12080313 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 20322 SILVERADO AVE CONTRACTOR:T D ROOFING PERMITNO: 12080313
OWNER'S NAME: PAN KUO-RUEIII AND CHEN IISIAO-FANG 675 TULLY RD DATE ISSUED:08/302012
OW'NER'S PHONE: 4087770924 SAN JOSE.CA 95111 PHONE NO:(408)892-8872
LICENSE[)CONI'RACI'OR'S DECLARATION BUILDING PERMIT INFO: BLDG I- ELECT IJ PLUNIB r
License Class—" flu5 1 fll e.4 3 C 171 r
NIECH RESIDENTIAL CONINIERCIAL
Contractor - Date SA
hereby aRrm that I am licenseGntlerthe provisions of Chapter 9 JOB DESCRIPTION: REMOVE EXISTING WOOD SHAKE ROOFING AND
(commencing with Section 7000)of Division 3 of the Business&Professions INSTALL NEW
Code and that m •license is in full force and effect. CLL OSB AND UFT CLASS
WITH NEW LIGHT WEIGHT
y CLAY TILE 26SQFT CLASS A
1 hereby affirm under penoltp of perjury one of the following two declarations:
I have and will 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.
I 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:$15000
APPLICANTCERTIFICATION
I certify that I have read this application and state that time above information is AI'N Number:36938012.00 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 ofCupeninoagainst liabilities,judgments, PERMIT EXPIRES IF WORT{ 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 reguItims per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION.
9.18. /
Signature Date 3& J )Z— Issued by: z/k GrT Date: //G'3G/c�—
❑ ONVNER-BUILDER DECLARATION'
I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is
I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaininZmsqpcl' n,I agree to remove all nnv materials for
will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code) /�l71,as owner of the property,am exclusively contracting with licensed contractors to Signature of Applic n i Date:
construct the project(Sec.7044,Business&Professions Code).
1 hereby affirm under penalty of perjury one of the following three ALI,ROOF COVERINGSTO BE CLASS"A"OR BETTER
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS NIATERIAIS 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. I 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 Ilealth&
Safety Code,Section 2553_(x)should I store or handle hazardous material.
permit is issued. Additionally,should I use equipment or devices which emit hazardous air
I certify that in the performance of time work for which this permit is issued,I shall contaminants ns 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 of California. If,after making this certificate of exemption,I Ilealth&Safet Code Se tions 2550.5.25533,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. Owner or out rize nth' `6 12.y
Date: !�
APPLI CANT CERTI F'ICAT'ION CONSTRI 'ION LENDING AGENCY
I certify that I have read this application and state that the above information is
correct.I 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 liabilities,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 ARCIIITECI"S DECLARATION
9.18.
I understand my plans shall be used as public records.
Signature Date
Licensed Professional
12-0 R 0
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333` /•buildino(cilcuoertino.oro
PRO ER AE QItES$ rl S I I Q y e APN Y 1 _ _ I
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OWNER PHO
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STREE[[ DRESS D 2 � .a S`I �� e rC7 _r CITY, ST ZIP e_4-'H
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CONT.A(.1 N[�t.(Eo�- t E.,J �Ll 'r Cl Ili P 11 c�- E.nua
Ss; ri.s ��� I�C%I ` •TA^z� �Se FAX
❑ OWNER ❑ OWNER41IRLDER ❑ OWNERAGENT ACTOR ❑CONTRACTORAGEN'T ❑ ARCFBIECr ❑ENaNEER ❑ DEVELoP ❑TENANT
CO• MCTOR ME .rj Q O LI y(�ER-�r I LICFNSET}'QE BUS.LIC.d
COMPANY NAA(E F1- E.KAU. -1/ /� �+ 'S• FAX
STgE RE d 1- �J �.� fel'.SrRTI;ZIP LJ/T -! � 1 I I � Ci V U I V
ARCHITECTiENCH ER NAME Imo- LICENSENNUn(BER BUS.LIC.0
COMPANY NAA/11- E-MAIL FAX
STREET ADDRESS CITY,STATE,ZIP PHONE
USE OF FD or Duplex ❑ Multi-Fmnily, ROOF.ARE� >��t-u.AT17:s� M^,�
sTRucnme: ❑ Commercial
ny l(0 CJ
EXISTING ROOF TYPE: ❑BUILT.UPROOF ❑ASPHALT SHINGLES IM-1 W_ D SHAKES ❑WOOD.�eSI*NyGGLES ❑OTHER(SPECmY)
REMOVE/REPLACE) IF NO. PL\'W'000 ❑ t5' Nkyzj PLYWD 'urlutl PITCH: , ROOF
❑ NO ti L 4 1 ' GA ❑ GB" TIP • ❑ X '1_ CLAS . 'a
'�
[cc ES REPORTM
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF 11 ASPHALT SHINGLES /❑�/WOOD SHAKES C1WOOD SHINGLES ❑OTHER
DESCRIPTION Ir e rY rj\.)OF IK
Q. W c5� eQ 5 VL S tLl'I' 'l k '
-7 « Q.
