12100100 CITY OF CUPERTINO BUILDING PERMIT
BUI LDLNG ADDRESS: 19766 DRAKE DR CONI'RA(:FOR:BUCK'S ROOFING PERMIT NO: 12100100
OWNER'S NAME: YONG YANG 6853 W RIVERSIDE.WAY DATE. ISSUED: 10112/2012
OWNER'S PHONE: 4089374787 SAN JOSE,CA 95129 Pl IONE NO:(408)313-3429
LICF.NSED7 CON'PRAC`fOR'S DECLARATION JOB DESCRIPTION: RFSIDF.,N'I'IAI.0 COMMERCIAL
LI
License Class _ r Lic.4 RE-ROOF 27 SQUARES, REMOVE AND REPLACE 1/2 IN.
PLYWOOD OS13 CLASS A
Contractor rn Date �0 � /L
1 hereby affirm that I am licensed and the provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business&Professions
Code and that my license is in full force and effect.
hereby affirm under penally 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. Sq.F1 Floor Area: Valuation:SI1000
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for die perfommnce of floe work for which this APN Number:31632013.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify thin I have read[his application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.[agree to comply with all city and county ordinances and state laws relating WITHIN1 0 DAYS OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives ofthis city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAVM OM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupertino against l iabilities,judgments, /
costs,and expenses which may accrue against said Cit'in consequence of the /r
granting of this pemhit. Additionally,the applicant understands and will comply Issued by: awl Dale:
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
/ RE-ROOFS:
Signatur Dale' /4 Z All roofs shall be inspected prior many rooting material bcing installed.If a roof is
LZ: installed withom first obtaining an inspection,I agree to remove all new materials for
inspection.
❑ -R1111.DF.R DECLARATION
2
I hereby affirm that 1 am exempt from the Contractor's License Law for aha of Signature of Applicnv
the follmying two reasons: ALL ROnOF COMER V CS TO BE CLASS"A"OR BE"ITER
1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to ILVLARDOUS MATERIAI S DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Ilealth&3nfety CnJe.Sections 25505.25533,and 25534. twill
I hereby affirm under penalty ufperjury one of the following three maintain compliance with the Cupertino Municipal Cute,Chapler9.12 and(lie
declarations: Ilealth&Safety Code.Section 25532(x)should 1 store or handle hazardous
1 have and will maintain a Certificate of Consent to self-insure for Worker's material. Addilionally,should I use equipment or devices which emil hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Boy Area Air Quality Management District
performance of the work for whichrhis permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
1 have and will maintain Worker's Compensation Insurance,as provided for by the Ilealth&Safety Code.Sections 25505,25533,and 25534.
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized a r gp � Date:/G 7 /Z
permit is issued.
I certify that in the performance of die work for which this permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation laws of California. If,after making this certificate of exemption,I CONSTRIICI'ION LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm thin[here is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CER'rIFICA"1'10N Lender's Address
I certify that I have read this application and state that the above infommion is
correct.I agree to comply with all city and county ordinances mid state laws relining
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 Cit'of Cupertino against liabilities,judgments, ARCHITECf'S DECLARATION
costs,and expenses which may accrue against said Cit'in consequence of die I understand my plans shall be used as public records.
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18,
Signature Dme
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
C O P E RT I N O Telephone: 408-7.77-3228
Fax: 408-777-3333
CONTRACTOR / SUBCONTRACTOR LIST
JOB ADDRESS: tVzhk y2t2i/ze 721 PERMIT#
OWNER'S NAME: (,e_ PHONE # 416 3 3 L
GENERAL CONTRACTOR: ,c BUSINESS LICENSE #
ADDRESS: CITY/ZIPCODE: J?k �T7 1207
*Our municipal code requires all businesses A,orking in the cite to have a City of Cupertino business license..
