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12020097 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11623 FOREST SPRING CT CON'T'RACTOR:CASTILLO'S ROOFING PERMIT NO: 12020097 OWNER'S NAME: DAVID&JANES CHEON TRUSTEE 1703 CATHAY DR DATE ISSUED:02/21/2012 OWNER'S PHONE: 4082527899 SAN JOSE„CA 95122 PHONE,NO:(4118)251-3565 ❑ LICENSED CONTRACTOR' DECLARATION BUILDING PERMIT INFO: BLDG F ELECT PLUMB License Class Lic.# MECH F RESIDENTIAL COMMERCIAL Con c Date C I hereby affirm t` t I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:'PEAR OFF EXISTING WOOD SHAKE,INSTALL 30LB PEI:f,INSTALL GAF GRAND CANYON COMP,EXISTING (commencing wi Section 7000)of Division 3 of the Business&Professions SHEATIFING REMAINS. Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$8800 permit is issued. APPLICANT CERTIFICATION APN Number:36651056.00 Occupancy Type: I certify that I have read this application and state that the above information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point sou cc regulations per the Cupertino Municipal Code,Section &gn �� j Issued b� � Date: 7 Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: 1 hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed. 11'a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for 1,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, er Business&Professions Code) Si natof pplic Date.` 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE I have and will maintain a Certificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the 1 have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,1 shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I w r or uthorized agent: �l become subject to the Worker's Compensation provisions of the Labor Code,1 must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONS'TRUCT'ION LENDING AGENCY APPLICANT CERTIFICATION 1 certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct. I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Signature Date licensed Professional Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# OWNER'S NAME: Y1 PHONE# 4d -j- �' J GENERAL CONTRACTOR `p BUSINESS LICENSE# ' ADDRESS: CITY/ZIPCODE 3 *Our municipal code requires all b inesses working in the city to have a City of Cupertino siness license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL UBCONTRACTORS HAVE OBTAINED A CITY,OF CU ERTINO BUSINESS LICENSE. 0'9^� I am not using 4"ubcontr Signature Date Please check applicable subcontractors and omplete 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 Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile e Owner/Contractor Signature Date CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: suew COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 36651056 . 00 DATE ISSUED. . . . . . . : 02/21/2012 RECEIPT # . . . . . . . . . BS000016075 REFERENCE ID # . . . : 12020097 SITE ADDRESS . . . . . : 11623 FOREST SPRING CT SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER DAVID & JANES CHEON TRUSTEE ADDRESS 11623 FOREST SPRING CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5119 RECEIVED FROM . . . . : CASTILLO' S ROOFING CONTRACTOR JOSE CASTILLO LIC # 25850 COMPANY CASTILLO' S ROOFING ADDRESS 1703 CATHAY DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95122 TELEPHONE (408) 251-3565 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ------ 1BCBSC VALUATION 8, 800 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 8, 800 . 00 0 . 88 0 . 00 0 . 88 0 . 00 1REROOFRES SQ FEET 17 . 00 238 . 00 0 . 00 238 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 239 . 88 0 . 00 239 . 88 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 239 . 88 17656 Jose Castillo --------------- TOTAL RECEIPT 239 . 88 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- -------- 309 EXTERIOR LATH 311 SCRATCH COAT 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 11623 forest spring ct. DATE: 02/21/2012 REVIEWED BY: bobs. APN: �pj BP#: pZa "VALUATION: $$,800 —� PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY PENTAMATION 1 SFDWLROOF USE: SFD or Duplex PERMIT TYPE: WORK sfd re-roof replace wood shake install comp shingles, existing sheathing remains. SCOPE FEE ID ROOF AREA s.f. 1 REROOFFRES 1,700 Li L Lj Li NOTE: This estimate does not include fees due to other Departments(Le.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc. . These,Les are based on therelin ina information available and are onA an estimate. Contact the De t or addn't info, FEE ITEMS (Fec Resolution 11-053 E'ff ;''1.""111 FEE QTY/FEE IVI[SC ITEMS Permit Fee: $238.00 Work Without Permit? a Yes G No $0.00 5trc)nriN9otion I Le: 1BSEISAIICR $0.88 Select an Administrative Item Bl&,,.St_&Comrnissiorf Fee: 1BCBSC $1.00 St1BTOTALS: $239.88 $0.00 TOTAL FEE: $239.8$ Revised: 1/19/2012 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE- CUPERTINO, CA 95014-3255 ELI (408)777-3228• FAX(408)777-3333 •building(-)cupertino.org CUPERTIN0 PROTECT ADDRESS r �, APN# ✓ F W "/ j�� f PHONE E-MAIL l/ OWNERNAME O�-:7991 FAX STREET ADDRESS �/�/ APPLICANT NAME 0,6_1s� E-MAIL STREET ADDRESS � CTTY,STATE,ZIP • ��"" . Of �J ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE BUS.LIC.#TYP i v ✓� oZ COMPANY NAME E-MAIL STREET ADDRESS j CITY TE,ZIP /"Cy PHO AKCHTTECTIENGINEER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME ` E-MAIL FAX STREET ADDRESS CITY,STATE ZIP PHONE USE OF SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: ` sTRUCfURE: ❑ Commercial 7 sem- ' EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE. YES IF NO. //� PLYWOOD ❑ 'h" ❑ PLYWD ❑ OSB PTTCFI �Ll ROOF❑ NO #LAYERS: Z THICKNESS: ❑ 5/8" TYPE: ❑ CDXCLASS: A ICC-ES REPORT# PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER DESCRIPTION OF WORK :7�F V�/1 J 6 , r C. Q By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have ovided is correct I have read the Description of Work and verify it is accurate. I a e to co ply with all applicable local ordinances an�Mla ws relatinto b construction. I autho ' esentatives of Cupertino tc enter the abovtion purposes. Signature of /Age Date: / SUPPLEMENTAJaH ORMATION REQUIRED — _. rr,a"r�r�+'rrrV�o�•� t1�G-S..0-L -�' _If building is associated witme Owner's Association,provide letter _ _ _ of approval from HOA. * 'T �°j $ �Ra Provide Planning approval to verify if there any restrictions. A �m �mrTg' ff _Provide copy of Manufacturer's Installation Specifications. ns `"� ' ( rovide signed copy of Cupertino's Tear-Off Policy. _ ReroofApp 2011.doc revised 03/02/11