08110025 CITY OF CUPERTINO
BUILDING DIVISIOf PERMITkCONT�IMC'�TOR,,,M.OR� TmI�ON -
BUILDING ADDRESS: PERMIT NO.
10471 SCENIC BLVD T D ROOFING ogiinQ29
OWNER'S NAME: PERMIT ISSUE DATE
Si 23Z WGNG 6:79 TUT�LY RE)
NE: ACONTROL N0.
(408) 892-6872
1�nca
HITECOENGINEER: BUILDING PERMIT INFO
BLDG EfECT PLUMB MECH
0 I�
30LICENSED CONTRACTOR'S DECLARATION Job Description
m1 hcrcby affirm tNi I am li med under pmvWons of CMpw 9(commencing P
Ztnaes< lftama afca. CRE—RF RMV WDSHK INSTL 7/16" OSB 15LBS FLT 50YR
t-, Dam Contrctar CI
MP
AR n'TJ DECLARATIO 25S CLSA
U I understand my Plate ahadl W seed u public rte 4
id
40 1 Licrncd Pmfcasianad
n OWNER-BUILDER DECLARATION
rayy 1 Wrtby M.Nat I I. eumpt from the Cssions o i3eroc Law for W
`p O following mason.(Saito 70315.Business and Ho.&MOI Code:Any city or county
$Pi whim requires•permit hd eons do admr.Wpmve,de permit
1 ar repair ad smmtum
prig m its ut rased p mmani to t o the allium for each Contractor's
to flla.cense La(ummenl
mo (that commencing
islicensedcdpurstion700)ofDiviomofthe eBuinam ndProeLaw(Cnapta9 Sq.Ft.Floor Area Valuation
yF$ (eommendngwith Station and
basisufrmtheBed exempt Professions Cuda)or
.- titer W I.eumpt deueftom and W buts for W alleged exemption.Any vlalauon of 8500
Secdon 7031.5 by any applicant for a permit subjects the applicant m a civil penalty of APN Number Occupancy Type
.1 mom Lin five hundred dollars($SM. 35707004 . 00
❑I.u owmar of the property.or my wployees with wages as their roto compensation.
MII do the wars,and destmaumut not immnded maffama for sale,(Stec.7044.Bommem Required Inspections
and Professions Code:The Comucmrs License Law data mol apply In e se owner of q P
property who builds aimprosestMma•nd wW daa,anwmkhimselfar Waugh his
awoemploym,prwidcd thsimch impro erramts.m not ino:ndr4 croBered forsale If.
bowcwr,W lou law
err Wn of having
hath within arc Weld of rompmtioa W wmer-
Wilder will naw Ju buNm of wilding that he did not 4414 or improve for purpose of
,am.).
❑I.as owmr of this Property,w exclusively corlom ng with licensed mnacmn On
construct W project.(Sec.7044.Business aad Professiom Code:)The Conuxuts l-
ame Law does nes apply m an owar of Ptolemy wine builds or improves Limon,and
who contracts far such projects with a ronuaaor(s)licensed pursuant to W Cunucur's
License Law.
❑I Me exempt under See ,B&P C for this mason
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby ail under penalty of perjury one of the following declarations:
haveand will maintain a Certificate of Consent to ulf-buum far Woftes Compes-
on,u provided for by Section 37W of dee Labor Code.far the Performance of W
Marc for which this permit is bound.
w W wiu maintain Wmace.Campmesma.be a mm.u regtdmd by Section
3T)C)a W Lamar Coast.far the performance of dee work for which this Permits issued. '
My Warkefs Comppeenww ihsuartier rtier and um Policy -
Cartier. (?i J I F Policy No: + I ��
CERTIFICATE OF EKEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(Thusmian teed not becompicmd lithe pennh is for.hundred doll.($100)
or less)
1 coolly that in the perfarmencc of to..it for which this permit is Wood.1 shall not
employ any person in any manner an u to become subject to the Worse s'Compensallon
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,spur mating this CeniRam of Exemption,you should
become subject m W Workers Compensation provisions of the Labar Cade.You muss
3O forthwith comply with each provisions or this permit 091 be domed revoked. .
zCONSTRUCTION LENDING AGENCY
[-nom Iloosely afloat that Nem is aronswc0an leading ageaY(ar the perfmmame of
a W wart for which shut permit u issued(Sex.3097.Civ.c.)