By my signature brow,l certify to each of the fol wi -: am the proper•oWPer or authorized agent to act on the property o%ner's behalf. 1 have read this
application and die informadonI have provided is o c I have
read the Description of Work and verify it is accurate. I a e to ccmpl• vith all applicable local
ordinances and state laws relating In building co I. 1 rorize representatives of Cupertino to enter the above-int ie�property or inSpection purposes,
Signature of Applicant/Agent: Date: J V
SUPPLEMENTAL INFORMATION REQUI - OFFICE USE ONLY _ -
If building is associated with a home Owners Association,provide letter PLAN CHECK TYPE R0Ul(1NG SLIP _
of approval from HOA. OYER-THr-COUNTER Y,BUILDING PL'AR REvirW
_Provide Planning approval to veri fj if there any restrictions. ❑ Exl•Ress ❑' PLANNING rLiN ReYtew
_Provide copy of Manufacturer's Installation Specifications. ❑ RAn•DARIi: - nae neer:
Provide signed copy of CuperTino's Tear-Off Policy. ❑ OT14ER
Reroofdpp_2011.doc revised 03/16/11
i
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 20322 Silverado Ave DATE: 09/30/2012 REVIEWED BY: Sean
APN: BPii: 'VALUATION: $15,000
*PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAn1AT1ON 1SFDWLRO0F
USE: PERMIT TYPE:
WORK Remove exiStinq wood shake roofing and install new 7/16" OSB and underla ment with new light
SCOPE: weight clay tile.
FEEID ROOFAREA
(s.f.
1REROOFFRES 2,600
Alech. Plan Check Plrunh.Plan Check F.lec. Plan Check
Mech. Permit Fee: Plumb. Permit reg: F:lec. Permit Fee:
Other•,%tech. Insp. _ Other Plumb Insp. El
Other Elce..1,
,Nech.bup. Fee: Plumb. btsp.Fee: Elce. Insp. Few:
NOTE:.This estimate Anes not include jeer due to other Departments(i.e. Planning, Public 1Vorks, Fire,Sanitary Sewer District,School
District,etc.). Thesefees are based on the prelitninan in ortnation available and are only an estinmte. Contact die De t ar addn7 info.
FEE ITEMS (Fee Rcsolurinn 11-053 /s D' 7/l/l 11 FEE QTY/FEE MISC ITEMS
lI Plan Check Fee:
p! Supp/. PC Fee
I Plumb.61dech.10ec
j Permit Fee: . $390.00
Suppl. knsp Fee
Plumb.1,14ech.lElec
Pluwh.lrblech./FlecPerwit Fee:
Construction Tac:
Administrative 1'ee:
Work Without Permit? O Yes (F) No $0.00
i
Advanced Planning Fees•:
Travel Documentation Fees:
Strong Motion Fee: IBSF/SAIICR $1.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $392.50 $0.001' TOTAL FEE: $392.50
Revised: 07/01/2012