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11090070 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11792 PINE BROOK LN CONTRACTOR:CASTILLO'S ROOFING PERMIT NO: 11090070 OWNER'S NAME: TIAN DINING AND SHI YAPING 1703 CATHAY DR DATE ISSUED:09/09/2011 O*VNER'S PHONE: 4087686709 SAN JOSE,CA 95122 PHONE NO:(408)251-3565 �. LICENSED CONTRACTOR'S DECLARATION q BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class 0 Lic.# 3� MECH RESIDENTIAL r COMMERCIAL r Contractor Date I hereby affirm at I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REROOF,SFDWL,15 SQ,TEAR OFF SHAKE AND REPLACE (commencing with Section 7000)of Division 3 of the Business&Professions WITH COMP SHINGLES,EXISTING SOLD SHEETING TO Code and that my license is in full force and effect. REMAIN I hereby affirm under penalty 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 Sq.Ft Floor Area: Valuation:$8500 permit is issued. APPLICANT CERTIFICATION APN Number:36655035.00 Occupancy Type: 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 to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, 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. /� C Signatur i Date � 7 /l Issued by:-� ''-� --�_.__--zDate: OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signature pplic - Date: I,as owner of the property,am exclusively contracting with licensed contractors to r` construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&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 Health& 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 b the Ba Area Air y y Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or authorized agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information 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 laws 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,judgments, Lender's Address ^ts,and expenses which may accrue against said City in consequence of the ting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION .,,.n all non-point source regulations per the Cupertino Municipal Code,Section 9.18• (� 1 understand my plans shall be used as public records. Signatt - Date ! All� Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: TraciC COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36655035 . 00 DATE ISSUED. . . . . . . : 09/09/2011 RECEIPT #. . . . . . . . . : BS000014721 REFERENCE ID # . . . : 11090070 SITE ADDRESS . . . . . : 11792 PINE BROOK LN SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : TIAN DINING AND SHI YAPING ADDRESS . . . . . . . . . . : 11792 PINE BROOK LN CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : CASTILLO ROOFING CONTRACTOR . . . . . . . : JOSE CASTILLO LIC # 25850 COMPANY . . . . . . . . . . : CASTILLO'S ROOFING ADDRESS . . . . . . . . . . : 1703 CATHAY DR CITY/STATE/ZIP . . . : SAN JOSE, CA 95122 TELEPHONE . . . . . . . . : (408) 251-3565 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 8, 500 . 00 1 .00 0 .00 1. 00 0 . 00 1BSEISMICR VALUATION 8, 500. 00 0 . 85 0. 00 0 . 85 0 . 00 1REROOFRES SQ FEET 15. 00 210 . 00 0. 00 210 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 211 .85 0 . 00 211 .85 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 409 .64 17310 --------------- TOTAL RECEIPT 409 .64 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 309 EXTERIOR LATH 311 SCRATCH COAT 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF C CITY OF CUPERTINO r `� FEE ESTIMATOR- BUILDING DIVISION ADDRESS: 11792 pinebrook In DATE: 09/09/2011 REVIEWED BY: bobs. APN: BP#: -VALUATION: 1$8,500 —� 'PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROOF USE: PERMIT TYPE: WORK tear off shake and replace with comp shingles. SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 1,500 NOTE. This estimate does not include fees due to other Depts(i.a Public Works,Sanitary Sewer District,School District,etc.). Thesefees are based on the prelindnary infor available and are only an estimate. Contact the De t or addh 7 info, FEE ITEMS (lee Resohition 11-053 Eff.' T'1,-'11, FEE QTY/FEE MISC ITEMS Permit Fee: $210.00 Work Without Permit? Q Yes Q No $0.00 Strom,Motion Fee: 1BSEISMICR $0.85 Select an Administrative Item Bid,Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $211.85 $0.00 TOTAL FEE: $211.85 Revised: 09/02/2011 1 REROOF PERMIT APPLICATION -- COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION \ 10300 TORRE AVENUE • CUPERTINO, CA 95014-3255 CUPERTlNQ (408)777-3228• FAX(408)777-3333 •building(a cupertino.org PROTECT ADDRESS I��[/� APN# �/� OWNER NAME /t n �'�l PHONE `_ /_ E-MAIL STREET ADDRESS Z I✓J�'J "1 ' ; _ rrr �� STATE,ZIP rhh 061 APPLICANT NAME �r--// /� S C PHONF ,r-. - E-MAIL STREET ADDRESS �� 11 G / ' CITY ❑ OWNER ❑ OWNER-BUILDER ❑ OWNERAGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCIiMCT ❑ENGINEER ❑ DEVELOPER ❑TE14ANT CONTRACTOR NAME `/ RQ� LICENSE NUMBER �,r LICENSE TYPE� BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS 13141_;_114 3�i CITY.STATE ZIPL5/" 7 j, �'/ t 0 ✓ ARCHITECT/ENGR=NVVME ALICENSE NUMBER BUS.LIC. COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE of SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATIO STRUCTURE: ❑ Commercial EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES 2.WoOD SHAKES ❑WOOD SHINGLES ❑OTHER.(SPECIFY) REMOVE/REPLACE ETG IF NO, PLYWOOD 13 %" ❑ PLYWD 13OSB PITCH ROOF 11NO #LAYERS: �� THICKNESS: 135/8" TYPE: ❑ CDX :12 CLASS: A PROPOSED ROOF TYPE: EDBUILT-UPROOF CJ ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK.- By ORKBy my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I 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 co coon. I authorize representatives of Cupertino tc enter the above-iden' ed prgp�,Fr for inspection purposes. Signature ofApplicant/Age Date: // SUPPLEMENTAL RMATION REQUIRED — — _If building is associated with a Home Owner's Association,provide letter ' s = _� - of approval from HOA. � 3— _Provide Planning approval to verify if there any restrictions. _Provide copy of Manufacturer's Installation Specifications. - 1 - � Provide signed copy of Cupertino's Tear-Off Policy. Reroof4pp_2011.doc revised 03/02/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C O P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: 11 7q2— Rylp 6r(yj'V— e PERMIT# - '/)C'-)—7 a OWNER'S NAME: ft I loer t-rA A PHONE# 35 GENERAL CONTRACTOR: s to l BUSINESS LICENSE # y' G ADDRESS: i 77cs ylCITY/ZIPCODE:S 51 2� *Our municipal code requires A businesses working in the city 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 SUBCONT CTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. C/ I am not using any subcontractors: ' OF 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 Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date