08120117 CITY OF CUPERTINO
BUILDING DIVISION PERMITaCQNT.ItACTORINIE?Q.RMATION
BUILDING ADDRESS: PERMIT NO.
843 KIM ST T D ROOFING
OWNER'S NAME: PER'WI'WOE DATE
PHONE: S CONT0.0L N0.
(408) 892-8872
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECN
V
LICENSED CONTRACTOR'S DECLARATIONIOb DOSCrIpn00
I herby affirm Nat 1 w Owed trader pm isimuofChapter9(commcneingwtthS cdon]0f10)ofDivision3oftheBu o..d a Code ed Itce is
inmBfoocea C RE-RF RMV 2 LYRS WDSHK &INSTL 40YR COMP 15#FELT
License Lle.X
�t—� Dam Co.
27SQ CLS A
QQ IT
CHECI'SDEC1 A
WU 1 usdcrsund edy plans shall tm used aspublic ret
a G h Licensed Professional
OWNER-BUILDER DECLARATION
gy 1 hereby aPom
that I am exempt from the Con"emes License Law for Ne
ZOO following mason.(Section 7031.5.Busirss and Professions Code:Any city or county
S$ which nexim.a permit in eoombeL alcor,improve,demolish,or repair any structure
poor us its issuance,also squires the applicam for such permit m file a signed statement
E Nazheulicensed punwntm0eproviaionsofNcContiacmr]licenselaw(Chapmr9 Sq.Ft.Floor Area Valuation
M�a (commencing with Section 7")of Divuirn 3rf NC Box.and Proposal Curio)or
that hes exempt tbemfron rad the basis for the aileged eaempdan.Any violation of
Section 7031.5 by any applicant for a permit sublccN the applicant to•civil pcmlty of APN Number Occupancy Type
not come than fire hundred dollars(53001. 35920007 . 00
0 1,as owner of the property,or my,employees with wages as Nob sok ctampe.adrn,
will do the wort,and ft smueum be=1iMcd&d or offered fm sale(Sec.]Ike,Busircss
and professor.Code:The Comomme.License Law dura oat apply N an owner of Required Inspections
property who builds m improves Nemon,a nd who dnes ouch work hu r teff or through his
own employers,provided Nat such imprwemenu are not intended mortared for We.If.
however.the building or Improvement it seld within one year rfeompledm,the owner
builder will have the burden of proving Nat Ir did ret build or improve for purpose of
ale.).
❑1,as owner of the property.am uclusively contracting with licensed co rtsusom m
construct tie project(Sec.7014.Business add Profcstione Code:)The Crnlaamors Li-
ccom law does not apply in an owner of property who builds rr inpvw thereon.and,
who conoacta for such projects with a contractor(s)licensed pursuant Re the com acmes
liana law.
❑lamesemptunder See .08PCfmthiimtasen
Owner Dao
WORKER'S COMPENSATION DECLARATON
1 hereby affsmt under penaity,of perjury one of dm fallowing decleradrv:
1 ,as ono will maintain a Cerdfi7M of Covent erCodc.am Ins admounCompcm
anion,a provided for by Section 3]00 of Ne labor Code.fm the performance of Nc
work for which Niapermit u issued
1 bare sad will-stores Wor s Compeuaurn Insurance, requi Stolon
if she labor fm Ne o mmca rf Ne wmtfor whit Nu " issued
Wotimes f In end Policy number
a raBdfuirim
Cartier. I `I UX Policy No
FROM
FlG OF SArION I N FROM W R /
COMPENSATON INSURANCE
(chis section need im iecrmpiced tribe permit Is(mode hundred dollars(S1
or Icer)
1 canify that in the performance of do,work for which this permit is issued.I shall not
employ any person in any meaner m.in bccvme subject o the Winters'Compensathn
Laws of CaRfomia.Dam
Applicant
NODCE TO APPLICANT:If,after making this Cenificam of Face ption,you should
became subject in the Worked Compensation provisions of Ne labor Code.you most
.J z forthwith comply with such provisions or this permit shall be deemed revoked.
Z N CONMUCDON LENDING AGENCY
Thereby option that there u a construction lending agency for the performance of
Gl
~� the were for which his permit is issued(Sec.3091,Civ.C.)
m
�n. Lenders Nae ,
= z 1<nderh Address
U C 1 certify Nat I have read this application sad sum Nu the above information is
L4 E' correct.I agree to comply with all city and county uNinarces and sum laws selavng In
0 building construction,and hereby Mouton mpoesenutina of Nu city to cner upon the
W amn-mentioned properly,for inspection purposes
(We)agree to ave,indemnify and OMP harmless Na City Of Cupertino against
faA
liabilities judgncnm,costs and cxpcmme which may in any way accrue against said City
U z
me sr a granting of Nu permit P „�
^� APPLI DERSTAN AND WILL COMPLY WI ALL 0)INT Issued by: Date ; .^/C
SOUR T 5
r Re-roofs
Sigifitureof Appjicfnvcon
Dam
HAZA 0 S MATERIALS DISCLOSURE Type of Roof
Will Ne applicant. building WL MOM or handle hinroout mamod
as deE.d by the Cupenioo tame I Code,Chapmf 9.13.and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Y.
Will Ne cam applint or lure building occulant use equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havxdnus air couseina or as ed by to Bay Area Air Quality Management all ne ma a Is for inspection.
District?
C]Yes No /
Ihamreed thehpado.mamoalsmquis 2534.1 Chapter"ifNe Califon-
H.INh SafelyC 25503.25533am1]553C.IundcnmM NuifNc building OL"
e n.cmrentlY hb a Net it u m n edibility as nodCI rata of Ne
quiremenmw ren aeeeor �et�aday OC/ Signature of Applicant Date
owner rr out rival agent oC/ 0 am C]] 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 . . . . . . . . : 35920007 . 00
DATE ISSUED. . . . . . . : 12/18/2008
RECEIPT # . . . . . . . . . : BS000006847
REFERENCE ID # . . . : 08120117
SITE ADDRESS . . . . . : 843 KIM ST
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER . . . . . . . . . . . . : ABOLFAZL KHOSROWBEYGI
ADDRESS . . . . . . . . . . : 843 KIM ST
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4322
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
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ---
1BSEISMICR VALUATION 9, 500 . 00 1 . 00 0 . 00 1 . 00 0 . 00
1REROOFRES SQ FEET 27 . 00 351 . 00 0 . 00 351 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 352 . 00 0 . 00 352 . 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
---------- --------------- ------------
CREDIT CARD 352 . 00 VISA
---------------
TOTAL RECEIPT 352 . 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 1/4 "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: /r I1 I`�� S ll�VJ IJ e lJ aT
Job Site Address: . R y 3 t�l 111 cC1
Roofing Company Name: I. Q ro n 1 h-
Applicant's Signature: Date:
Greg Casteel
Building Official
• Revised 07/30/08
Community Development
10300 Torre Avenue
F. / Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPERTINO
Building De artment
JOB ADDDR3ESS: 1� m S f- PERMIT #
OWNER'S NAME: oS n W ONE # '
GENERAL CONTRACTOR: T uD v FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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
Owner/Contractor Signature Date
CITY OF CUPERTINO
Mpc>// 7
REROOF
CUPEkTINO PERMIT APPLICATION
41APN �U000l 0 Date:
Building �drress-
Owner's Name: rr Phone #:
f� 60l Fca I klOoS tra yl bey C7T' C) gd'
Contractor: Phone #:
i D VDo Fly i B. L 408 8L/ � 0 ,91( 0
Fax #:
Cupertino Business License #: Contractor License #:
$ q �-S-q �
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
XWood Shakes ❑ Wood Shakes
❑ Wood Shingles o 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:
7u—m o Q e o2. La:l 2 ( S� �ec� 6Z� S�n c� I� e / ' ; v,
CAI)Up
Residential -Commercial IT
Green Building: Please complete relevant portion of the Confirmed with Planning D, t. if
Green Building Checklist & attach it to the application or if there are any restrictions:
applicable, include in plan set & the sheet index.
Valuation: 6 a
I Have Read, n stand and Will Comply with Cupertino's Tear-Off Policy:
•Signature
Revised 6/16/08
t
CITY OF CUPERTINO
w REROOF
CUPEI,TINO 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
1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
Revised 6/16/08
•