08100174 CITY OF CUPERTINO + aa�ywa~Ls y "`6-" `'
BUILDING DIVISION PERNUT tOk�FTRAC-TWI�NF()RMt1'�ION�
6 i, w'at't
BUILDING ADDRESS: PERMrr NO.
7554 HOLLANDERRY PL BAKER ROOFING 08100174
OWNER'S NAME: PERMIT ISSUE DATE
ONE
A O. CONTROL NO.
(408) 559-5105
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
-� BLDG ELECT PLUMB MECN
u o p LICENSED CONTRACTOR'S DECLARATION
1 hereby aRm de
der 1 am licensed unr pmrham,of Chapter 9(commcneing lob Description
nth Smdon7000)ofDivldon Sof dm Buainas and Profeaiov Code.aM myy liceiaa u
in fell forceamcffm. H�.'L RE—RF RMV ASPHLT SHNGLS& INSTL ASPHLT SHNGL RF
Ll z License Cl Lle,0
Date iZ. —Contramor CLS
ARCHITECTS DECLARA
Iunderuamlmyplans small heused!upublic records A. 30S4
JyU
,a� licensed Pvfesalow
Oat I am eURDER DECLARATION
I,.- .Rrm that 11. exempt froms an the Comrmers License taw for the
`e o which ro rta:ma(Saito cn Is,Budmus and w,dmo ns code:Any mity m county
m which its in a permit re eon9sue4 aline impmw,demolish,Or mPsir any museum
thaIXmiu lensed,aborequite provision;
for such Permit Uee as Law(Chned ¢mem
£ `o thnWunanscaporswnlmthe provialnonoin,theBlsiness .cemn�onsCod�9 Sq.Ft. Floor Area Valuation
y�g (commencing with Section 7000)0(Divisim3of thh Businessud Promssiov Code)or (.10000
— that he is eamept theorems w me barna for dm n.An
alleged exemptioy violation or J
Section 7031.5 by any applicant for a Permit Objects the aPPlmant m a civil Penalty of APN Number Occupancy Type
tet come Nan five hundred dollus(3504 36229011 . 00
1,u eavnu of the pmlrny,ser mY employm with cages a the'v sole eompensadon,
and dotWwmk.Code,he Cmiurottmndede Law dos 1apply.to aBudneu
and property
whom Codc:The Conuacmrs License Law does eel apply ll rt owner is Required InSpeChODS
cure my wycaaWild,
pro IXimtows'such
ion n.wavems amand not
work hlmKHm through his .
own emtloyeWipresided dmsoh improvemmu art not intended meaertt fm winter,
however.the building or Impnswment 4 sot within one year of completion.the owner-
builder aN have the WNm of proving that W did colt Wit IX improve for pugose Of
❑1.as owner of the propeny.am conclusively contracting with licensed mmanon to
conswct the prim(Sec 704x.Businev aM Pmfecdons Code:)The Ces uacmYs Li-
,onew Law does not apply m an oceans of p opcny who Wits Or improves therm.and,
who contracts for such projects with a cmuactor(s)licensed pursuant to the Conuecto's
Licenu Law.
❑Iamacmpnundcar a .BAPCfor N-osmn
Owen Dam
WORKERS COMPENSATION DECLARATION
I hereby Num under pesulty of perjra,one of the folmwing declantions:
I have and will maintain a Certificate of Covent an self-insure fee Worker',CIXnper,
'on.as provided for by section 3700 or dee labor code.for dee perfnrmanm of the
wort for which this permit is Issued.
❑1 hale and will maintain Workers Compensation Insurance,as required by Senior
3700 of the LabIXCode,for the performance of the work fmwhich Nu Permit U iamA '
My Workers Compnwtim Laurance cerin and Miry nuen
Cartier: Policy No.;-2V `v r
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need rotbo cmnplemd If tW Permit Is faun hunthcd doBan($100)
or less.)
