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12090177 I CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 20647 GARDENSIDE CIR CON'T'RAC'T'OR:BRADSHAW ROOFING INC PERMIT NO: 12090177 OWNER'S NAME: CHILI CHENG 1 AND YIN HSIN I 1821 S BASCONI AVE.I'\IB 160 DATE ISSUED:09/19/2012 OW'NER'S PHONE: 4083091256 CAM I'll ELL,CA 95008 PHONE NO:(408)246-9930 LICENSED CO\'RACfOR'S DECLARATION BUILDING PERMIT INFO: BL DC r ELECT I_ PLUMB r License Clas Lic.N MECH — RESIDENTIAL — COMMERCIAL Contractor . Date 1 hereby affirm that 1 nm licensed under the provisions of Chapter 9 JOB DESCRIPTION: REMOVE EXISTING WOOD SHAKE ROOF AND INSTALL (commencing with Section 7000)of Division 3 of the Business d Professions NEW Code and that my license is in full force and effect. COMPOSITION SHINGLES(AGED BARK)CLASS A 12 SOFT 1 hereby affirm under penalty of perjury one of the fallowing 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 die work for which this Sq.Ft Floor Area: Valuation:$6000 permit is issued. API'I.ICAN'f CFR'I'IFIGVI'ION APN Number:36232009.00 Occupancy Type: I certify that I have read this application and stale that the above information 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 above mentioned property far inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgnments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this 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. ��-'�7��7 �7 Signature DateA4al-1v Issued by: � �N .'/76� Date: v Cl OWNER-RUILDER DECLARATION RF:ROOFS: hereby affirm that 1 am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to my roofing material beiig installed.If a roof is the following two reasons: installed without first obtaining an in pec ion,I agree to remove all new materials for I,as owner of the and the u my employeess not ante with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business B Professions Code) Signature of Applicant: Date: I,as owner ofthe property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). AL1,ROOF COVERINGS TO BE CLASS"A"OR BETTER 1 hereby affirm under penally of perjury one of the following three declarations: I have and will maintain a Cerlificale of Consent to self-insure for Worker's IL\'/.,\RDOIIS DLVI'ERh\LS DISCLOSURE 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 permit is issued. California Ilealth S Safety Code.Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code.Chapter 9.12 and the Ilealth S Section 3700 of the Labor Code,for the performance of the work for which this Safety Code.Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the BayArea Area Air Quality Management District 1 still I certify that in the performance of the work for which this permit is issued,l shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ my person in my manner so as to become subject to the Worker's Ilealth S Safety Code.Sections 25505,25533,and 25534. Compensation laws a Worker's m after making this certificate of Labor Code, I I C A // become subject to the Worker's Compensmion provisions of the Lobar Code,1 must O ncr r i n ugenr forthwith comply with such provisions or this permit shall be deemed revoked Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGFNCY I certify that I have read this application and state that the above infommtion is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state lass relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgmcnts, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCUITECI"S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. 