07060179 CITY OF CUPERTINO
BUILDING DIVISION PERMITPERMIT NO.
�lt' '7RACTQ�2I�1 + }RMTIIIY:
BUILpIy�'iI�glt" EAR TREE CT T D ROOFING ING 07060179
OWNER'S NAME: r PERMIT ISSUE DATE
PEIDER TSENG 675 TUI,LY RD 06/21/2007
SNE: (408) 8S12-8872 SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
I o p LICENSED CONTRACTOR'S DECLARATION Job Description
W P 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
izw with Section 7000)of Division 3ofthe Business and Professions Code..ndmyli�cnseis REROOF- REMOVE COMP, INSTALL 50 YR COMP 30# FELT
o y in full force and cffet e3 �� I
j ? Licenac CI s Lic.# 24
Date Contractor
ARCHITECTS DECLARATIO QUARE:�, CLASS A
7
R-4 1 understand my plans shall be used as public rccor
>yU
u.ti Licensed Professional
y a OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
C p 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�y prior to its issuance,also requires the applicant for such permit to file a signed statement
x< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area $8000
Valuation
ut_ (commencing with Section 7000)of Division 3 of de Business and Professions Code)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 316 3 0 0 f t 9 Number Occupancy Type
not more than five hundred dollars(5500).
❑I,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 (1 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.).
❑I,as owner of the property,am exclusively contracting with licensed contactors to
construct the project(Sec.7044,Business and Professions Cade:)The Contractors Li-
cense Law does not apply to an owner of property who builds or improves themon.and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
❑I am exempt under Set. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
L]1 have and will maintain a Certificate of Consent to self-insure for WorkcesCompen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
KI have and will maintain Workers Compensation Insurance,as required by Section
h300 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers om ensati Insuranc rrier and olicy number ate: Q o
Carrier. CL No.:
CERTIFICATE OF EMPTION FROM WOjUCERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the perfo an e f the work for which this permit is issued,1 shall not
employ any person in an m e so a to bee ject to the Workers'Compensation
Laws of California.Da
Applicant
NOTICETOAPPLIdAW.lf,after making this C cats of Exemption,you should
become subject to the Worker's Compensation provi'on of the Labor Code,you must
Oforthwith comply with such provisions or this permits a I be deemed revoked.
Z" CONSTRUCTION LENDING AGENCY
(-+(A 1 hereby affirm that there is a construction lending agency for the performance of
p!> the work for which this permit is issued(Sec.3097,Civ.C.)
WCC.A Lender's Name
z Lender's Address
V 0 1 certify that 1 have read this application and state that the above information is
(y— correct.1 agree to comply with all city and county ordinances and state laws relating to
0U building construction,and hereby authorize representatives of this city to enter upon the
� a k
above-mentioned property for inspection purposes.
(We)agree to save,indemnify andeep harmless the City of Cupertino against
Ht) liabilities,judgments,costs and expenses which may in any way accrue against said City
V Z in cojecric%o the granting of this permit , , Date
r� APPLT DERanting AND WILL COMPLY W[TH ALL N N-POINT Issued b .SOUR
Re-roofs
Sign ofApplican c or Date Type of Roof
�l
HAZARDOUS ALS DISCLOSURE yp
Will the applicant or future buil ing txcupantstorCor handle hazardous matcrial
as defined by the CupertinoZN
alCode,Chapter 9.12,and the Health and Safety
Cede,Section 25532(a)? All roof: shall be inspected prior to any roofing material being installed.
❑yes
Will the applit ant r ruin building occupant use cyuipmcnt or tk vices which If a roof is installed without first obtaining an inspection,I agree to remove
cmit hazardous air contam an defined by the Bay Area Air Quality Management all new r laterials for inspection.
District?
❑Yes ❑No
1 have re the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health Sof y ode,Section 25505,25533 and 25534.1 understand that if the building
docs not c nt ave a tenant,6111 that it ism responihilily to nod the oc t of the
rcquircmc t c t Tin o once oraCertir, oZu b Signature:of Applicant Date
All roof coverings to be Class"B"or better
Owner orauthorized agent Date
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 31630089. 00
DATE ISSUED. . . . . . . : 06/21/2007
RECEIPT #. . . . . . . . . : BS000001733
REFERENCE ID # . . . 07060179
SITE ADDRESS . . . . . : 19981 PEAR TREE CT
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER PEIDER TSENG
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2318
RECEIVED FROM . . . . : LESLIE 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
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 8, 000 . 00 147. 96 0 .00 147 . 96 0 . 00
BSEISMICRE VALUATION 8, 000 . 00 0. 80 0 .00 0 .80 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 148 . 76 0 .00 148 .76 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 148 .76 VISA
---------------
TOTAL RECEIPT 148 .76
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 1997 UBC Standards
and manufacturers specifications on rE-roofing.
2. New roof coverings shall not be appliE d without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the bu-ilding inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to ani roofing installation.
4. To receive a final sign off from the Cib,,the following steps are
required:
1) Pre-inspection and/or tear off appraval.
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: ��.i c� e S r�
Job Site Address: FS ( �� e c`tr 'f C e e C1
Roofing Company Name: D _ O O rN
Applicant's Signature: li _ Date:
Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
RF-ROOF
CUPErRT INC► PERMIT APPLICATION FORM
�
APN#
6
Building Address:i 619
S ,t-
Owner's Name: Phone#:
17�ei 3 y 3 3
Contract r: License#:
! n o P► C, S y S S 9 1
Contact: o N Cupertino Business License #:
Le. s �; � �.
Tyth of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
,.9' Asphalt Shingles .Er'Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
/d� To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read,Understand and Will Comply With Ciipertino's Tear Off Policy: ❑
Job Description:
QJ e 1 CA-1,Y) P Q-
Residential � Commercial ❑ 3o #
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: Type of Constn ctio Occupancy gr
�OT
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 Plan Check Fee BUILDING
BUSLIC Business License BUILDING