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07090058 E'OF CUPERTINO 77777=7 7777.7777777777777 BUILDING DIVISIO CITN PERMIT 'C�11TR�GTCIR IECIRMATIOIY. PERMIT NO. BUILDING ADDRESS: TNT- ROOFING PE OWNER'S NAME: _ SA CONTROL NO. V . BUILDING PERMIT INFO ARCHITEC(ENGINEER: BLDG ELECT PLUMB MECH REMOVE SHAKE ROOF INSTAT-1 0 zLICENSED CONTRACTOR'S DECLARATION OSB 30 LB. FELT 3 0 Job Description F I hereby affirm that I am licensed under provisions of Chapter 9(commencing r U with Section 7000)of Division of the Business and Professions Code,and my license is - -- . - in full force an 4 O �Z 3 Z License Lic.i p Datc d Contractor W ARCHITECTS DEC RATION I understand my plans shall be used as public records U F- Licensed Professional a OWNER-BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractors License Law for the jO following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure y prior to its issuance,also requires the applicant for such permit to file a signed statement I;q,Ft. Floor Area Valuation c that be is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $ (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 Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number not more than five hundred dollars($500). ❑I,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.). ❑1.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors 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. ❑1 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I Itsoe and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation In nce cam and Policy number are: ✓2 v Carriers r10'f/t� ILIA)Eft icy No.0/-?66' CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Mis 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 Califomia.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 7-. forthwith comply with such provisions or this permit shall be deemed revoked. 0 0-4 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.) QLender's Name z Lender's Address 1 0 I certify that 1 have read this application and state that the above information is H correct I agree to comply with all city and county ordinances and state laws relating to j U building concoction,and hereby authorize representatives of this city to enter upon tete t W above-mentioned property for inspection purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,costs and expenses which may in any way accrue against said City Z in con race of the granting of this permit. Date G }' AP C ERSTANDS A WILL COMPLY WITH A L NON-POINT Issued by: OU EG U ¢ J! Re-roofs Signature o li etor Dare Type of Roof HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety Code,Section 25532(a)? All roofs ;hall be inspected prior to any roofing material being installed. [3 Yes CJno Will a roof i;installed without first obtaining an inspection,I agree to remove ll the applicant or future building occupant use equipment or devices which nit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection. District? / ❑Yes u �� 1 have mad the hazardous materials requirements33 nd55 under Chapter that if the Calding Q J� �"7 or- nia Health&Safety C tions 25505,25533 and 25534.1 understand that iCthc building T d rrentl h vc a tcna that it' responsibility to notify the occupant of the r Dire which met 'o . uance of a Certificate of Occy6ancy. Signature WApphcant Date I' V All roof coverings to be Class"B"or better Owner or au o'ed agent Datc D7oqQ � � � CITY OF CUPERTINO n REROOF CUPEkTiNO PERMIT APPLICATION FORM APN# 3-C 1 ` 1020 Date: j !1 O 7 Building Address: -Z 9 S C y �t - hone#: Owner's Name: / �1 P Nv ry 6 C t,1 Cil/ `11S` -z7/ Contractor: License#: �aoN /M/ G 15'0 �� Z Contact: Cupertino Business License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles L9I/Asphalt Shingles *09'Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles 13 Other(Specify) C3Other(Specify tC7 Number of existing coverings ❑ Provide I.C.B.O.Report# 3--'To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read,Understand and Will Comply With Cupertino's Tear Off Policy: Job Description: I [� 1 v✓6 S�� 1-2001C t L v,.g: i - v 0. �K Residential Commercial ❑ 3 S- c Li4�S 4 Fire Zone: Yes ❑ No [Lam Confirmed with Planning Det. if there are any restrictions: LJ Cost of Project: o� Type of Construction: Occupancy group: 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 agr(-e 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 i irst obtaining an inspection, will require the removal of all new mai erial down to the sheathing, so a proper City inspection can be performed. 7. NOTE: If you call for a plywood nail ilspection and the job is not ready, you will be charged a re-inspection fee of$176.18. The re-inspection fee must be paid before another inspection can be 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 abovc stated policy on re-roofing. Homeowner's Name: NU m� e 14e- /V Job Site Address: -2-o i D 9 z A e Roofing Company Name: -F/y7___ 6 Applicant's Signature: _aA, Date: P,, 6r7 Greg Casteel Building Official Revised 11/2/04 CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk : Lot: APN 359 11 020 DATE ISSUED. . . . . . . : 09/11/2007 RECEIPT #. . . . . . . . . : BSC00002611 REFERENCE ID # . . . : 07C90058 SITE ADDRESS . . . . . : 20E09 SHELLY DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA OWNER HUD G CHEN ADDRESS . . . . . . . . . . : 20E09 SHELLY DRIVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : EDWARD J DRAMINSKI CONTRACTOR . . . . . . . : WILLIAM TYLER LIC # 22988 COMPANY TNT ROOFING CO ADDRESS 2843 AIELLO DR CITY/STATE/ZIP . . . : SAPS JOSE, CA 95111 TELEPHONE (408) 277-0800 FEE ID UNIT QUANTITY 114OUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ---------- BPERMFEE VALUATION 12, 500. 00 201.96 0. 00 201.96 0. 00 BSEISMICRE VALUATION 12, 500. 00 1.30 0. 00 1 .30 0. 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 203 .26 0. 00 203 .26 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 203 .26 VISA --------------- TOTAL RECEIPT 203 .26