07080269 .,77777777777
CITY OF CUPERTINO
BUILDING DWISiON PERMIT TQR'I
......... ....:.
BUILDING ADDRESS: PERMIT NO.
1132 KENTWOOD AVE OLD COUNTRY ROOFING 07080269
PERMIT ISSUE DATE
OWNER'S NAME:
NELSON YUEN 707 ALD
SANITARY NO. CONTROL NO.
ONE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
REMOVE EXISTING COMP, BLDG ELECT PLUMB MECH
Z LICENSED CONTRACTOR'S DECLARATION r
o ELTJO s i tion
W C Sc'hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z m with ction 7000)of Division 3 of the Business and Professions Code,and my license is
e o. in full force and effe (�9�3 1
LicenwXlas Lic.N
Date t n Contractor
ARCHITECTS DECLARATION
1 understand my plans shall be used as public records
LuU
a
u.y Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors License Law for the
in O following reason.(Section 7031.5,Business and Professions Code:Any city or county
r, which requires a permit to construct,alter,improve,demolish,or repair any structure
Z y prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation
a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area
I=- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars($500).
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.if,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
[11.as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li.
cense Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
C3 1 am exempt under Sec. B&P C or this ason
Owner
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
L]I have and will maintain a Certificate of Consent to self-insure for Worker's Compcn-
sation,as provided for by Section 3700 of the Labor Code•for the performance of the
work for which this permit is issued.
EJ I pave and will maintain Worker's Compensation Insurance,as required by Section
3 of the Labor Code•for the performance of the work,&pr which this permit is issued.
Wor is Coo�mp/enation insurance r)IgiepapA
Carie T�1 DA I, tPolicy No.: t
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(rhis section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
`f-, forthwith comply with such provisions or this permit shall be deemed revoked.
H
O CONSTRUCTION LENDING AGENCY
�►-. I hereby affirm that there is a construction lending agency for the performance of
> the work for which this permit is issued(Sec.3097,Civ.C.)
Q QLender's Name
jLender's Address
0 1 certify that I have read this application and state that the above information is
4 rr cormL I agree to comply with all city and county ordinances and state laws relating to
Vbuilding construction,and hereby authorize representatives of this city to enter upon the
U above-mentioned property for inspection purposes.
" (We)agree to save,indemnify and keep harmless the City of Cupertino against
y liabilities,judgments•costs and expenses which may in any way accrue against said City
Z in consequence of the granting of this permit. Date
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued Iy:
SOURC GUL I NS.
Re-roof;
Signaturi ofAppltcant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE Type,of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Munici 1 Code:Chapter 9.12•and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes o
Will the applicant or fu re building occupant use equipment or devices which
If a roof'is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminaTo
cfincd by the Bay Area Air Quality Management all new materials for inspection.
District?
[I Yes
1 have aced the de,Sectio materials requirements under understand
the if the Califor-
nia
ria Health&Safety Code,Sections 25505.25533 and 25534.1 understand thatiCthe building
doesnot curcn ly It ve a tenant,that it is my responsibility to notify the occupant of the
rega,ro hi h ust be met prior w issuance of a Certificate oSignam-e of Applicant Date
f cup
O
All roof coverings to be Class"B"or better
Owner or autho'zed agent Date
IDeve!cement Department
BuLid ng Division
t
Cityif Cupertino
10300 Torre Avenue
Telephone: (408) 77-3228
CITY OF Fax: (408) 7 i-3333
% 'UPEkTINO
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 sped:,rations on re-roofing.
2. Nev,- 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 obtkned 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 tzar off aperoval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
3. If ply.vood is installed, a ply,.vood nail inspection is required.
6. .any roofing which is applied without first obtaining an inspection,
-,vill require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
IMPORTAtiT:
1. Flat roofs must have a minimum of?'a " 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 abcve stated policy on re-roofing.
Homeo�,,-ner's Name: t�� r1
Job Site Address: k: _
Roofing Company Name:Q L'_5) C O(/1 N--i
Applicant's Signatur:;7�1 Date;O 3 /6)
Greg eel
Building Official
Re-ised 1/30/03
Printed on Recycled Paper
Community Dcvclopment
10300 Torrc Avenue
Clipertino.CA 9501
Tcicplzonc(408) 777-3228
CITY IF Fax(408)777-3333
��iId111c epartn ent
JOB ADDR.ES PERMIT
'—[—FHQTNTE #YOY
GEN r F kL COi,rIT.ACTORo � C-V(44r /4' � FAX �� F �= _-Z, 0 1
� c:x I asn.not using an)' subcontractors: �_,1- '
Signat-ure Date
Please check ,,L-)rhcable slibc-onl=ractor.s and ccmLplete the fo.Uor`ring i.rdormation:
" LIBCONTRA.CTOiR I BUSINESS NAME BUSINESS LICENSE #
I Cabs,-LeLs & MiLlwork
f
Cement Finishing
Electrical -
ExcavaL�on
Fencing T _
Flooring: Caxpeling
Lu--lolc=/ ti•Vood
-- � Glass / GIaz.u-te� � -�--
Heating
Lnsulation
Landscaping _
T_7 thing -
-1a,onr;
Ornarrnental Sheet \letal.
