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11080012
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 18836 LOREE AVE CONTRACTOR:CD ROOFING PERMIT NO: 11080012 OWNER'S NAME: WANG JIN LING 2909 WILBUR AVE DATE ISSUED:08/01/2011 " "NER'S PHONE: 4086238225 SAN JOSE,CA 95127 PHONE NO:(408)898-6605 CV LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT r PLUMB r License Class MECH RESIDENTIAL COMMERCIAL Contractor //��,� � Date 7_ < <-- Z eU V v I hereby affirm�h I licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAR OFF EXISTING ROOF&REPLACE WITH (commencing with Section 7000)of Division 3 of the Business&Professions TORCH ON TYPE ROOF CLASS A 20SQFT Code and that my license is in full force and effect. 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 Sq.Ft Floor Area: Valuation:$5500 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:37515019.00 Occupancy Type: APPLICANT CERTIFICATION 1 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAY ROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source re ati a rtino Municipal Code,Section _ 9.18. Issued by: I t Date: Signature Date r \ 2 l OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection I agrey to remove all new materials for the following two reasons: inspection. I,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, Signature of Applicant: 1 r Date: t f Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1 hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sect' ns 25505,25533,and 25534. 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 Owner or a�' ed become subject to the Worker's Compensation provisions of the Labor Code,I must Date: \1 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION 1 hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address indemnify and keep harmless the City of Cupertino against liabilities,judgments, -ts,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION .ting of this permit.Additionally,the applicant understands and will comply ..ith all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 3 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 37515019 . 00 DATE ISSUED. . . . . . . : 08/01/2011 RECEIPT #. . . . . . . . . : BS000014269 REFERENCE ID # . . . : 11080012 SITE ADDRESS . . . . . : 18836 LOREE AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : WANG JIN LING ADDRESS . . . . . . . . . . : 18836 LOREE AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : CHARLIE DUONG CONTRACTOR . . . . . . . : CHARLIE DUONG LIC # 28245 COMPANY . . . . . . . . . . : CD ROOFING ADDRESS 2909 WILBUR AVE CITY/STATE/ZIP . . . : SAN JOSE, CA 95127 TELEPHONE . . . . . . . . : (408) 898-6605 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 5, 500 .00 1. 00 0. 00 1. 00 0. 00 1BSEISMICR VALUATION 5, 500 .00 0. 55 0. 00 0 .55 0. 00 1REROOFRES SQ FEET 20 . 00 280. 00 0. 00 280. 00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 281.55 0 . 00 281 .55 0. 00 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 ( I � U0' -2- REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION Lis 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 (408)777-3228• FAX(408)777-3333 • building(d)cupertino.org CUPERTINO PROJECT AD15?D S 'AL3�6 /5 D /� OWNER NAt� . PRONE RESS _ CITY, STATE,ZIP C FAX STREET ADD APPLICANT NAME PHONE E-MAIL \ 0\,D STREET ADDRESS CITY,STATE, ZIP FAX CD �Wq ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT 4/CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGWEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME LICENSE NUMBER LICENSE TYPE BUS.LIC.# z 4 -- COMPANY N \ E-MAIL FAX (DRESS _ CITY,STATE,ZIP PHONE -\ © �9\� V C_ ' _,t S k- 629 6G 0 ARCHTTECT/ENGINEER NAME LICENSE NUMBER BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE of ❑ SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: STRUCTURE: ❑ Commercial 1 0 EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE ❑YES IF NO, PLYWOOD ❑ K., ❑ PLYWD ❑ OSB PITCH ROOF ❑ NO #LA THICKNESS: ❑ 5/8" TYPE: ❑ CDX 12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑O= ICC-ES REPORT# DESCRIPTION OF WORK: R e 0 ff By 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 construction. I authorize.representatives of Cupertino to enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED �� If building is associated with a Home Owner's Association,provide letter N � - auTu� sLlr of approval from HOA. xattttl � 0 xBt�nv�'� _xEvz>;uy— y� Provide Planning approval to verify if there any restrictions. Sg .... _Provide copy of Manufacturer's Installation Specifications. RE — �` - _Provide signed copy of Cupertino's Tear-Off Policy. ReroofApp_201 1.doc revised 03/02/11 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: V C�� PERMIT# OWNER'S NAME: PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: *Our municipal code requires all 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 SUBCONTR ORS BTAINED A CITY OF CUPERTINO BUSINESS LICENSE. ' I am not using any subcontractors: — ign re Date Please check applicable subcontractors and complete the following information: V 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