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11070071 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10982 WILKINSON AVE CONTRACTOR:PRINCIPLE ROOFING& PERMIT NO: 11070078 OWNER'S NAME: CHUANG SHIH-HSIEN AND SU-JAN L TRUS 10160 STERN AVE DATE ISSUED:07/13/2011 OWNER'S PHONE: 4082345580 CUPERTINO,CA 95014 PHONE NO:(408)898-7298 U LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r— ELECT I— PLUMB r License Class 1 C'XJ_ Lic.# MECH f— RESIDENTIAL f— COMMERCIAL� Contractor Date C?z/3/i/ I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REROOF,30 SQ REPLACE EXISTING WOOD SHAKE WITH (commencing with Section 7000)of Division 3 of the Business&Professions LIGHTWEIGHT METAL ROOF SYSTEM,CLASS A,1.5 LB/FT 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:$17500 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:35613053.00 Occupancy Type: APPLICANT CERTIFICATION 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 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 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. Issued by: _ - -'-- Date: l/ Signature Date 0,-)-/ 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 agree 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: Date: C11?-� 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 I 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,Sections 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 Owne thorized agent: become subject to the Worker's Compensation provisions of the Labor Code,I must Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I 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, `s,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 With 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 3 PERMIT RECEIPT OPERATOR: TraciC COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 35613053 . 00 DATE ISSUED. . . . . . . : 07/13/2011 RECEIPT #. . . . . . . . . : BS000014027 REFERENCE ID # . . . : 11070078 SITE ADDRESS . . . . . : 10982 WILKINSON AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : CHUANG SHIH-HSIEN AND SU-JAN L ADDRESS . . . . . . . . . . : 10982 WILKINSON AVE CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4700 RECEIVED FROM . . . . : DERECK LOI CONTRACTOR . . . . . . . : DERECK LOI LIC # 27564 COMPANY . . . . . . . . . . : PRINCIPLE ROOFING & ADDRESS . . . . . . . . . . : 10160 STERN AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 TELEPHONE . . . . . . . . : (408) 898-7298 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 17, 500 . 00 1 . 00 0 . 00 1 . 00 0 . 00 1BSEISMICR VALUATION 17, 500 . 00 1 .75 0 . 00 1 . 75 0 . 00 1REROOFRES SQ FEET 30 . 00 420 .00 0. 00 420. 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 422 . 75 0 . 00 422 . 75 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 422 . 75 097099 --------------- TOTAL RECEIPT 422 .75 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 CITY OF CUPERTINO y FEE ESTIMATOR-BUILDING DIVISION ADDRESS: 10982 wilkinson ave. DATE: 07/13/2011 REVIEWED BY: bobs. APN: -j1j (.p 13Q53 1BP#. 'VALUATION: 1$17,500 -� *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1 SFDWLROCF USE: _T_ PERMIT TYPE: WORK re lace exisitnq wood shake with lightweight metal roofs stem. SCOPE FEE ID ROOF AREA s.f. 1 REROOFFRES 3,000 F7 ...... F-1 _L_ Li I NOTE. Thesefees are based on the preliminary information available and are only an estimate. Contact the De t or addn'l info. FEE ITEMS (Fee Resolution 11-05; FEE QTY/FEE MISC ITEMS Permit Fee: $420.00 Work Without Permit? 0 Yes No $0.00 Stron;z Motion Fee: IBSEISMICR $1.75 Select an Administrative Item Bldp,Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $422.75 $0.00 TOTAL FEE: $422.75 Revised: 07/04/2011 Building Department City Of Cupertino IM 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: /C1z y✓;L/L t1€ PERMIT# �7 OWNER'S NAME: PHONE# C4 y —5-C.P6 GENERAL CONTRACTOR: BUSINESS LICENSE# 2 ADDRESS: 1, /V& CITY/ZIPCODE: *Our municipal code requires all businesses working in the city to have a City of Cupe tino 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. I am not using any subcontractors: - 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 LMREROOF PERMIT APPLICATION O� COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTIN4 (408)777-3228• FAX(408)777-3333• building a-cupertino.org PROJECT ADDRESSg j ��• , /- Y / APN# 3 S� ' 053 OWNER N S I H rl S I F, I/(/-N PHONE64 v�� 4 �fy E-MAIL STREET ADDRESS O� L 1 uG>J�� AVL CITY,STATE,ZIP Sb' a ` FAX APPLICANT NAME I ` �) PHONE / i G 17" � E MAII STREET ADDRESS �i�L L CITY,STATE,ZIP FAX ✓% � ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CDNTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NAME i LICENSE NUMBER LICENSE TYPE G BUS.LIC.# COMPANY NAME N E-MAIL FAX a'/. G / Gd STREET ADD S C STATE,ZIP P ONE ARCHI I rCT/ENGINEER NAME LICENSE NUN6ER 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 .3 U_/� / 7,-6 I EXISTING ROOF TYPE: BUILT-UP ROOF ❑ASPHALT SHINGLES OOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE YES IF NO, PLYWOOD ❑ %" ❑ PLYWD ❑ OSB PITCH: ROOF ❑ NO #LAYERS: THICKNESS: ❑ 5/8" TYPE: ❑ CDX 12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLESOTHER Krf_ ICC-ES REPORT# DESCRIPTION OF WORK: 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 buildin construction. I authorize representatives of Cupertino tc enter the above-identified property for inspection purposes. Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIREDoi=FlcE.usE a `."' _If building is associated with a Home Owner's Association,provide letter PN'caEc TmE RotLT1Na sLiP of approval from HOA. ETp R_T` courM" R ❑ B"�ua n>�ic iLAN REVIEW -R, Provide Planning approval to verify if there any restrictions. ❑'EXPRESS ❑ PLANNING _Pro 'de copy of Manufacturer's Installation Specifications. ❑ sTANDRD ❑ 'FIRE DEPT Provide signed copy of Cupertino's Tear-Off Policy. ❑ OTHER: ReroofApp_2011.doc revised 03/02/11