i
Pa_inun4T / GVa_lll,apc-r _I
Po vLio-
Plastering __�.
RoofirL9 --
Septic "1 arlk
-� Sheet jvtetcal
i .S11cct Rock
Date
Oi,vn.e.r/Con tractor Sigizature
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: christya
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 35931056. 00
DATE ISSUED. . . . . . . : 08/30/2007
RECEIPT #. . . . . . . . . . BE000002524
REFERENCE ID # 07080269
SITE ADDRESS . . . . . : 1132 KENTWOOD AVE
SUBDIVISION . . . . . .
CITY CL PERTINO
IMPACT AREA . . . . . .
OWNER NELSON YUEN
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : SPN JOSE CA, CA 95125
RECEIVED FROM . . . . : OLD COUNTRY ROOFING
CONTRACTOR . . . . . . . : FCLK, DIETER LIC # 20389
COMPANY . . . . . . . . . . : OLD COUNTRY ROOFING
ADDRESS . . . . . . . . . . : 7C7 ALDRIDGE RD STE A
CITY/STATE/ZIP . . . : VP.CAVILLE, CA 95688
TELEPHONE . . . . . . . . : (%07) 864-5557
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
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 137 .86
---------------
TOTAL RECEIPT 137 . 86
CITE- OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN i 0 Date: yJ3 o-�L
B,_,.;dine Address
O,.t ner's Name- Phone #:
%low � (Ak%A) yc a Ci� �
Cc ntractor: PhLNe # License #:
l� C G L1
C Lc: hone #: Cupertino Busines License #:
Type of Roof Covering:
Existing: Proposed:
], Built-Up Roof ZI Built-Up roof
Asphalt Shingles Asphalt Shinzles
j Wood Shakes Z) Wood Shakes
j Wood Shingles zi Wood Shingles
z) Other(Specify 1 Z) Other(Specify)
Number of existing coverings :1 Provide I.C.B.O. Report#
:3 To be Removed :I Provide ;vIfgr. Installation Specs.
I Have Read, Understand and «'ill Com lv 'With Cu ertino's Tear Off Policy:
)b Descriptio� I
Residential Commercial ❑
Fire Zone: Yes ❑ do Confirmed with Planning Det. if
there are any restrictions: I8
Cost of Pro*ect: Type of Construe-tion: Occupancy group:
T
Qty. if
Applicable Fee ID Fee Description Fee Group
BPER IFEE '31da Permit Fees BUILDING
BENERGY Ener-v BUILDING
BSEISINIICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK —Plan Check Fee BUILDING
BUSLIC Business License BUILDING
I
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
PERMIT INVOICE OPERATOR: christya
Sec: Twp: Rng: Sub: Blk: Lot:
APN 35-1131056. 00
INVOICE DATE. . . . . . : 08/30/2007
REFERENCE ID # . . . : 07080269
SITE ADDRESS 11:>2 KENTWOOD AVE
SUBDIVISION . . . . . .
CITY CU]BERT I NO
IMPACT AREA . . . . . . .
OWNER NELSON YUEN
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : SAN JOSE CA, CA 95125
CONTRACTOR . . . . . . . : FO:JK, DIETER LIC # 20389
COMPANY . . . . . . . . . . : OLD COUNTRY ROOFING
ADDRESS . . . . . . . . . . : 707 ALDRIDGE RD STE A
CITY/STATE/ZIP . . . : VACAVILLE, CA 95688
TELEPHONE . . . . . . . . : (7 )7) 864-5557
FEE DESCRIPTION DUE. FOR AMOUNT DUE PAID BALANCE
--------------------------- ---------------- ---------- ---------- -----
BLDG PERMIT FEES PRINTING PERMIT 137 .16 0.00 137 . 16
SEISMIC FEE RES PRINTING PERMIT 0.70 0. 00 0.70
---------- ---------- ----------
137 .86 0 .00 137 . 86