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05070172 (2) CITY OF CUPERTINO ' z��'ay7�rrgg.. s�n"�k y ay�' ne ' BUILpING DIVISION PERMIT T 4s-QllTT"OT �l� 1N1O14��1V1F'.T,jOi\ yw , BUILDINO ADDRESS: LOS GATOS ROOFING PERMRNO.05070172 ' 0799 WILLOWBROOK WY WS NAME: FERMITISSUEDATE LUI SIK K AND SOPHY L 888 FAULSTICH CT 07/27/2005 E SANITARY NO. CONTROL NO. (408) 298-9399 ARCI-1=01ENGINEER. 1 n ., 1 •fl ' BUILDING PERMIT INFO BLDG ELECT IPLUMB MECH 'da •.,;IAY;Z,r-uLAR CENSEDCORMA: R'SDECATION - >+ ) - _ _ JobDescri - 1 hamby.affirm Nil l am Iimosed under Provisions of Chapter 9(commere j 13 r `• �• withgection7000)of Division3afdte Business"Profmiam Code,mdmylic is WfIfformand3 Lka TidG�O� REROOF—REMOVE 2 (E) .ROOFS IM I " '! 8z_ License Clu. off . OathContractor sir r7,s a , OSB FELT/SHINGLES — ZOOS y y p ARCHITECT'S DECV,R,91 011N� I Tun&nundm bas ehellW p%$IeFaE6ryL� 7 5� Licensed P melba onel BUILDING"I L I NG OWNER-BUILDER DECURA71ON U f ,• 1 ready .Korn'Nali 1. eacmpt from Ne fest o License Law.for the I' 1 0o fallowingreaum: emits 7(171.3,BusimmAnd Prufesstons Code:Any tiny or county I $ which icyuirca i permit la mconstruct,0alter,c Improve,dcmaldh,or repair any ucan"d 1 pdaina issuance,an"man"''eeppliean'Me Contract's gaw(ChateeI gg < Imature licenmilputivanttoNoPmvisinnsnfNeComrecmr,Lhcnsolaw(Chepmr9 Sq.Ft. Floor Area .. Valuat!o6390 1 $ (commencing with Section 7000)nf Divixioa 3mf the Business and Profucians Cn&)m .. Nit be ieeanipcNemfroN and Ne buns far the dleged exemption.Any violation of i seal..70315 by iny:Ppneim far i permu aabieaB Na.ppbeat tan.aivu pen.hy of APN Number Occupancy Type oat... he.nae hundred delta.(Ssmk ❑1,as owner of the property,or u my employcwith wagu u their ale compenadon. 3 6 9 2 2 0 3 8 . 00 will do the work,end Ne swdum O not imended or offered formic(Sm.704E Business Required Inspections and Profesalmu Code:The Convectors Limine dins ie Law mat apply to an owner of q p property who buil&or lmprovu thereon,and who does arch work himself a through his own cmplowu,prodded that such lmparwamnu arc mat intended or offered fm ale.It, however the building or improvement is sold within one year of complodon,the owner. buil&r will leave the human of proving that he did not Wild or improve for postpone,of - - seleJ. 0 I.As owner of the property,am exclusively contracting with licensed mnuactore to - cauwct the projem(Sec.7014.Business and Rofessimn CmI The Con mean).U. 1 . ..favi dins not apply in an owner of property who Wil&or improves Merton,and, who conuaB for such pmjecu with aconuamoKs)limmed pursuant to the Contractors Lice.law. + - ❑lamexemptunderSee. BB PC fm this maven r Date WORKERS COMPENSATION DECLARATION' - 'n .• _. ` . "' . ' r 1 hereby 4B ri un&r pemlty of perjury one of Ne foltow ng declenti.ns:x !' tj It • ,t, El f mainulna CcNfinti of Coruabor Cop.fordo performance of Me ,sspmddm for by Secd6 3700 of 0¢Labor Cade.for Ne performance of Ne - far which this permit Is leaved. - t ' ive and will maintain Workeri Compensation Insurance,u required by Smahm of the labor Co&,fm Ne performance of Ne work far which Nis permit is issmtl. orkers Compensator,Insurance coria and Policy number. Ste, jrywl) Policy No.: ZZ J��Zds� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ,(Thlsmctan mad nothecmnpleted if the permit is for one hundred MAWm($100) mr least• 'q I I ceitify thit in the performance of the work for which this permit is issued:I shall not employ any Person In any manncru As in becomesubjecuo the Workers'C.mpenuuan Laws of California.Desi Applicant 'r. : NOTICE TO APPLICANT:If,after making this Cendleaw of ascription,you should " become subject to the Worker.Compensation provision,of the Labor Co&,you must .'O forthwith comply with each provisions or this Permit shell be accrued mmked. Z r'" CONSTRUCTION LENDING AGENCY - N F.t '1 hereby,which Nn there heco (Sea.3n lending agency lm the perform.nce of IY dicLa wart rear wnlan thin penton b issme(Sea.3097l Cu.c.) GQ Leaders Name D Z len&raAddrea, U O I anify Net 1 hew read We application sib.tate that the aWw Information it ' LL F incorrect,I agree to comply with all city and county ordinances and awe law retailing to O U Wilding construction,and hereby.uNorire rcPrenenmivu of this city to enter upon dw W shove-mentionW property fm Inspection purpmee O. (We).gra to save.in&sonify and keep harm ass the City of Cupertino against V7 liabiliticsjudgmenta.conu and expenses which may In any my amus Against said City U Z in consequence of Ne granting of this Much. �y �r APPLICANT UNDERSTANDS AND WIL COMPLY WITH ALL NON-POINT Issued by: Date 2-2- �f SOURCE REG UUTIO r 7/Z7 d Re-roofs to Signuurcof ApplicarVComracror -i Dam iHAZARDOUS MATERIALS DISCLOSURE `I '. Type Of ROOF ,Will the applicant or future building occupant store or handle Mrudaos miarial Id= fined by the Cupenuo Municipal Code.Chapter 9.13,and the Health and Safety - Section 25332(.). �d All roofs shall be inspected prior to an roofing material bei. C]lines 225 4- P P Y g g installed. Will the apprcam or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove harudow air contaminants u&fined by the Bay Area Air Quality Management all new materials for inspection. District? Oyes OA Ihrvcreulthe hmamnusm.wta,25533mmemeun&rCertand,93 if the Wilding ..lIha mad Cada adouoc255Oa,so,qui m125334.1un&rsmndthniftha Wilding not cutmndy have a wheat,that it is my mapondhilhy to notify No mcupat of Ne reymramauwhich in a Suane ofaCcrtiliawof�cuy�y 44 Signature of Applicant Date Owner or authrrind agent Dow All roof coverings to be Class"B"or better Community Development 10300 Tota Avenue acloF Cupertino CA 95014 Telephone(408)777-3228 PEI�1'�A'O Fax(408)777-3333 I�1 Building De artment JOB ADDRESS: PERMIT # /0-799 L Lo(A,61Lo vX, WAY Y �,5—D7CY�� OWNER'S NAME: 5)K L t/ I PHONE # 3S' 3 3 GENERAL CONTRACTORG 77�s 2 oafO W 6 FAX # I am not using any subcontractors: Lo�� -2A-71(J-� Signature Date Please check applicable subcontractors and complete the following information: ha 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 v 7 A,7 /0 S-� Owner/Contractor Signature Date CITY OF CUPERTINO • Item 1 of 3 PERMIT RECEIPT OPERATOR: suem COPY # 3 Sec: Twp: Rng: Sub: Elk: Lot: APN . . . . . . . . : 36922038.00 DATE ISSUED. . . . . . . : 07/27/2005 RECEIPT #. . . . . . . . . : 30541 REFERENCE ID # . . . : 05070172 SITE ADDRESS . . . . . : 10799 WILLOWBROOK WY SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : LUI SIK K AND SOPHY L ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : SUNNYVALE CA, CA 94087-3634 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 7,000.00 137.16 0.00 137.16 0.00 BSEISMICRE VALUATION 7, 000.00 0.70 0.00 0.70 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 137.86 0.00 137.86 0.00 • I CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION FORM APN# Date: 3bl- 2 Z—o 3�f 712 SIO S Building Address: l0 7 9 9 Gvi//o�ub�o o� llJ Owner's Name: Phone#t `S i is 4,� 930 -yi3s Contractor: Phone#:ZZ)sLicense#: t�, o s $ 02 $ ADO 7 d 7 Contact: Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles X Asphalt Shingles )d Wood Shakes ❑ Wood Shakes Wood Shingles ❑ Wood Shingles ❑ Other(Specify) 6 Other(Specify) I S do fc�s Number of existing coverings ❑ Provide I.C.B.O.Report# To be Removed Provide Mfgr.Installation Specs. .S • I Have Read, Under tand and Will Com I With Cu ertino's Tear Off Polic Job Description: Re tdential Commercial .❑ Fire Zone: Yes ❑ No Confirmed with Planning Dept.,if there are an restrictions: LJ Cost of Proje Type of Co ction: Occupancy oup- Qty. if A licable Fee ID Fee Description Fee Group BPERN= Bld Permit Fees BUILDING _ BENERGY...: ._ .. ....... ... .. ..._.. ..Energw---- BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOMSeismic Commercial BUILDING BPLANCHK Planheck CFee BUILDING BUSLIC Business License BUILDING • Community Development Department Building Division City of Cupertino • 10300 Torre Avenue r CI OF1 Telephone: (408)777-3228 CUPERTINO 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 the/above stated policy on re-roofing. Homeowner's Name: Jnb_Site Address: � 1 Roofing Company Name: A plicant's Signature: �/ Date: • Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper