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INFORMATION -
BUILDINL' DIVISION PERMIT
CONTRtIiG''OR
k'w"'r .3'': its w 4+.si?.°,�^ c.c¢hac nb _ L 4� ,rn. • ,�
Buu.DllflO "SKIVE SPRING CT
TBD - TO BE DETERMINED
PERMFl NO.
08100048
OWNER'S NAME:
PERNM ISUE DATE
ZVIAD JACKHUA
10/09/2008
E
SANITARY NO. CONTROL NO.
ARCHTfECT/FNGINEER:
BUILDING PERMIT INFO
'BLDG ELECT PLUMB MFOH
0
LICENSED CONTRACTOR'S DECLARATION
lob Description
1 bereby &firm that 1 am lianod under provisions of Chapr, 9 (mommenciny
withS«Ilon 70f10)o! vmon3 of WC Busincv case Pro manned Code. ane myliceAvcis
RE—RF RMV EXT SHKRF INSTL 30LB UNDRLYMNT, VNT
Lifull fora aM e
uan,cau, Lic.g 41-0
FLSHNGS, GAF/ELK GRND CNYN CLS A 27SQ
am ARCH SDECLAR i ��—
NOTE: THE HOME IMPROVEMENT SOURCE PD FOR BUS LIC
1 undersand my Plans shall W used as Public nor,
Licensed Pmfcssional
OWNER -BUILDER DECLARATION
I hereby aRrm that I am exempt from We Contractor's Uccnm law for Ue
following mason. (Section 7031.5. Buman s and Professions Code: Any city or county
which requires a permit m construct ahs. improve. &.Wish. m .Pair any museum
prior m its imam. Am requires We applicant rorsuch permit w file a signed tummcm
We Conuacmr, Liavc Law(Cbapm9
Sq. Ft. Floor Area
Valuation
that he is lammed moment In the provisions of
$11576
(commencing with Scceon 7000) of Division J o(Wc Basin... and Professions Cade) car
that he is exemp thercfham atm We basis for tie alleged mmeeption Any violation of
36654098.'VU' Number
Occupancy Type
P Y YP
Section 7071.5 by any applicant for a permit objects the applicant W a civil prosily of
nor come Wan five hnw.d dollars ISM
1, as owm of Ne p,vpeny. a mY emplgm with wages u tiev ante compensstion,
Required Inspections
7U s4,
will dethcwons endo; omema`3 not
owner of
Law dace net apply m an owner
and The Limm Lawapply
Cade: Th Ces
q P
wh W
Naugb his
and who da is
theemrf nd who
property h
erty wlm WipEsm ed
dedmpeered for sale B,
me th, such impro semw notintwohhimffered
not ear
dot melt cat
own err,
is t in of
the Wilding 4 hale within m. year Ot compleefor We ower -
however, the building adem
of pmern
builder will have Ile buNm of proving that k did not AdW a improve for purpose of
uN.1.
❑ 1, As Owner of the propen,, am exclusively contracting with licensed mnoacbm W
moonset tk project (Sec. 7064, Business sod Profeseo t Code:) The Cmtracmrs U.
revs Law does not apply he an owner of property who builds or improves theme. and
who camsacts for such projects wild a mnuscmr(A licensed pursuant m We Convenor,'
Limens, law.
D I Am eaempt undo See . B d: P C for this reahan
Owner Dam
WORKERS COMPENSATION DECLARATION
1 thereby afNm under penalty c(perjmy arc of the following declamations:
d have and will mm au.CerORmm ofComentm self -stun. forWorkcrsCompos-
ration, es Provided for by Section 3700 of We Labor Cade. for the pufamance of We
work for which dust Permit is Toed.
D I have and will maintain Workers Compensation Inor . as mr i ed by Section
'
3700 of We Labor Code, far We performance ofthe wort for which Wis permit is Lssae.
'
My Worker m fi,.glI=.a trier And Policy numbe�jr K�:��v -
Catricr. Policy
FIG OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(This Aenim need Out heconplemd lithe Permit a fare= hundred dollars (SIM)
m leis)
1 antify Wat in floe perfo res. of the work for which Wis permit is issued. I shall not
employ any person in any manner an u lo become subjen to Irk Workers Comput ation
Laws of California. Due
Applicant
.
NOTICE TO APPLICANT: It, after making Wu Certificate of Exemption, you should
become subject m the Workers Compensation provisions of the tabor Code you most
comp, with such ProvWo s or this permit shall tc damnd nevokcd.
CONSTRUCTION LENDING AGENCY
I hereby alfml that there is a construction lending agency for the performance of
the work for which Wis permit is hued (Sec. 3097, Civ. C.)
Lenecra Name
,
,
Lenders Addrea
I must, that I have read this application anal tum that the above infatuation I,
I agree m comply with all city and county ordinamn and sum laws mlaeng m
Wilding construction. and hereby uWoiae.pounturves ofthis city to enter upon the
ahuve-mentionee property for inspection purpmes.
(We) agree to ave, indemnify, and kap harmless Irk City of Cupcnmo almost
imbilitimjudgments, coats and expcmes which may in any my aurae Against said City
in connequena of the RSTAN Of this permit.
APPLICANT UNDE STANDS ND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCE!
Re -roofs
Sig so rc of Applio ter Dem
O MATERIALS DISCLOSURE
Type of Roof
Will the mplic orfumm building numpantsmm«Mndlehaallow material
u &Rnee by tiro Carpe . Municiml Coee. Chapter 9.12, and the H.iW and Safety
Code. Section 2553x4)7�-
All roofs shall be inspected prior to any roofing material being installed.
0y.11 e
If a roof is installed without first obtaining an inspection, I agree to remove
the applicant or future Wilding Occupant use equipment at devices which
jWill
It huva kms At comm�inanu a defied by We Bay Ams Air Quality Management
all new materials for inspection.
iav ct7
Dy.
I have real We Ammons memri0is re'veree s under@cep e'6.95ofthc Califor.
his Health&Safety Code, Slxemts25505.25533 mvd25534. 1 underswd thatifthc building
O/I �r
"f' sr
A
dims notcum mvnkjhu its my tesposibilily m notify the anvP.1 of de
ragas. c pnarmissummofacurl"Wor
� vv
Signature 0f ppi ant Datem
All roof coverings to be Class 'W' or better
Owner Dam '
or auNamrA t
IT
CITY OF CUPERTINO
• 3 ITEMS OF 3 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk:. Lot:
APN ........: 36654098.00
DATE ISSUED.......: 10/09/2008
RECEIPT #.........: BS000006310
REFERENCE ID # ...: 08100048
SITE ADDRESS .....: 11699 OLIVE SPRING CT
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
I
OWNER ............: ZVIAD JACKHUA
ADDRESS ..........: 11699 OLIVE SPRING CT
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-5141
RECEIVED FROM ....: THE HOME IMPROVEMNT
CONTRACTOR ..-.....: TBD - TO BE DETERMINED LIC # 00096
COMPANY ..........: TBD - TO BE DETERMINED
ADDRESS ..........:
CITY/STATE/ZIP .... ,
TELEPHONE ........:
•
FEE ID UNIT
QUANTITY
AMOUNT
PD -TO -DT
THIS REC
NEW BAL
-----------------------
1BSEISMICR VALUATION
---------
11,576.00
--
1.20
----------
0.00
-
1.20
----------
0.00
1BUSLIC FLAT RATE
1.00
110.00
0.00
110.00
0.00
1REROOFRES SQ FEET
27.00
351.00
0.00.
351.00
0.00
TOTAL PERMIT
----------
462.20
- ---
0.00
----------
462.20
----------
0.00
METHOD OF PAYMENT
------------
CHECK
TOTAL RECEIPT :
AMOUNT
---------------
462.20
---------------
462.20
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
REFERENCE NUMBER
--------------------
#1788
VOICE ID DESCRIPTION
------------------ ------
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
•
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 agree to comply with 2007 IBC Standards
and manufacturers specifications on re -roofing. All roofs are Class "A" per Cupertino
municipal code 16.04.080.
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.
7. NOTE: If you call for a plywood nail inspection 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 above stated policy on re -roofing.
Homeowner's Name: 2v 1 G -,A tAG. 11
Job Site Address: r7 D' I V 2
Roofing Company Name:
Applicant's Signature:
Greg Casteel
Building Official
Revised 07/30/08
Date: q -A
CITY OF
6UPERTINO
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:PERMIT
179 1��� ct..
#
L
OWNER'S NAME:pa
PHONE # (V — ate(
GENERAL CONTRACTOR: V
FAX # (G •- ?S" GO 1C)
I am not using any subcontractors: .�i�/� v ld
S' ature Date
Please check applicable subcontractors and complete the following information:
s
r/Contractor Signature
�a -0r-o�
Date
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
s
r/Contractor Signature
�a -0r-o�
Date
0
•
(,D.
CUW5F
CUPERTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION
APN # 2�/ O (� O
Date:
/))
— O —
Building Address:
%/49 hve. 04.
n„h
Owner's Name:
Phone #:
i c a
f- 25 7- 9d9 -S7
Contractor:
Phone #: -
Tilt AQ OLL V-(- e—
Fax#: S 1 6�5'c�O1Q
Cupertino Business Lic nse #: g z 1 0
Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built -Up Roof ❑ Built -Up roof
❑ Asphalt Shingles V Asphalt Shingles
V Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify)
Number of existing coverings nnip ❑ Provide I.C.B.O. Report #
V✓ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: 1Rew �i� ��� .� i N 5L;, n� . 'Iv%d —t!
3o 16 ;.AvdUeal me..,Jr i v QK - ,F1ctsL �,vj s I e A F/EI k,
0-lase,.1 18
Residential Commercial El
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation: o
% S76 .
I Have Read,
Signature
and Will Comply with Cupertino's Tear -Off Policy:
Revised 6/16/08