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BUILDINGDIVISION PERAIIT
CON:TRACTOIt°�I1�FFOLLMATIOIV'
LDING ADDRESS:
PERMIT NO.
1066 COLONY
WESTERN ROOFIN
NER'S NAME:
L
PERMrr ISSUE DATE
ONE.
A O, CONTROL NO.
(831)278-1837
H=IENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 I�
LICENSED CONTRACTORS DECLARATION
Job Description
1 hmeby atm Nat 1 am li¢rswd under pmvivona of chapter 9 (commencing
with Section 70(10) of Division 7 of um Business and Profeaoiuns Code. and my license is
in full foeaand effect. f�Ggi—
RE—RF T/0 WDSHK FILLSHTNG AS NDED 40LB FLT INSTL
'
U.C. L2 S Lte.P
Dam rr a—t,F�� Contractor
MTL TILE LIGHTWEIGHT CLS A 365Q
ARCHIIT3CI-S DEC
1 unders and my plans shall W used u p is mcordn
lumccd fhvlcssional
MNEII-BUILDER DECLARATION
1 Weby Amro Na 1 am exempt from the Canvases Lic. Law Tar tK
fallowing wan. (Section 7071.3. Business and Profeaoas Cade: Any city or county
which requires a permit to emswcl slur. improve, demnhbh, Or repair my emcmum
prior to its intonate. auo natures the applicant for such permit to file a signed atsumcnt
Nn he is named pursuant m the provisions of do Committers License Law (chapter 9
Sq. Ft. Floor Area
Valuation
(commencing with Sation 7000) of Division 1 of the Business and Prefesvons Code) or
Nat be b exempt therefrom and the basis for the alleged co mpuan. My violation of$20000
APN Number
Occupancy Type
P y'7P
Settle. 70716 by any applicant for a permit subjmu the applicant m . civil penalty of
rot mane tan five hundred dollars (35M).
35928013.00
❑ Laowresofthe Property. amyemploy= withwagsutheirsokeompmaean,
Required Inspections
will do ted work ora du.w is.1intended ootreed for sale(Sc.71W. Busirea
and Professional Code: The Customers Li mate Law dos rot appy m an owner of
progeny who builds or im porms Burman and aam dos soh wok Mmaeer a r through his
Own cmployas, provided thasoch improvemmu arc not intended o offered formic. if.
however. the building m improvement u sold within oro year of completion. the owrer-
Wiider, MO have this burdra of proving chat K did mm Wild m improve for pur om of
sals.h
0 i, as owner of the property, am acm.ively constructing with licensed mntnnms m
canswct the pmjen (Sec. 706/, Business and Professions Cade:) The Contactors V•
cone law dos not apply u an owner of property who Wilda m imprew thermn, and .
who contacts for such projects with a eonuatlor(s) licamsd pursuant m the Contra en's
LTeenm law.
❑ I are exempt ands See . B & P C for this mom
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby aurum under penaby of perjury, me of dm following decluationc
IMan andwillmu e of-Insure Workman Compeer-.
tion 3i7M.f Meea
an, provided fpc by Sectio 7]00 of Ne lJWr Code. for the Performance a( do
,
wart for which Nu permit u issued.
r
❑ I have anal will maintain Workers Compensation Insurance, as required by Section
77Mof the labor Cade, for chic performans of tie work for which Nu permit u issued
'
My Worker. Commnmdon Insursnm stip and Polity number ars:
Cartter/;iagAaA. �ft.)Ae 19/Iv Qsolicy No.: fJI int kY
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Ono mnim need not becmnpleud iftM Permit a foam hurc ddOBms(SIM)
or less.)
I certify Net in tie paromanoe of the work roe which data permit u ivued. I shall Out
,
employ any person in any maner.w as m became subject to the Workers' Comperunim
Laws of Ci ifomia. Dau
Appliant
NOrICE TO APPLICANT: IL after making that Cenhfream of Exemption, you should
become subject m the Workers Compensation provisions of the lobo Code you most
(mMwith comply with Inch pmvuions or Nu pewit Mail W dsmrd mvalecd.
