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08110053 CITY OFCUPERTINOMI » BUILDING DIVISION PERT s CONTRA0TT, RINFQ MATION`! BUILDING ADDRESS: - PERMR NO. 10204 PENINSULA AVEWESTSHORE ROOFING ' OWNER'S NAME: FERMn ISSUE DATE A CONTROL NO. i.NE: (408) 694-0060 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG B= PLUMB MECH. 0 0 0 0 not LICENSED CONTRACTOR'S DECLARATION Job Description u I hereby afflm Wal 1 am licomm d under provisions of Chapter 9(mmmcncinb .. 4 with Section]Ob3)a(Division 3o(the Business and Professions Code,aM myliccracH ? Ste infailraaaand B Z ( RMV 1 LYR WDSHK INSTL OSB TECH OWNS CORNING DURTN npz LiaenraCl q, — 30 CLS A 155Q t, Date Convector GS ARCHITECT'S DECLARATION 1 understand my plans shall W used as public mmords , 'lU g G Licenced Profcsaional s 5 OWNER-BUILDER DE the ConT10N ac coo 1 Wrtby.mflum(Sce that I am ucmpt from the Ca d..O s License law for 1W s p O fallowing mown.Permit t 193M.B slum, p Rvfetdons Code:Any city m Countytato K29 which requires a Pamir ne cmu.uCL eller.improve,de Permit m e a sig any statement °thy chit he 4l iensrcs.alwrlto the io for such communon's LommeLn,dswpter9 < thuWucng with pSccmom to the provisions of the CO.uanessan cense faw(CludWr9 Sq.F[,Floor Area Valuation (commeyt=-S doilhesccoompt Sunfrou1a00)of ndthe asisfon roftheBudcomeOtion.AufansCMe)or 12000 Wt he u exempt mertfrom and the buts for the alleged exemption.Any violation of Section 7031.5 by any applicant(m a permit subjects the applicant to a Civil penalty of APN Number Occupancy Type mat more than five hundred dollars(SSW), 32622034 . 00 wi L u ow.erk.the pmpu er.I, emnot nended es with vngo u the lm(Sec.compete d. will do iawms Ccddterauvum iscum's Liccuse aw doand roruapply]aa.Blnervof Required Inspections and Professions Code The Dmtsetors Linn.lute don not apply r an owner of tl p property eche builds viimposesch improvements andwho amssuchwork M1imselfmthrough his ow.cmr.the uiprovided dm improvements am not ear o m orortetM Ire sale If. however.the building m Improvement enproving that e within arc year of campkdm.ie twn,r- builder w10 have the burden of gvving that W did not build o Improve for purpose of sale.). . ❑1.as awn,r of the property.am exclusively concaving wild licensed cenbamars w construct de project(Sec.7044.Business and Professions Code:)Tie Contractor's Li. cents law does not apply W in owner of property who build or improves Norton,and. who convects for such projects with a concactor(s)licensed puissant w the Conuamor's License Taw. ❑I Can exempt under Set .Bb.P C for this must. Owner Dan WORKERS COMPENSATION DECLARATION 1 hereby•B'.m under penally of perjury on,of the followinb declamations: I hsw and will maintain•Cmificaut of Conant to self-insure fm WorkesCompc.- on.as Provided for by Section 37W of the Labor Code.fm the performance of the wart for which This permit is issued. 1 have and will maimuin Workers Compensation huurance,as touched by Seeman 37W of the labor Code,for the performance or the work for which this permit Is Issued. My Workers Compensation Insurance coma and Policy number are: Cartier. ,�ioje— Fftvld Policy Ne.:2-60�'�� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thfsseerlm aced not W cemplemd time pcmftls furan humeddoBa s(SIM) or lest) 1 certify that N the perfermame of the work for which this Permit is issued,I snail act employ any penin in any mouser so as n become subject n the Workers Camperuauon Laws or California.Dan Applimuu NGnCE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject M the Workees Compensation provisions or the Labor Cod,you most .,O forthwith comply with such provisions or this Permit shall W deemed rovahcd. z'-" CONMUCIION LENDING AGENCY [+� handby which thi than them tsmand(Sem.30 lending agency for the performance of ISY .