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND-ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
1 am not using any subcontractors: 10/eZ//
Signature Date
Please check applicable subcontractors and complete 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
Painting/Wallpaper
Paving
Plastering
umbing
Roofing ,�
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
REROOF PERMIT APPLICATION n,
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 �1
CUPERTINO (408)777-3228• FAX(408)777-3333•buildingftcuoertino. W9
PROJECT ADDRESS/ / 1 / APN w
OWNER NAME �i a PHONE 3 9/ _ el? G-MAIL
STREET ADDRESS 7639 III tG✓ n /. CITU' ZIP /v / / ) FAX 1
CONTACT NAME (^TDI yn / a�Sl_aC-C PHONE 9d83133Yzq E-MAIL
STREETADD7 _�// LLL «i�i6" v\ CIT' STATETZI(P/ FAX /7
Cru ✓ Com.- k 44 3f/2
OWNER ❑ OwNEB-BUILDER ❑ OWNERAGEhT nn ❑ CONTRACTOR ❑COMlUCT00.AGENT ❑ ARCHITECT ❑[NGINFER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME /. f �I LICENSE ?II 'R LIC[ T1'P 9 BUS.LIC.M
COMPANY NAME �.1 vr1 E-AIAIL / m 16V r L, e -�/' [d.,.` FAX
STREET ADDRE;S � ' I, /J rte{ CITY,ST E,Z /I�f�,q PHONEARC I TECTIENGINEER NAME LICENSE NUMBER 7 -I BUS.LIC.0
COMPANY.NAME E-MAIL FAS
STREET ADDRESS CITY,STATE.ZIP PHONE
USE OF FD Or Duplex ❑ hlultl-Family ROOF AREA: VALUATION:
TU7
STRUCRE: ❑ Commercial � `I I I V V
EXISTING ROOF TYPE: ❑BUILT-UPROOF PHALT SHINGLES \\'DOD SHARES ❑WOODSHINGLES ❑OTHER(SPECIFY)
REMOVE[REPLACE RYES IF NO. PLYWOOD R" ❑ PLYWD OSB PITCH: ROOF
❑ tl AYERS' NICENESS' 11 51S" TYPE' ❑COX :12 CLASS A
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF VSKIALTSHINGLEs ❑\\'DOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT i
DESCRIPTION OF WORK: ,r � n -u/ O D 4-0 1 4 V /f NI&o
5nsrr9« 361 s! ie^-R'►'Ll
By my signature below,I cenify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. 1 have read this
application and the information 1 have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupenino to enter the above-Ude tifried/P,ropeIT for inspection purposes.
Signature ofApplicamlAge Date: /(7��-// Z
SUPPLL'NIIENTALV 1A-PION REQUIRED OFFICFuSEONLY
-
_If building is associated with a IIolnc Owners Association,provide letter PLAN CHECK1 YPE- RoUrtNC sEH,
of approval from I10A. ❑ OYER-THF}COU\TEN ❑ BuILDUNG PLAo'NEvICW,
_Provide Planning approval to Yerifi•if there any restrictions. ❑ EXPRESS ❑ PLANNING PLAs.RebiEW
Provide copy of Manufacturer's Installation Specifications. ❑ STANDARD ❑ FIRE DEPT
Provide signed copy of Cupenino's Tear-Off Policy. ❑ oiHER:
Reroof 1pp_2011.cloc revised 03/16/11
REROOF TEAR-OFF POLICY
" COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
CUPERTINO 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
(408)77777-3228• FAX(4088J�t)777-3333• buildinoPcuoertino.oro
PROJECT ADDRESS %Q"1/ � O eeQb ��///1- I APN 0
OWNER NAME / /G u // Orta'` P"HSO O Ath'J r�� E-MAIL
STREET ADDRESS �/ c'TM/��TE.Zw /�/7Al 1 ��O/ I FAX
CONTRACTOR NAAffi-rtO/�\ / _„r, LIC F c'vE Y- LICE` BUS.LIC.d
COWAN NANIE •'ftLs ( /EMAIL11 ✓L/4rf� �-fAt/ FAX
STREET ADDRESS((/��V�t l3 w.2;kl/ET t GG CrrY A JZIPI . PHO
I UNDERSTAND AND AGREE TO THE FOLLOWING:
I. The re-roof project shall comply with all applicable provisions of the 2010 California Codes.
2. An inspection request can be scheduled up to one business day before the requested inspection date.
Please call (408) 777-3228 from 7:30-3:30pm (Mon-Thurs) or 7:30-2:30pin (Friday) to schedule
inspection. For Tear-Off and Nailing Inspections, you must also call on the day of the inspection only
after that phase of the work is completed. The building inspector will be available within one hour.
Final Inspections will be given a two hour windoxv.
3. Tear-Off Inspection is required. Any and all dry-rotted wood shall be replaced prior to this inspection.
Unless new plywood roof sheathing is proposed throughout, all the nails/fasteners shall be either
completely knocked-down or removed prior to this inspection.