ALandrls Nurse ,
La
z ndefs Addma
U Q I cuury Nn I have read this application and sum dead W above INommitat is
W!' carica.I ague In comply with all city and county eminences and auto Ian relmag lo
Wilding construction,and bembY authorize rtwesenutiws alibis city to enter upon f
6Wi some-mentioad pmpery for inspection purposes _
(We)agree to save,indemnify aad kap harmless the City of Cupertino against
iF",.t v1
liabilities Judgments case and expenses which may in my nyamue against said City
U Z in con" ell etanting of Nis permit.
"-' APPLIC'A ER74A AND WILL COMPLY WITH ALL ION-POINT Issued by: Date
SOURCE
fl 6 $ Re-roofs ^ /
Signuurt of ApplicuUContrcmr Data , v
HAzARDoutpAgrERIALS DISCLOSURE Type of Roof
Will the applicant or(atom Wilding aeupent sato or Wadk hazardous material
u de0ad by theCupertino Mu ""vel Code.Chapter 9.12.and W Health and Safety
Code.section u532(a)7405Z
532(a)7 \ All roofs shall be inspected prior to any roofing material being installed.
❑Ya �a
Wit W."Hearn or runem Wilding Occupant use waiPment art dcviea which
a roof is installed without first obtaining an inspection,I agree to remove
't hoondom air ronumin ts fined by W Bay Area Air Qualify Management all new mate 'cols for inspection.
al
❑Ya No
Iheve aJ dee hvartlms materials mqulrtmentsunJer Chepmrd.95 ofJm Cali(or-
ria Haiti& c ,Sad.25505.25533.d25534.luadcr dNuifthe Wilding a
Jas not cu ve•tenant.thad it u my mvpansibilisy ro oufy tic occupant of tiro
rcauftman mi. ofacanfmmar wn Signature of Applicant Date
n (o a
All roof coverings to be Class'W'or better
Owner or mthonired agent Dam
CITY OF CUPERTINO
e 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35707004 . 00
DATE ISSUED. . . . . . . : 11/06/2008
RECEIPT #. . . . . . . . . : BS000006566
REFERENCE ID # . . . : 08110025
SITE ADDRESS . . . . . : 10471 SCENIC BLVD
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . .. WESLEY WONG
ADDRESS . . . . . . . . . . : 10471 SCENIC CIR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2764
RECEIVED FROM . . . . : LESLIE A HOANG
CONTRACTOR . . . . . . . : LESLIE HOANG LIC # 23155
COMPANY . . . . . . . . . . : T D ROOFING
ADDRESS . . . . . . . . . . : 675 TULLY RD
CITY/STATE/ZIP . . . : SAN JOSE, CA 95111
TELEPHONE . . . . . . . . : (408) 892-8872
OFEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
----- ---------- ----
1BSEISMICR VALUATION 8, 500 . 00 0 . 90 0 . 00 0 . 90 0 . 00
1REROOFRES SQ FEET 25 . 00 325 . 00 0 . 00 325 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 325 . 90 0 . 00 325 . 90 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- -
CREDIT CARD 325 . 90 VISA
---------------
TOTAL RECEIPT 325 . 90
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- ---------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
•
i 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 Raid before another inspection can be scheduled
IMPORTANT:
1. Flat roofs must have a minimum of V4 "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: In/Vq�- lc A t/f7l G
Job Site Address: l C L t x
Roofing Company Name:
Applicant's Signature: Date: I:
• Greg Casteel
Building Official
Revised 07/30/08
:
CITY OF CUPERTINO
gip
REROOF
UPERTINO PERMIT APPLICATION
APN #
Building Address: l
/oH ! cev� , c Cr
Owner's Name: Phone #:
VVt'sUt woti� 9 (qws) X88 6 `i 8°t
Contractor: Phone #:
C'(oa) $ 4q o8y �
Fax #:
Cupertino Business License #: Contractor License #:
gySS9 /
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )c Asphalt Shingles
XWood 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: ( ��
►s ws sa y C01-yk? As
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:
I Have Read, stand and Will Comply with Cupertino's Tear-Off Policy:
Signature
Revised 6/16/08
CITY OF CUPERTINO
REROOF
CUPERTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1RER00FC0M Re-roof Commercial B 1COMMLROOF
IBSEISMICO Seismic Commercial B
1RER00FRES Re-roof Residential B 1SFDWLROOF
2S
/ 1BSEISMICRE Seismic Residential B
1REROOFMRES Re-roofMulti-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08