CONSrRucnoN LENDING AGENCY
1 hereby atm that Nem I.. mruvucnnn lending ii me, far the perfom roes of
Is work for which Nu pemit u bound (Sce. R)9), Civ. C.)
leviers Namc
'
lendeh Addw
1 terrify that 1 have cad this application wed sum than Me above infomatim is
coned 1 agree b comply with all city and county oNinunan and sate laws reaming to
Wilding construction, and hereby authorix mpreenumim of this city to enurupnn the
above-mentioned property for impeNen P.,PML
(We) agree to ave, indemnify and kap hamtess the City of Cupertino against
li.bilids,)udgmcou, cmu and N. which may in anyway static against said City
in consequence of the granting of this psmiL
ICAR UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
CER CATION
Re -roofs /fes
Type of Roof
u- r�
Signuu'af AMI m Date
HAZARDOU AIS DISCLOSURE
Will the applicant or fist ildin cupanutofe or handle himalloes material
as defined by do Cupertino Monto ado. Chapter 9.12. and the Health and Safety
Code. sectio 25372(a)7
❑Ys �iN^ /
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will Ne applicant or future Wilding Occupant um equipment or devices which
it harsrdoua air contaminants as defined by the Bay Area Air Quality Management
10
all new materials for inspection.
v <t7
❑ Ys pAw—
I hive mad the lumNouamauriW reqummem under Chapter 6.95 of the Cities,
nha Health & Safety Codc, Sections, 255(15.M537 amt 15514. T undersand that if the Wilding
does WE currently haw a ton, uat It u in maponsMility b notify the Occupant of NI4-
requim bots which mew no a car a of. CotifNamofOccupanoy.
Sig ature of Applicant Date
AI o coverings to be Class In" or better
Dam'
mer antharied agent
• 2 ITEMS OF 2
CITY OF CUPERTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 35928013.00
DATE ISSUED.......: 10/28/2008
RECEIPT #.........: BS000006477
REFERENCE ID # ...: 08100175
SITE ADDRESS .....: 1066 COLONY HILLS LN
SUBDIVISION ......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT
AMOUNT
---------------
470.00
---------------
470.00
VOICE ID DESCRIPTION
-----------
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
0
REFERENCE NUMBER
--------------------
VISA
VOICE ID DESCRIPTION
-------- --- ------------
602 ROOF PLYWOOD NAIL
605 FINAL REROOF
OWNER ............:
CHANG CHAD -YUAN AND YASYWE HU
ADDRESS ..........:
1066 COLONY HILLS LN
CITY/STATE/ZIP ...:
CUPERTINO CA, 95014-5825
RECEIVED FROM ....:
MICHAEL D LUNNEBORG
CONTRACTOR .......:
MICHAEL LUNNEBORG LIC # 25896
COMPANY ..........:
WESTERN ROOFING SYSTEMS
ADDRESS ..........:
1328 WHITE OAKS RD
CITY/STATE/ZIP ...:
CAMPBELL, CA 95008
_
TELEPHONE ........:
(831)278-1837
• FEE ID
UNIT QUANTITY
AMOUNT PD -TO -DT THIS REC
NEW BAL
-----------------------
1BSEISMICR
----------
VALUATION 20,000.00
---------- --------------------
2.00 0.00 2.00
----------
0.00
1REROOFRES
SQ FEET 36.00
468.00 0.00 468.00
0.00
TOTAL PERMIT
---------- --------
470.00 0.00 470.00
--
0.00
METHOD OF PAYMENT
-----------------
CREDIT CARD
TOTAL RECEIPT
AMOUNT
---------------
470.00
---------------
470.00
VOICE ID DESCRIPTION
-----------
601 ROOF TEAR OFF
604 ROOF IN -PROGRESS
0
REFERENCE NUMBER
--------------------
VISA
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 I/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:
Job Site Address: (fa,/a,171-1,14 4 ti!
Roofing Company Name:
Applicant's Signature Date:
OGreg Casteel G
Building Official
Revised 07/30/08
s CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION,
APN # 3e 6 , V l
✓
Date: 2
Building Address:
Owner's Name: k
Phone #:
ChgoYua,j ChM,
Contractor:
Phone #:.yor =&q yi;;
Fax #: YoY tS 0 /7 3
Cupertino Business License #:
Contractor License #:
6;,-f
Type of Roof Covering:
Existing:
Proposed:
o Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
o Asphalt Shingles
Shakes
❑ Wood Shakes
�ood
ood Shingles
❑ Wood Shingles
a Other (Specify)
Other (Specify) �e�e
Number of existing coverings
y4rovide I.C.B.O. Report # �Co LG
❑ To be Removed
❑ Provide Mfgr. Installation Specs. .
Job Description: N �r rti.eke —
,!( C7(sr�o�—
Residential/�11
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: �-
7,0/ N�
I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy:
Revised 6/16/08
OF
CUPERTINO
CITY OF CUPERTINO
REROOF
FEE SCHEDULE
0
Number of
Squares
Fee ID ' '
Fee Description
Fee
Group
Permit Type
1REROOFCOM
Re -roof Commercial
B
1COMMLROOF
18SEISMICO
Seismic Commercial
B
IREROOFRES
Re -roof Residential
B
1SFDWLROOF
r
1BSEISMICRE
Seismic Residential
B
1REROOFMRES
Re -roof Multi -Family
B
1MFDWLROOF
1BSEISMICRE
Seismic Residential
B
IBUSLIC
Business License
B
Revised 6/16/08
0