4. If plywood is installed, a plywood Nailing Inspection is required.
5. Roofing shall not be applied without first obtaining all prior inspection and written approvals from the
building inspector. Any roofing which is applied without first obtaining an approved inspection will
require the removal of all new material down to the sheathing so a proper inspection can be performed.
6. A Final Inspection and approval shall be obtained from the building inspector when the re-roofing is
completed. To receive a final sign-off, the following items will be verified:
a. Flat roofs shall have a minimum of'A" per foot of slope and demonstrate there is no ponding.
b. Listings from approved testing agencies for all pre-manufactured products used shall be
available on-site to review at the time of the inspection. ,
c. Proper spark arrestor installation, vents painted, gutter/downspouts installed, debris removed.
7. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete, you will be
charged a re-inspection fee. The re-inspection fee shall be paid before another inspection can be
scheduled.
By my signing below, 1 certify each of the following is true: 1 am the property owner or authorized agent to act on the
property owner's behalf. I understand and agree to comply with the re-roof policy stated above. 1 also understand that
smoke detectors and carbon monoxide detectors are required to be installed in accordance with Sections R314 and R.315 of
the 2010 California Residential Code.
Signature of Applicant/Agent Date: /Z
RerooJPo1icy_2012.doc revised 10/7/13
2 oo��
EM
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228 • FAX(408)777-3333 • buildinG(a)cuoertino.om Net
\
/ PROJECT'ADDRESS �I APN a h - �ia_ Ne I
OWNERNAME p„ � ✓/ ' ONE E-MAIL
STREET ADDRESS - -"� SLATEZIP Tz�1 CY FAX
2 TY
APPUCAN'T NAME ` �L + /S }[ jJE EMAM ,
STREET ADD 5 CITY(,jST�ATE, ZIP FAX
a/% G.a-cl)oI
❑OWNER ❑ OWNER-BUN-DEA ❑ OWNFAAGENT 4l�CONiAACIOR ❑CDNrxA=R AGEn7 ❑ ARCHnECr ❑£NGM<_TR ❑ DEVfl.OPER ❑TENANT
COMRACI'OR-j'AME UCENSE NUMB LICENSE]�'P BUS.UC.0
/465,7
COMPANY N X�G iT/ /G E-MAT. /f FAX
lmee—
5 EF/.�DRFSS v , /G T"� CRY,SFA']E, /� G� PHONE ^, `,
ARCHRECTIENGINEER NAME YI-" UCEME NtD,1B I BUS.lic..Jp C JY
COMPANY NAME E-MAIL FAX
STREET ADDRESS_ CITY,STATE,ZIP I PHONE
/
USE OF 6d'SFD or Duple, ❑ Muhi-Family ROOF AREA: vALUA710M
STRUCTURE: ❑ Commercial ?,7-09aOd
EXISTNO ROOF TYPE: ❑BUILT-UP ROOF ASPHALT SFBTIGIM ❑WOOD SHAKES ❑WOOD SHING E ❑0'HI R(SPECIFY)
A.MOVE/RFPI.ACE YES' U,NO. PLYWOOD ❑ K" ❑ PLYWD ❑ OSB PITCH RfIOF
❑ N q A / ❑ SB" E' ❑ X •)2 A
PROPOSEDROOF TYPE: ❑BIBLT-UP ROOF QASPHALT SHBdm FS ❑WOOD SHARES ❑WOOD SHINGLES �❑OTHER ICC-FS REPORT b
DESCRIPTION OF WORK
/�-'- vA�Sfz�� ,�r.>i •,2 �� sof!'
By my signature below,I certify to each of the following: I am the property owner or authorized agent m act on the property owner's behalf. I have read this
application and the information I have provided is correct. 1 have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to building construction. I authorize representatives of Cupertino tc enter the above-idendfic/Q�property for inspection purposes.
Signature of Applicant/Agent 1�� Date: 2—
SUPPLEMENTAL
SUPPLEMENTAL INFORMATION REQUIRED
If building is associated with a Home Owner's Association,provide letter ''�PLAI:;ct>Ecr,zY-PI%"zww��o[mNecsLTr
of approval from HOA. 'ex=T11 1 PIJAN'RE 1
Provide Planningapproval to verify if there an restrictions. �
PP fY Y rt .Jtt ss`�Ss "" PuF`NNINcal„si�-aBv %"F -
_Provide copy of ManufactuTer's Installation Specifications. xpr'"` 11 Ile
G < 1
rovide signed copy of Cupetino's Tear-Off Policy.
ReroofApp_?011.doc revised 03/02111