09070111 CITY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDING ADDRESS: PERMIT NO.
10839 SYCAMORE CT HIGHLIND R
^W NER'S NAME. PERMIT ISSUE DATE
PHONE: QUNG SA CONTROL No.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
RE—ROOF REPLACE OLD ROOF
!000 LICENSED CONTRACTOR'S DECLARATION WITH 1/2 INCH 4X8 Job Description
U) I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z with Section 7000)of Division 3 of the Business and Professions Code,and my license is
in full force and effect.
vn Z License Class Lie.N
^ DateContractor
RC
t' AHirmcrs DECLARATION
I understand my plans shall be used as public records
D W d
Oin Licensed Professional
O 3 OWNER-BUILDER DECLARATION
rA
i<x I hereby affirm that I am exempt from the Contractor's License Law for the
COO following reason.(Section 7031.5,Business and Professions Code:Any city or county
14 m which requires a permit to construct.alter,improve,demolish,or repair any structure
,3 Z y prior to its issuance,also requires the applicant for such permit to file a signed statement
F=`e that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area Valuation
n 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).
Q I,as owner of the property,or my employers with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business Required fired Ins ections
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.).
I.as owner of the property,am exclusively contracting with licensed contractors to
co truct the project(Sec.7044.Business and Professions Code:)The Contractor's li-
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.
❑I am exempt und�er/ C44(V
&P C for this reason
Isrbier /'� / _Date 'O
WORKER'S CO SATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,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 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. Policy No.:
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 Workcrs'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 0 forthwith comply with such provisions or this permit shall be deemed revoked.
z'"' CONSTRUCTION LENDING AGENCY
4 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.)
Wts.0 Lender's Name
z Lender's Address
U 0 1 certify that I have read this application and state that the above information is
LL" corcct.I agree to comply with all city and county ordinances and state laws relating to
0 V building construction,and hereby authorize representatives of this city to enter upon the
w above-mentioned property for inspection purposes.
O, (We)agree to save,indemnify and keep harmless the City of Cupertino against
HIn 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
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: U
SOURCE REGULAMONS. v_t 3'o
Re-roofs
Signature of Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of R sof
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
ie.Section 25532(x)? All roofs:;hall be inspected prior to any roofing material being installed.
❑Yes No
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new m iterials for inspection.
District?
[3 Yes A—No
l
L�
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505.25533 and 25534.I understand that if the building
doesnot currently have a tenant that it is my responsibility to notify the occupant of the
requirements which must be met prier to issuance of a certificate of Occupancy. Signature of Applicant Date
74 -1 f—U-u2 All roof coverings to be Class'J�"or better
Owner or authorized agent Date
Community Development
;.::
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
CUPEkTINO
Building Department
JOB ADDRESS: 5-Y«44.0 e-r- Cf . PERMIT#
OWNER'S AME: �, �,t, ,� PHONE #4 C3J>-- -72 9-- -1 ,z- f
GENERAL CONTR TOR Q,,, 1 d FAX #
I am not using any subcontractors:
Si gnature Date
Please check applicable subcontractors and com Clete 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
Owner/Contractor Signature Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT.' RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: B1}:: Lot :
APN . . . . . . . . . 34257029 . 00
DATE ISSUED. . . . . . . : 07,'13/2009
RECEIPT #. . . . . . . . . : BS000008182
REFERENCE ID # • • • 09070111
SITE ADDRESS . . . . . : 10839 SYCAMORE DRIVE
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER YOUNG WOO KIIM
ADDRESS . . . . . . . . . . : 101339 SYCAMORE CT
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : YOUNG W KIM
CONTRACTOR . . . . . . . : TONY NGUYEN LIC # 26323
COMPANY . . . . . . . . . . : HIGHLAND ROOFING
ADDRESS . . . . . . . . . . : 1486 PARSONS AVE
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (408) 206-5890
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----------
1BCBSC VALUATION 13, 000 . 00 1 . 00 0 . 00 1. 00 0 . 00
1BSEISMICR VALUATION 13, 000. 00 1 .30 0 . 00 1 .30 0 . 00
1REROOFRES SQ FEET 30. 00 390 .00 0 . 00 390 . 00 0 . 00
- --------- ---------- ---------- ----------
TOTAL PERMIT 392 .30 0 . 00 392 .30 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 392 .30 1321
---------------
TOTAL RECEIPT 392 .30
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF CUPERTINO
kap REROOF
CUPEkTINO PERMIT APPLICATION
APN # Date:
ftq64- z ��� 02q 00 .?- (3
Building Address:
6S,'R S ori C ) e/L�+hd � ���
Owner's Name: /�, n� �o ;'�-• Phone #: C' y o 8
HOA: Yes ❑ No If yes, provide le-:ter from HOA
Contractor: Phone #: " 21j6 810
Fax #.
Cupertino Business License #: / Contractor License #:
Type of Itoof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
* Asphalt Shingles )!!� Asphalt Shingles
❑ 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: fk (cc- .e_ o L d " o-f- Lo :tom- / �/� i� mac,, q k;}',
Residential ® c, sf A Commercial El
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the a pplication or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation: ! C7 --- -
I Have Read, Understand and Will Comply wits. Cupertino's Tear-Off Policy:
Signature
Revised 02/05/09
1 CITY OF CUPERTINO
REROOF
CITY OF
CUPEkTINO FEE SCHEDULE
• w
Number of Fee ID Fee Description Fee Permit Type
Squares Croup +
1 REROOFCOM Re-roof Commercial B 1 COMMLROOF
1 BCBSC Cal Bldg S:andards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Commercial B
1 REROOFRES Re-roof Re 3idential B 1 SFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1 REROOFMRES Re-roof Mt.lti-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1 BSEISMICRE Seismic Re 3idential B
1BUSLIC Business License B
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
Fax: (408)777-3333
y
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 ie-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 b uilding inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to arty roofing installation.
4. To receive a final sign off from the Cily,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 nai 1 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 fe� 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 or.the job site at the time on inspection.
I understand and will comply with the above stated/policy on re-roofing.
Homeowner's Name: l p t.�n o✓o o G°�`+-►
Job Site Address: [ p 8, R MV*ee- C
Roofing Company Name:
Applicant's Signature: �2 Dater
Greg Casteel
Building Official
Revis!d 07/30/08