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