1 o unify dot in the performance of the work for which this Permit is Wised,I shall not
employ any person in my manomm as to becmne subject to the Woken'Compensation
Laws of California.Dao
Applicant
NOTICE TO APPLICANT:If.after making this Cer ifiam of Exempfion•you should
become subjm be the Worker's Compmumion provisions of the Labor Code,you most
.J O forthwith comply with such provisions IX this permit Shull bo dmm
cced eted.
Z ti CONSTRUCT ON LENDING AGENCY
[-� 1heftyaffirm dm tort is a construction loading agency for dee perfomana of
C4> the weft for which this permit is issued(sec 3(97,Civ.C,)
QUndors Name
.7- z lendeh AM.
U O 1 cemify Out 1 have mad Ihia application and sum lead the above infmmauen L
LU f"' comcL I agree be comply with all city and county on inances and sum laws relating to
.0U Wilding construction,and hereby anthmien rtpresenwiWat of this city commsuNn the
[Il above-mentioned property for inspection purpmea
13. (We)agree to saw,indemnify and keep harmless the City of Cupertim so=
_F,A liabilities,judgemms.eosas and eapensa which may in my way amue against said Cy
U z in covequrme of the grmdag of this NMIL
F-t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 0—t-Q,-101
SOURCE REG LA s.
ARe-roofs G�
Sigauure of ApplianUConuanor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or(teem building occupant tame or handle haaudous material
as de0rod by the Cupeniro Municipal Code.Chapter 9.11,and the Horth and Safety
Ches.smite 25532an
❑Yes d;aq All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
It harardov air cmumirunu as dcfimdI by the Bay Ara Air Quality Management all new materials for inspection.
ricly
❑Ya QNn— - '
I have mad the hvudousmatermis mquinemenuummr Chapterd.95 oflW Celina-
, ni.H ]"SedyCede SavoyZ505.25533nu125534.1udervM thuiflhe baiting
does tet currently haw a tenon.that It H my reapunsilulity to story the Occupant of the
requimmenu which mow met prior whoance nfa cmtifmamofaam ry my. Signature of Applicant Date
a Ge- �G 2 All roof coverings to be Class'%q"or better
Owner m anthmind agent Dam
CITY OF CUPERTINO
• 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 36229011. 00
DATE ISSUED. . . . . . . : 10/28/2008
RECEIPT # . . . . . . . . . : BS000006476
REFERENCE ID # . . . : 08100174
SITE ADDRESS . . . . . : 7554 HOLLANDERRY PL
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : CHEW
ADDRESS . . . . . . . . . . : 7554 HOLLANDERRY PL
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5261
RECEIVED FROM . . . . : JAMES L BAKER
CONTRACTOR . . . . . . . : JAMES BAKER LIC # 25385
COMPANY . . . . . . . . . . : BAKER ROOFING
ADDRESS . . . . . . . . . . : 2067 LA CON CT
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408) 559-5105
• FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BSEISMICR VALUATION 10, 000 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1REROOFRES SQ FEET 30 . 00 390 . 00 0 . 00 390 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 391 . 00 0 . 00 391 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 391 . 00 #418
---------------
TOTAL RECEIPT 391 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 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/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 above stated policy on re-roofing.
Homeowner's Name:
Job Site Address: "I SS� �Xikc� t �j1/L-V'✓.��
Roofing Company Name:
Applicant's Signature: ✓ Date:�j �-d
eGreg Casteel
Building Official
Revised 07/30/08
0 7c/
�jgA CITY OF CUPERTINO
Qom" REROOF
�UPEIIiTINO PERMIT APPLICATION
APN #j�a a q p Date: 6
Building Address:
h 5-L �i
Owner's(Name: Phone
#: /! /
Contractor: U Phone #:
Fax #:
Cupertino Business License #: Contractor License #:
A` - FL '� 3
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles %a-,Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report #
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description:
Residential Commercial
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:
no
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 6/16/08
CITY OF CUPERTINO
("re imm" REROOF
C1 o
CUPERTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMICO Seismic Commercial B
D 1REROOFRES Re-roof Residential B 1SFDWLR00F
/ 1BSEISMICRE Seismic Residential B
1RER00FMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08