 y zZ 7b 5
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors com let_ the following information:
SUBCONTRACTOR. BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
• Linoleum/ Wood
Glass/ Glazing
Heating
Insulation "v
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
/ r Contractor Signature Date
Community Development Department
Building Division
i - City of Cupertino
10300 Torre Avenue
� CITY OF Telephone: (408)777-3228
U PERTINO 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.
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 thee above stated policy on re-roofing.
Homeowner's NIIJA: 6/—) ,� Zae-)
Job Site AddrMs: 1972--5 %ISU✓b
Roofing Company Nam
AplicanYs Signa Dater
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
NIS REROOF
CITY OF
CUPERTINO PERMIT APPLICATION FO
APN# C� Date.
Building Ad ress:
Owner's Name ,,�� Ph ne#:
CD8 yie)-49�;51,30
Contractor Phone#: License #:
Zvi7 7316
Contact: Phone #: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
X Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑, Other(Specify) '�6 Other �jgr�j�00 J���
er
Number of existing coverings ❑ Provide I.C.B.O. Report#
';E` To be Removed ❑ Provide Mfgr. Installation Specs.
• I Have Read, Understand and Will Com 1 With Cu ertino's Tear Off Polic El
/�
u� TSG SPS C l� �rz �a /aTe� �d �Q
Residential E] Commercial E] 41
2S�CTRs 4�sz
Fire Zone: Yes E] No r-1Confirmedwith Planning De t. if
there are any restrictio
11441
Cos P oj�cti �� Type of Co to Occupancy gro
. if
1'cable Fee ID Fee Descrition Fee Grou
BPERMFEE BldgPermit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
0- 2-7 0 .
_ CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: conniew
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN 37518001 . 00
DATE ISSUED. . . . . . . : 07/28/2004
RECEIPT # . . . . . . . . . 26469
REFERENCE ID # . . . : 04070176
SITE ADDRESS . . . . . : 18725 TILSON AVE
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . :
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : PAUL KAO
ADDRESS . . . . . . . . . . : 18725 TILSON AVE
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : STEPHEN HICKMAN ROOF
CONTRACTOR . . . . . . . : STEPHEN HICKMAN LIC # 23600
COMPANY . . . . . . . . . . : STEPHEN HICKMAN ROOFING, INC
ADDRESS . . . . . . . . . . : P.O.BOX 7071
CITY/STATE/ZIP . . . : SAN JOSE, CA 95150
TELEPHONE . . . . . . . . : (408) 266-6359
4EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
--- - ------ ------------- ---------- ---------- ---------- ----- ----- ----------
BPERMFEE VALUATION 10, 000 . 00 169 . 56 0 . 00 169 . 56 0 . 00
BSEISMICRE VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
BUSLIC FLAT RATE 1 . 00 100 . 00 0 . 00 100 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 270 . 56 0 . 00 270 . 56 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- -- --_—�--- ------------------
CHECK 270 5 9127
TOTAL RECEIPT 270 56