06100099 (3) CITY OF CUPERTINO
BUILDING DIVISION PERMIT
'TOR .
IRMTI€)N
BUILDING ADDRESS: M C ROOFING PERMIT 0 610 0 0 94
11609 BIRCH SPRING CT
PERMIT ISSUE DATE
OWNER'S NAME:
MRS SUSAN LIU 1415 MT
SANITARY NO. CONTROL NO.
jNE:
(408)729-3436
ABUILDING PERMIT INFO
RCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
O 0 LICENSED CONTRACTOR'S DECLARATION Job Description
i U p I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is
!=y in full force and effect._2 L� # -- REROOF- TEAR OFF SHAKE, INSTALL 7/16 OSB & 50YR
Z License Class J BARKWOOD ELK CLASS A
p
Date Contractor
UJ
ARCHITECT'S DECLA
a< 1 understand my plans shall be used as public re
:A.
Oin Licensed Professional
m OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors License Law for the
'M0 following reason.(Section 7031.5,Business and Professions Code:Any city or county
% rL which requires a permit to construct,alter,improve,demolish,or repair any structure
—H prior m its issuance,also requires the applicant for such permit to file a signed statement
0
rise Law(Chapter 9 Sq.Ft. Floor Area Valuating 3 0 0
that he is licensed pursuant to the provisions of the Contractor's Lice
t-$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
.. 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 APN Number Occupancy Type
not more than five hundred dollars(5500). 36654077 . 00
❑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 forsalc(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs 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.).
❑I,as owner of the property.am exclusively contracting with licensed contractors to
construct the project(See.7044,Business and Professions Code:)The Contractor's Li-
cense Law docs not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractors
License Law.
C]I am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
❑1 have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for 'h this permit is issued.
ave and will maintain Worker's Compensation Insurance,as required by Section
3710 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number are: n
Carrier' Policy No.: 6��7oL
' CERTIFICATE OF EXEMPTION FROMWORKERS'
C �OO�M,►PPEN ATION INSURANCE
�` L, \
(This section need not?& tcd if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,1 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 Workers Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
z"' CONSTRUCTION LENDING AGENCY
Er I 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.)
LLa ALender's Name
az [..enders Address
U C) I certify that I have read this application and state that the above information is
V. correct.I agree to comply with all city and county ordinances and state laws rclating to
rJ- V building construction,and hereby authorise representatives of this city to enter upon the
U above-mentioned property for inspection purposes.
W (We)agree to save,indemnify and keep harmless the City of Cupertino against
to liabilities,judgments,costs and expenses which may in any way accrue against said City /
U Z in consequence of the granting of this permit. Date
P- APPLICANT UNDERSTANDSWILL OMPLY WITH ALL NON-POINT Issued by:
SOURCE R ULATIO
Re-roofs
ignatu pplicant/ ontractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
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 shall be inspected prior to any roofing material being installed.
❑Yes ❑No
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes ❑No
1 have mad the hazardous materials requirements
reunder Chapter f Ute Califon-
ria Health&Safety Code,Sections 25505,25533 and 25534.l understand thatifh
building
docs not currently h a tenant.that it is y responsibility to notify the occupant of the
requircmc w ' must be t prior tss ce cruficate of upanc. SlgnatuApplicant Date
o All roof coverings to be Class"B"or better
Owner ora rizcd agcnl Date
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36654077 . 00
DATE ISSUED. . . . . . . : 10/12/2006
RECEIPT # . . . . . . . . . : 36420
REFERENCE ID # . . . : 06100094
SITE ADDRESS . . . . . : 11609 BIRCH SPRING CT
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MRS SUSAN LIU
ADDRESS . . . . . . . . .
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : MC ROOFING
CONTRACTOR . . . . . . . : MIGUEL CASTILLO LIC # 24741
COMPANY . . . . . . . . . . : M C ROOFING
ADDRESS . . . . . . . . . . : 1415 MT LASSEN DR.
CITY/STATE/ZIP . . . : SAN JOSE, CA 95127
TELEPHONE . . . . . . . . : (408) 729-3436
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- -- - - ---- - --- ---- ----- - ---------- ------- --- ---------- ---------- ----- -----
BPERMFEE VALUATION 9, 000 . 00 158 . 76 0 . 00 158 . 76 0 . 00
BSEISMICRE VALUATION 9, 000 . 00 0 . 90 0 . 00 0 . 90 0 . 00
BUSLIC FLAT RATE 1 . 00 105 . 00 0 . 00 105 . 00 0 . 00
---- ------ ---------- ---------- ----------
TOTAL PERMIT 264 . 66 0 . 00 264 . 66 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
- --- - - ---- ----- -- ------------ --7-- ---------- ---
OTHER 264 . 66 VISA
TOTAL RECEIPT 264 . 66
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
„CITY OF Fax(408)777-3333
''UPEi�TINO
Building Department
JOB ADDRESS: PERMIT #
GCS "N �� .:-,-) 00 ` cl
OWNER'S NAME: c v PHONE # Q 702 — C
GENERAL CONTRACTOR: tk C FAX # Z
I am not using any subcontractors: D
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
.1117— Owner/Contractor Signature Date
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 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: 1::__p U S Atli 1_ ,t �
Job Site Address: �� 00
Roofing Company Name: k—N,
Applicant's Signature: O Date: /Q �Q
Greg Casteel
Building Official
Revised 11/2/04
0(_01000q+
CITY OF CUPERTINO
REROOF
CUPCIIYCW
ER`TINO PERMIT APPLICATION FORM
APN# Date:
Building Address: \
'.�
Owner's Name: Phone#:
Contractor: License#:
can
Contact: � h
Cupertino Bus' ss License #:
2#gTL-
\ Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ B ilt-Up roof
❑ phalt Shingles Asphalt Shingles
q,.,- ood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
®r'-T—o be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy:kc�
Job Description:
o L'
Residential [v/ Commercial F1 ' 1�
Fire Zone: Yes ❑ No ED" Confirmed with Planning Dept. if
there are any restrictions: LJ
C st of Project® Type of Construction: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energ BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING