12080276 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11693 VINEYARD SPRING Cf CONI'R.ICEOR:CASTILLO'S ROOFING PERMIT NO: 12080276
OWNER'S NAME: HUI WING F AND MAGDALEN C 1703 CAT UAY DR DATE ISSUED:08127/2012
OWNFR'S PIIONE: 4084315410 SANJOSE,CA 95122 PHONE NO:(408)251-3565
k�e_ f LICENSED COYI'RACI'OR'S DECLARATION r_ r- F_
C� q5�1-�S�p BUILDING PERMIT INFO: BLDG ELECT PLUMBLicense Class Lie.N
_ p1ECF1 r RESIDENTIAL r COMMERCIAL r
�.�Z
I hereby affir that 1 am licensedunder the provisions of Chnptcr 9 JOB DESCRIPTION:TEAR OFF WOOD SHAKE INSTALL COMP SHINGLES 18
(commencing with Section 7000)of Division 3 of the Ilusincss&Professions SQFf
Code and that my license is in full force and effect. CLASS A
hereby affirm under penalty of perjury one of the following two declarations:
I have and rill maintain a certificate of consent to self-insure for Worker's
Compensation,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 provided for by
Section 3700 of the Labor Code,for the performance of the work for which this
permit is issued Sq.Ft Floor Area: Valuation:$9000
APPLIC,\N'1'CER'I'IFICA'1'ION
I certify that I have read this application and state that the above information is APN Number:36654007.00 Occupancy Type:
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 above mentioned property for inspection purposes. (We)agree to save
indemnify and keep harmless the City ofCupertinoagainstliabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR
with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18.
Signature � Date (;0 )_ L_ Issued It �G�—� Date:
❑ ONSNER-RUILIIF.R DECLARATION
hereby affirm that I am exempt from the Contractor's License Lmv for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to my roofing material beimg installed.If a roof is
1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for
will do the work,and the stmcture is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Si,�t#t e f AppI c rack, Date:
construct the project(Sce.7044,Business&Professions Code), —
hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to scl Ginsure for Worker's DA'J,ARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code.Sections 25505,25533,and 25534. 1 will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino;Municipal Code,Chapter 9.12 and the Health&
Safely Code,Section 5532(a)should I store or handle hazardous material.
permit is issued. Additionally,should 1 use equipment or devices which emit hazardous air
I certify that in the performance of the work forw'hich this permit is issued.I shall contaminants as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
Compensation laws ofCalifomia. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505.25533,and 25534.
become subject to the Worker's Compensation provisions of the Labor Code,I must
forthwith comply with such provisions or this permit shall be deemed revoked. .Own r or thorized agent: Z_
[late:
A PPLI CANI'CERTI FICATION CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is
correct.1 agree to comply with all city and county ordinances and state laws relating I hereby affirm that there is a construction lending agency for the performance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabil itics,judgments,
costs,and expenses which may accrue against said City in consequence of the Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCII ITECI"S DECLARA'T'ION
9.18.
1 understand my plans shall be used as public records.
Signature Dale
Licensed Professional
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT` BUILDING DIVISION -
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228` FAX(408)777-3333•buildino(ftuoertino.orG
PROJECT ADDRESS I l,Yr n APN M r -
OWNER NAME IJ" PHONE iIZI �G I 'I I� ///w���E-0fALL
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CONTACT NAME CA
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❑OWNER ❑ OW'NER4m111DFR ❑ OWNERAGENT CONTRACTOR ❑CONTRACTORAGFM ❑ ARCHITECT [11ENGINEER. ❑ DEVELOPER ❑ TENANT
CONTRACTORNAME LICENSENUMBER LICENSE T}Py •�Z� BUS.LIC.N
COMPANY NAM ` ' I E-MAIL FAX /,r
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COABANY•NAME E-MAIL FAX
STREET ADDRESS CITY,STATE.Zip PHONE
USE OF IPTIFD or Duplex ❑ hlulti-Family ROOF AREA: VALUATION: -
sraucruae: • ❑ Commercial r
q �
EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLFS WOOD SHAE:FS ❑WOOD SHINGLES ❑OTHER.(SPECIFY)
REMOVE/REPLACE gM IF NO. `� PL}IVOOD 11 :5" ❑ CLri1'D ❑OSB PITCH: , ROOF ,
110 tl R4 J ❑ 55' PE ❑ D -'l` CUSS
PROPOSED ROOF TYPE: ❑BUILT-UPROOF ASPHALT SHINGLES 10 WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT
DESCRIPTION OF WORE:: T• { -- I N A)
By my signature below,1 eerdCv to each of the following: Iran die property owner or authorized agent to act on the property mover's behalf. b have read this
application and die information I hilve pro ded is correct. 1 have read the Description of Work and verify it is accurate. 1 agree ro comply with all applicable local
ordinances and st s relatins b ing a cion. 1 authori represenatives of Cupertino to enter the above-idea ifi d pmpe •for inspection purposes.
Signature Of App i Date:
SUPPLEMENTAL( •ORNIAT10N REQUIRED - OFFICEUSEONLY
_If building is associated with a'Horue Owners Association,provide letter - PLkNCHECKTYPE R6uri.N6SLiP_
of approval from HOA. O}'CR-TRE-coun-rea .iO" IILDINNG et.Xk RelTe}J -
_Provide Planning approval to verify if there any restrictions. O EXPRESS o ❑ PLANNING rcaiv aEviEw
Provid pyofMviufacmrer'slnstallation Slxcifcations. ❑ STANDARD ❑ nRE DEPT
rovide signed copy of Cupertino's Tear
-Off Policy. ❑ OTHER'
RerwfApp_2011.doc revised 03/16111
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 11693 vineyard spring ct. DATE: 08/27/2012 REVIEWED BY: bobs.
2 APN: BPP: 'VALUATION: 1$9,000
*PERMIT TYPE: Building Permit PLAN CIIECK TYPE: Alteration/ Repair
PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF
USE: PER IT TYPE:
WORK tear off wood shake install comp shingles
SCOPE
Mesh. Plan Check Plumb. Plun Check Flec. Plan Check
ablech.Permit Fee: Phindr. Permir Fee: Elec.Permit Fee:
Other,Yeah.Insp. Other Plumb Insp. Other Elcc. Imp.
,Mesh.ln,,p.Fee: Plumb. butt.Fee: Elec.Insp.Fec:
NOTE: This estimate does not include fees clue to other Departments(i.e. Planning, Public lVarks, Fire,Sanitary Server District,School
District, etc. . These fees are based on rise prefintinan information available and are only an estimate Contact Ute Dept for addn'I info.
FEE ITEMS (Fee Resohtion 11-053 E!L 7/1/1/) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 1,800 s.f. Re-roof
Suppl. PC Fee: Q Reg. Q OT FO.0 1 hrs $0.00 $270.00 IREROOFRES
PME Plan Check: $0.00
Permit Fee: $0.00
Suppl. Insp. Fee0 Reg. Q OT FO.0 hrs $0.00
PME Unit Fee: $0.00
PME Permit Fee: $0.00
Construction Tax:
Administrative Pee: O
Work Without Permit? O Yes (F) No $0.00
Advanced Planning Fee. -Residential$0.00 Select aNon
Travel Documentation Fees: Building or Structure 0
i
Strong Motion Fee: /BSEISAHCR $0.90 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $1.90 $270.00 TOTAL FEE: $271.90
Revised: 07/01/2012