07060117 7777
CITY OF CUPERTINO 7� 77
BUILDING DIVISION PERMIT
BUILDING ADDRESS: PERMIT NO.
10238 E ESTATES DR CUPERTIIAO ROOF, INC 07060117
OWNER'S NAME: PERMIT ISSUE DATE
ANDREW & MOONY CHUM 1052 KEiLY DR 06/14/2007
SANITARY NO. CONTROL NO.
NE:
(408) 973-9427
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
0 Q LICENSED CONTRACTOR'S DECLARATION Job Description
U1): 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z co with Section 7000)of Division 3 of the Business and Professions`C,ode an my license is TEAR OFF' COMPOSITION AND INSTALL 40 YRS ELK
y in full force and effect- �y S 'f
�Z License Class Li,•# SHINGLES .
F p Dam Contractor C U(��Q�'+1• —
RCHITECTS DECLARATIO
be used i z< I understand my plans shalled as public records
iarJ
u �W- Licensed Professional
y� OWNER-BUILDER DECLARATION
< I hereby affirm that 1 am exempt from the Contractor's License Law for the
:n o following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve,demolish,or repair any structure
?Z; prior to its issuance,also requires the applicant for such permit to file a signed statement .Ft.Floor Area Valuation
_ that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 >q
t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $7500
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by arty applicant for a permit subjects the applicant to a civil penalty of 3690702', .W
Number Occupancy Type
not more than five hundred dollars(5500).
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of q p
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li-
ccnse Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractors)licensed pursuant to the Contractor's
License Law.
E]I am exempt under Sec. B tit P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I I have and will maintain a Certificate of Consent to self-insurc for Workces Compcn-
sation,as provided for by Section 3700 of the labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are-
Carrier
Carrier. ":3r�`e&n) Policy No.:!I Z-re' O
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed lithe permit is far one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
,J. O forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
HI hereby affirm that there is a construction lending agency for the performance of
�Y> the work for which this permit is issued(Sec.3097,Civ.C.)
WWQ Lender's Name
a z Lender's Address
U 0 1 certify that I have read this application and state that the above information is
LL. correct.I agree to comply with all city and county ordinances and state laws relating to
O U building construction,and hereby authorise representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
fn liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit.
t— CAM Date UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOUICK RE LATE
-(Q Re-roofs
Si Appliram/Contractor Dare Type Of R�Of
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs:,hall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or future building occupant use equipment or devices which
If a roof i:,installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new m 3terials for inspection.
District?
❑Yes No > )
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor• \ �� b /
ria Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building 1 --
oI currently have a tenant,that it is my responsibility to notify the occupant of the
req>w% ck must metpnortoissuanceofaCeruffateofgc�p�rtcy. Signature of Applicant Date
All roof coverings to be Class"B" or better
0zed agent Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk : Lot:
APN . . . . . . . . . 36907027 .00
DATE ISSUED. . . . . . . : 06/14/2007
RECEIPT #. . . . . . . . . : BSC00001652
REFERENCE ID # . . . : 07C60117
SITE ADDRESS . . . . . : 10238 E ESTATES DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : ANLREW & MOONY CHUM
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-3305
RECEIVED FROM . . . . : DALE SMITH
CONTRACTOR . . . . . . . : DA`E SMITH LIC # 25701
COMPANY . . . . . . . . . . : CUPERTINO ROOF, INC
ADDRESS . . . . . . . . . . : 1052 KELLY DR
CITY/STATE/ZIP . . . : SAID JOSE, CA 95129
TELEPHONE . . . . . . . . : (4C8) 973-9427
FEE ID UNIT QUANTITY TMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 7, 500. 00 147 .96 0. 00 147 .96 0. 00
BSEISMICRE VALUATION 7, 500. 00 0.80 0. 00 0.80 0. 00
BUSLIC FLAT RATE 1. 00 107 . 00 0. 00 107 . 00 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 255.76 0. 00 255 .76 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 255.76 MC
---------------
TOTAL RECEIPT 255.76
0-7 0 0 f l -7
CITY OF CUPERTINO
? REROOF
CUPEkTiNO PERMIT APPLICATION FORM
APN# 3 / _q 0 -7 ®oC (lDate: _ i V—o
lP am/� 0 v D
Building Address: 1 0 l 2 � S ` �� C
l—r "�
Owner's NaPh
one
e: #
�''Y1 v o VNC k L/
Contractor: �c :V ki C License
Contact: Cupertino Business Licensej)C_4 #:
v_,r Z 2 - Y t ��-7 �
Type of Rc)of Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
---5 Asphalt Shingles 119 Asphalt Shingles
❑ 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.
I Have Read,Understand and Will Comply With Cu ►ertino's Tear Off Policy: ❑
Job Description: 11
Resident Commercial ❑ C I Q SS„
Fire Zone: Yes ❑ ---Nn—Q Confirmed with Planning Debt. if
there are any restrictions: LJ
Cost of PPrroje ou Type of Construction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK 'lan Check Fee BUILDING
BUSLIC Business License BUILDING
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 afire 2 to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be appliec.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 f rst obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be perfc rmed.
7. NOTE: If you call for a plywood nail irspection 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:
Job Site Address:
C
Roofing Company Name:
Applicant's Signature: Date: l9 l
Greg Casteel
Building Official
Revised 11/2/04
Community Development
10300 Torre Avenue
'€ Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
"UPEkTINO
Building Department
JOB ADDRESS: D
� � 6 PERMIT #�.?06�`l
OWNER'S NAME: oxj7 PHONE # 25-2— I 2 Z
GENERAL CONTRACTOR: 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 Lv
Sheet Rock
Tile
Owner/Contractor Signature Date