1 understand my plms shall be used as public records. Signature Date Licensed Professional ( 7-7 1 - – REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3223 • FAA(408)iii-3333•buildinG(a7cuoertino.oro PROJECT ADDRESS C APN a '_ O OWNERNAAIECV V 1 t 1 1 HON _ + K•n EI.ULL STREET ADDRES CR. STATE,ZIP 1 q C� O /J`Y I FAX CONTACT NAME PHONE _`EE-MAIL STREET ADDRESS CITY,STATE, ZIP FAX ❑O%VNER ❑ OWNER-BUILDER ❑ OUNERAGENTCOIfiRACIOR ❑CONTRACIORAGE.YT ❑ .-ACIOTECT ❑ENCdNEER ❑ DEVILOPER. ❑TENAM CONTRACT 11.14 LICEISENIJMBER LICEISETYPE BUS.LICA - om COMPANY'NAAE E.AU bef'bC c FAX , STREET ADDRESS C(Tl',STATE IP PHONE - :r n 4 ARCHITECTrENGINEER NAME LICENSE NUMBER BUS.LIC. COMPANY NAMEEd1AIL FAX STREET ADDRESS CRY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex ❑ Dluld-Famil V, ROOFAREA: VALUATIOtj: - �STRULTURE. ❑ Commercial ,, ,(BY^ EXISTINGROOFTYPE;�/OBUILT.UPROOF ❑ASPHALTSHINGLES a2'A'OODSH.AKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) .REMOVE/REPLACE 94B IF NO. /,I� PL"VOOD Y' ❑ PLl'WD 11OSB PRCH: .(2 ROOF CLASS a ❑ D B Re- 1iTHICKNESS ❑ 4S TV ❑ DX PROPOSED ROOF TYPE: ❑BUILT-UP ROOF 2 ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT d DESK ZON OF IVORK: .� By try signature below,I certify W each of rhe following: 1 am the property owner or authorized agent to act on the property owner's behalf. 1 have read this application and the information[have provided is correct. I have read the Description of Work and verify it is accurate. I agree m comply with all applicable local ordinances and slate laws relating to butl4m cons/uy�¢wn. 1 au/dprtz praenratives of Cuperuno co enter the above-identir)pd property for inspection purposes. Sigeamre ol'ApplicanJAgenr.�.ff//.(�L�-1�'t�.y%7l�/ Date: 7(a�h/ I�n1Z r✓ SUPPLEMENTAL INFORMATIONREQUIRED OFFICEUSEONLY _If building is associated with a Home Owners Association,provide letter PLAN CHECK TYPE ROUTING SLIP ofapproval from HOA. OVER-THEECOUNTER BUILDING PIAN RGVTEW Provide Planning approval to verity if there any restrictions. ❑ EXPRESS ❑ PL\NNING PLAY REVIEW _Provide copy,of Manufacturers Installation Specifications. ❑ Srtitp,� ❑ FIRE DEPT Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER: ' Raroojdpp 201 Ldoc revised 03!16//1 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION :21 ADDRESS: 20647 Gardenside Cir. DATE: 09/19/2012 REVIEWED BY: Sean A PN: BP#: 'VALUATION: $6,000 *PERI111T TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARYPENTAMATION USE: SFD or Duplex PERMITTYPE: 1SFDWLR00F WORK Remove existing wood shake roof and install new composition shingles (Aged Bark). SCOPE FEEID ROOFAREA s.f. 1REROOFFRES 1,200 Xlech. Plan Check Plumb.Plan Check Elec. Plan Check Mech. Permit ree: Plumb.Permit Fee: I Elec.Permit ree: Other Sleeh. /nvp. Other Plumb Insp. Other Elco /asp. J/ech.ht.y. ree: Phanh. hr.sp. Fee: /ileo Insp. rte: NOTE: This evi n ate noes not inclucde jeer due to other Departments(i.e. Planning, Public Works,.Fire,Sanitary Sewer District,School District,etc. . These jeav are baser/on rite prelintinan information mailable and are on/v an estinwte. Contact the De t or addn'l info. FEE ITEMS (Fee Resblulion 11-053 r_IL 71111 1) FEE QTY/FEE MISC ITEMS Plan Check ree: S)grpl. PC ree: Plumb./ddech./Elec Permit Fee: $180.00 Suppl. li-sp Fee Pluntb./d-lech./Elec P/umh./hblech./61ec Permit Fee: Construction Tar: Administrative Fee: Work Without Permit? O Yes Q No $0.00 Advanced Planting Fces: Travel Documentation Fees: Strove Motion Fec: IBSEISMICR $0.60 Select an Administrative Item Bldg Stds Commission Fee: IRCBSC $1.00 SUBTOTALS: $181.601 $0.001 TOTAL FEE: $181.60 Revised: 07/01/2012 can be scheduled. By my signing below, I certify each of the following is true: I am the property owner or authorized agent to act on the o. 1-1—tr t ,, ,tP eta t ar,t anrPe tr�rmmnly with the re-rnnf nnlicv stated above. I also understand that