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12070242 CITY OF CUPEIRTINO BUILDING PE,WNIIT BUILDING ADDRESS: lolls SWAN OAK LN COINTRACMR:PEFEltslin- :,w Inc rERMIT NO: 120702,42 OWNER'S NAAIIi: WAIn'ON SIIOR'f&JIiNNu'EH KUOInG 7980 ENTEIRPHIS h;DR DATE, ISSUED:07/30rzo12 OWNER'S PHONE: 4085689319 NE\VAIt E,CA 94;60 PBONE NO.(510)494-9982 LICENSED CON1'llAC1'OR'S DECLARATION BUILDING PERMIT INFO: 13LDC r ELECT r PLUMB r License Class-_%9 Ha k y6$1l 7r r r y1 I_- �-7 NECK RESIDENTIALCOALAl1iRC1.\L Contractor ?86_5�ea2J Date (—3 Q_/ Z I hereby:(firm that I eat licensed under the provisions of Chapicr 9 J013 I)ESCRI IIT[ON:REMOVE WOOD SHAKE AND INSTALL I I SOS PRESIDENTIAL' S (commencingwith Section 7000)of Division3 othe Business& Professions Sill'NGLLS OVE R In RADIANT PI-YW'OOD 30d F131 I' Code and(hill mv license is in full force:ted effect. hereby affirm under penally of perjury one of the I'allooing two declarations: I have:nd w ill maintain a certificate of consent to self-insure for Worker's Compensation,az provided for by Section 3700 of the Labor Code,for the performance of the work Ibr which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided leu Ins Section 3700 of the Labor Code.for the performance of the ours kir which this Sq,FI Floor Arcs Valuation:$6357 permit is issued. APPLICANT CE0,117ICTION APN Number:34232133.00 Occup:mcy Type: I certify than I have read this application and state that the above infatuation is correct.I 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 shove mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTLI) indemnify and keep harmless the City of Cupertino against liabilities,judgincnls. WITHIN ISO DM'S OF PER1'I I"I ISS UANCI: OR costs,and expenses which may accrue against mid Cily in consequence of the granting od'Ehis permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Signature IT.ue �— Issur — Date: ❑ (MINER-BUILDER DECLARATION li I•:HOOPS: I hereby'affirm that I am e\empt from the Cuntraclor's License La%v for one of All roofs shall be inspected prior to any roofing material being installed. If a roof is the following tw'a reasons: installed%yilhout first obtaining'a inspection.I agree to remove all new materials tot I,as owner of the property,or lip•employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for s lc(Sec.7044. Business&Professions Code) Sig ore ofA police� Date: I,as owner of the property,am exclusi%vcly conuracting with licensed contractors to �`'— construct the project(Sec.7044,Business&Professions Code). ,\I,1,ROOF COVERINGS TO BE CLASS"A"OR Bf:ffER I hereby affirm under penalty of perjury site of the folluwi o, three declarations: HAZARDOUS MATERIALS DISCLOSURE 1 have and will maintain a Cenificate of Consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the 1 have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this pemtil is issued. California I lealth&Safety Code.Sections 25505.25533,and 25534. 1 will maintain 1 have and will maintain Worker's Compensation Insurance,as provided for by compliance%vith the Cupertino Al unicipal Code.Chapter 9.12 and the Ilcal(h& Salcly Code.Seclion'_5532(:)should I store ur handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Addilionallc,should I use equipment or devices which emit hazardous nit permit is issued. contaminant,as dcl-Ined by the Buy Area Air Oualiq'.\In nagemem District I will I certify that in the performance of the work for which Ibis permit is issued,I shall maintain cunt plia lice with the Cupertino)Municipal Code.Chapter 9.12 and the not employ any person in any manner so as to become subject to ober W4nker'sIO Iridin fi Safely C e.Sections 2550:,.25533,and 25534. Compensation laws of California. If.after making this ceniticate of c.xennption,n1 - become subject to the Worker's Compensation provisions of the Labor Code,I nsl "ner s r:u.�r •t •t cit •�,_� —/ forthwith connply with such provisionsor this pcnnit shall be deemed revoked. Darr. [ CONSTRACTION I.ENDING AGI•:N", APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby atiirin thin there is it construction lending agency 1'ur the performance of work's correct. I agree to comply with all city and county ordinances and state Imus relating fur which this pcnnit is issued(Sec.3097.Civ C.) to building construction,and hereby authorize representatives ol'this city to enter Lender's\;nuc upon the above mentioned property for inspection purposes.