�. the work for which this permit u issuW(See 7091,Civ.G) 114 Q Zanders Name , 7 z Lenders Address V 0 1 certify that I have mad this application and sate Nar We above information is ty f' caroel l agtce to comply with all city and county ordinames and mm laws relating w 'O V building conesueactian.and larehyaumorim mpmse.adves of this city to enterupnn the r shove-mentiamd property for inspection purposes (WO)agree in tow,indemnify and keep harmless the City of Cupertino against liabilides.judgmeou,costs and expense which mey in any way accrue against said City ^ U z in covequcnce of the b.list of this pamiL ^r APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date L SOURCER IATIONS. Fom.,j7 14 — Re-roofs 3ignuure ufA IiOntCtntsxtor HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will do apPlicam ar(utum building oceuput store or handle hiscudous mamriai u defined by thc Cupertino Munici al Cade.Cbapnr 9.13,and the Health and Safety Code.Section 15532(11)] All roofs shall be inspected prior to any roofing material being installed. r]Y. No Will the applicant or forum building occupant arse equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove . It h.rardons air contaminants as dcfined by the Bay Am.Air Quality M..agCount all new materials for inspection. uict7 ❑yes (dna Ihawread iedm S cda Ma . rtquimmmtso.lur4 ditifthe Glding cCr- dies nithkrently cvM,savmu2550S15 y mmoZS534.I indnaand mai(thc Wilding Jca not currently have a mnam,this it c Y respansihility to notify do amipant of de — �� requirements wN arab metpnerw yanvC° �°nate traawpart�'. gnature of pplieant Dale Owner r anth� l / Dan. All roof coverings to be Class'W'or better CITY OF CUPERTINO - 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 32622034 . 00 DATE ISSUED. . . . . . . : 11/17/2008 RECEIPT # . . . . . . . . . : BS000006619 REFERENCE ID # . . . : 08110053 SITE ADDRESS . . . . . : 10204 PENINSULA AVE SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : CHANG IRENE H & ANDRE CHIU ADDRESS . . . . . . . . . . : 10204 PENINSULA AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-1211 RECEIVED FROM . . . . : BEN FOWLER CONTRACTOR . . . . . . . : PAUL FOWLER LIC # 21417 COMPANY . . . . . . . . . . : WESTSHORE ROOFING INC ADDRESS . . . . . . . . . . : 2245-A FORTUNE DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95131 TELEPHONE . . . . . . . . : (408) 694-0060 • FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---- ---------- -- ------ 1BSEISMICR VALUATION 12, 000 . 00 1 .20 0 . 00 1 . 20 0 . 00 1REROOFRES SQ FEET 15 . 00 195 . 00 0 . 00 195 . 00 0 . 00 TOTAL PERMIT 196 . 20 0 . 00 196 . 20 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 196.20 MC --------------- TOTAL RECEIPT 196 .20 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 rBC 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: �A od yy C h to II no Pi e t'( man Job Site Address: ' / O Z Oq Pe V) i`hr5 (it /0� iq V, Roofing Company Name: /�e4L) V� &4 I 1,0(-, Applicant's Signature: o, Date: • Greg Casteel Building Official Revised 07/30/08 CITY OF CUPERTINO Cil ( 0 0525 REROOF Of CUPEkTINO PERMIT APPLICATION APN # Date: ( I / Building Address: I0?,09 Pen j h S LAIa AV, Owner's Name: yid✓e C In i (� l Y2 yl 2 G eta vl5 Phone #: U �Revte - �� -Z► Z � Contractor: WeS� Phone #: y56 —O Z. o-o Fax#: 6 -0 23 3 Cupertino Business License #: Contractor License #: j g }Z 2,1 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles X,Asphalt Shingles )d,,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: ¢eKAo e ( (c y V.ovd 5tnw �� + n5¢�(� p 5� Tfc% Sh,e.1I ( T-� uo} Ajr&,oy Tyi3wled) - T 5t,tl1 3016 �/� , Tiqsm14 Owev' ) Cor" ,n ,Ara f-1`6K_ 3D. C turas 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: 12/ 000 I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: • �eL6 Signature - T Revised 6/16/08 - � CITY OF CUPERTINO REROOF 10 CUPERTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BSEISMICO Seismic Commercial B 1RER00FRES 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