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CITY OF CUPERTINO
PERMITIto
BUILDING DIVISION
BUILDING ADDRESS.
PERMIT NO.
988 SEPTEMBER DR
INTEGRITY ROOFING
09030199
OWNER'S NAME:
PERMIT ISSUE DATE
S A CONTROL NO.
"INE:
(408)225-9263
ARCHrrEC IFNGINEER:
BUILDING PERMrr INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
RE -RF F MV S HKRF I N S TL 7 / 16 0 S B S HTHNG I N S T L
in full force and effect (�
,
License Class 11 Lk
Contractor
CRTAINTEED LNDMRK 40YR SHNGLS OVR30LB UNDRLYMNT
Date
ARCHITECI'SDECLARA lON
CLSA 1S SQ
1 understand my plans shall be used as public record
i
Licensed Professional
OWNER -BUILDER DECLARATION
�
I hereby affirm that 1 am exempt from the Contractor's License Law for the
i 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
Sq. Ft. Floor Area
Valuation
prior to its issuance, also requires the applicant for such permit to file a signed statement
9
that he is licensed pursuant to the provisions of the Contractors License Law (Chapter
(commencing with Section 7000) of Division 3 of the Business and Professions Code) or
$8343
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (5500)_
3 6 215 0 � 6 .00
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
Required Inspections
will do the work and the structure is not intended oroffered for sale (Sec.7044,Business
and Professions Code: The Contractor's License Law does not apply to an owner of
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 U.
cense Law does 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 Contractor's
License Law.
❑ 1 am exempt under See. B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self -insure for Workers Compen-
....don, 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 artier and Policy number am:
L
Carrier. / 1 Policy No.: -0
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed 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, 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
7 forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
> the work for which this permit is issued (Sec. 3097, Civ. C.)
aLender's Name
Lender's Address
I certify that 1 have read this application and state that the above information is
corecL 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, indemnify and keep harmless the City of Cupertino against
y
Liabilities, judgments, toss and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
Date
APPLICA UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued b":
SOU C GUL NS.
Re -roofs --
T Of Roof
Type
nature of an ontractor Dare
HAZARDOUS MATERIALS DISCLOSURE
t 1 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 shall be inspected prior to any roofing material being installed.
❑ Yes
roof:
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant o future building occupant use equipment or devices which
mit hazardous air contamina as defined by the Bay Area Air Quality Management
all new materials for inspection.
district?
❑ Yes
1 have read the hazardous materials requirements under Chapter 6.45 of the Califon-
ter /
nia Health & Safcty Code, Sections 25505, 25533 and 25534.1 understand that if the building
- -----
does not currently have a tenant. that it is my responsibility to notify the occupant of the
Date
reyuircmen ch must be metpriorwissn e flute Occupanry.
Slgnaturt�ef:Applieant
LJ
/ ` All roof coverings to be Class','W' or better
wner or au zed a Date
t
CITY OF
':UPEkTINO
CITY OF CUPERTINO
RE PROOF
PERMIT APPLICATION
cFi D3a 9 9
APN #
Date: 03/24/2009
Building Address: 988 September Drive,
Cupertino 95014
Owner's Name: Gang Lu
Phone #:
HOA: Yes ❑ No If yes, provide letter from HOA
408-446-2874
Contractor:
Phone #: 408-225-9263
INTEGRITY ROOFING
Fax#: 408-362-9930
Cupertino Business License #:
Contractor License #: 7 6 0 5 5 7
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
m Asphalt Shingles
a Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
❑ Other (Specify)
Number of existing coverings
❑ Provide I.C.C.E.S. Report #
❑ To be Removed
❑ Provide Mfgr. Installation Specs.
Job Description: Remove Shake roof install 7/16 O.S.B. Sheathing install
CertainTeed Landmark 40
year shingles over 301b underlayment.
Residential Q
Commercial ❑
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application
or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation: $8,343.00
I Have Read, Understand and Will Compl with Cupertino's Tear -Off Policy:
i ature
Revised 02/05/09
CITY OFCUPERTINO
1- avzo RI,.ROOF
CUPEkTiNO FEE SCHEDULE
Number of
Squares
Fee ID
Fee Description
Fee
Group
Permit Type
1REROOFCOM
Re -roof Commercial
B
1COMMLROOF
1BCBSC
Cal Bld€; Standards
Commission Fee
B
ALL PERMIT TYPES
1BSEISMICO
Seismic Commercial
B
(9
1REROOFRES
Re -roof Residential
B
1SFDWLR00F
1BCBSC
Cal Bld€; Standards
Commission Fee
B
ALL PERMIT TYPES
1BSEISMICRE
Seismic Residential
B
1REROOFMRES
Re -roof Multi -Family
B
1MFDWLROOF
1BCBSC
Cal Bldg; Standards
Commission Fee
B
ALL PERMIT TYPES
1BSEISMICRE
Seismic Residential
B
1BUSLIC
Business; License
B
Community Development Department
Building Division
City of Cupertino
10300 Tone 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 nz it inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new m aterial down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nai.. 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 cion be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of li " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be an the job site at the time on inspection.
I understand and will comply with the abo're stated policy on re -roofing.
Homeowner's Name:
Job Site Address: 98:R e 7TH 1` 1 P s' lm) i" ► U __
Roofing Company Name: ROOFr�
Applicant's Signature: Date:
Greg Casteel
Building Official
Revi;;ed 07/30/08
` �, ao'
CITY OF
"WEI�TINO
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
PERMIT #
CH 03 c�'I C ' q
OWNER'S NAME: Lv
PHONE # 4/o - ZZ - 7 Z4 3
GENERAL CONTRACTOR. z,
FAX #
I am not using any subcontractors:
Si ature Date
Please check applicable subcontractors -plete the following information:
yip /0
Qwner/ Contractor Signature Date
SUBCONTRACTOR
BUSI14ESS 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
yip /0
Qwner/ Contractor Signature Date