(We)agree to save - indemnify and keep harmless the City ol'Cuperlino against liabilities,judgments• Lender's Address costs,and expenses which may accrue against said City in consequence of the gunning of this permit.Additionally the applicant understands and%r ill comply ,\Incl II'1'ISCI"5 UP:CI„UtA'1'10\ %%ith all non-point source regulations per the Cupertino Municipal Code,Section 9.18, 1 understand my plans shall be used as public records. Signature Dale Licensed Professional CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION :91 ADDRESS:/0//_5_ I DA'Z'E: 07/30/2012 REVIEWED BY: bobs. APN: BP#: %aQ76 2 .;), 'VALUATION: $6,357 *PERMIT TYPE: Building Permit PLAN CRECR'1'YPE: Alteration/ Repair PRIMARYPENTARIATION USE: SFDOrDuplex PERMITTYPE: 1SFDWLR00 WORK tear off wood shake and install comp shingles. SCOI'1's Mech. flan Check Plumb.Plan Check Flee.Plan Check a tech.Permit Fee: /'Iamb.Permit Fec: Flee Permit Fee: Other A1ech. /asp. Other Plumb Insp. Other Flee.Insp. Li I .[loch. hc+p.Fee: Plumb. hhsp. Fee: Elco.lntp. Fee: NOTE: This estimate floes not include feet due to other Departments(i.e. Planning, Public Narks, Fire,Sanitary Server District,School District,etc.). These fees are based on the preffininart information available and are onlP an estimate. Contact the Den for whin'I in r. FEE ITEMS (Fee Resohnion 11-053-L-&-7111111 FEE QTY/FEE MISC ITEMS Plan Check Fee: $0.00 1,100 s.f. Re-roof SuppI. PC Fee: Q Reg. O OT 0.0 hrs $0.00 $165.00 IREROOFRES PML' Plan Check: $0.00 Permit Fee: $0.00 Suppl. Insp. Fee-.0 Reg. Q OT 0.0 hrs $0.00 PME Unit Fee: $0.00 PME Permit Fee: $0.00 Construction Tits: Administrative Fee: 0 Work Without Permit? O Yes Q No $0.00 E) Advanced Planning Fee.- $0.00 Select a Non-Residential E) Travel Documentation Fns: Building or Structure 0 A Su'ong Motion Fee: IBSEISABCR $0.64 Select an Administrative Item Bldg Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $1.64 $165.00 TOTAL FEE: $166.64 Revised: 07/01/2012 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT •BUILDING DIVISION 10300 TORRE AVENUE• CUPERTINO, CA 95014-3255 Is (408)777-3228 •FAX(408)777-3333 • buildingOcupertino.org CUPERTINO (� d / 0�7ay� 0 PROJECT ADDRES-/U1____'._ APNM OWNERNAM-• L� ! PHONE E-MAIL (JcA Al `Jenl) Y 06 / 868- I3/ STREETADDRESS ,�O.z lr] ©� Rd CICT-Y,�STATEZIP �� CC�?O FAX /� �Jciv� G r'� /J CONTACT NAME / � I PL�/O —S7Z E-MAIL STREET ADDRESS •11nFAX ❑OWNER ❑ OWNCR--DOILVEERR ❑ OWNERAGENr Z LJCONTRACTOR `11CONTRACTORAGENT 11 ARCHITER ❑ENGINEER ❑ DEVELOPER 11 TENANT LICENSE NLICENSE BA.LIC.M COATRARsC1AdeavR -Q N `f99//7 NO3.0 COMPANY NAME E-MAIL FAX STREET ADDRESSCITY.STATE 21P PHONES/d -y�'y 9 7 5-0 C.4ec sr- l�(� ,vecwc�r < CA 5'56 G ARCHITELT/ENGTNEER NAME LICENSE NUMBER BUS.LIC.9 COMPANY NAME E-MAIL FAX STREET ADDRESS CITY.S1 Al ZIP PHONE USE OF ❑ SFU or Duplex Multi-Family ROOF AREA: VALUATION 7 O_n STRUCTURE: E] Commercial (D( /7V1 / 57 EXISTING ROOF TYPE: 11 BUILT-UP ROOF 11ASPHALT SHINGLES f•ppWOOD SHARES ❑WOODS14INGLES ❑OTHER(SPECIFY) REMOVE/REPLACE�LLYF.S if NO. PLYWOOD �'b" ❑ PLYWD `TD OSB PITCH: ROOF ❑ NO tl LAYERS THICKNESS ❑ sIR- TYPE. ❑CDX ''Z CUSS: A PROPOSED ROOF TYPE' ❑BUILT-UP ROOF j3LASPHALTSHINGLES ❑WDODSHAKWOOD SHINGLES ❑OTHER ICC-ESREPORTtl ES ❑ I S REP DESCRIPTION OF WORK: RerqoUL •� I �J ( G I_ I 7rAS( O�A I l� I C I Iy Ier- ovo-� z Rad Vt Pl 0000l M1 0-4 Fe rl ` G F J L� By my signature below,I certify to each of the follmving I am the property owner or aulhorized agent to act on the property owner's behalf. I have read this application and the information I have Prov' cd is correct. I have read the Description of Work and verify it is Income. I agree to comply with all applicable local ordinances and stale laws relating to b I i c0 W<lion. aulhoriu rcpracntativ�s Of Cupertino to toter the above-iddentified property for inspection purposes. Signature Ol'ApplicandAgcne '7� Date: SUPP1,13MENTAL INFORMA'T'ION REQUIRED I OFFICEUSEONLY - t ' ' " Ir' " i-1' "' _ If buildingis associated with a Home Ow•ncr's Association,provide letter PLANCHECKTIPE � - ROUTIN'GSLIP . of approval from HOA. N'TEN •„ •I d mm.mNC DUAN RF.YIEiV 1 i A _Provide Planning approval to verify if there any restrictions. ❑ EvrRu 1• - ❑ Plenn'rNcri.nn dErlEw _Providec 1Manufacturer's Installation Specifications. O'STANDARD' ' " ❑ FIRE.DEPT rOvidc signed copy Of Cupertino's Tear-Off Policy. •❑ OTIIER: ^ ReroojApp_201 l.doc revised 03116111