09100117 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 21571 COLUMBUS AVE CONTRACTOR:R E ROOFING& PERMIT NO:09100117
CONSTRUCTION INC
O"'NER'S NAME: YING-YING HSU 15230 CLYDELLE AVE DATE ISSUED: 10/20/2009
G_iER'S PHONE: 4082552236 SAN JOSE,CA 95032 PHONE NO:(408)626-9320
Vf�LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT I- PLUMB
License Class v Lic.# 7 2_7�
�) � U MECH I- RESIDENTIALr COMMERCIAL
tract
Co oi Date
1 here y affirm that I am_liEensed u e rovisions of Chapter 9 JOB DESCRIPTION:RE-ROOF REMOVE EXISTING I LAYER OF
(commencing with Section 7000)of Division 3 o Business&Professions WOOD SHAKE,
Code and that my license is in full force and effect. INSTALL NEW 1/2"CDX,30#FELT AND"LIFETIME"
PRESIDENTIAL COMP CLASS A 21 SQ
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.
1 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:$9000
permit is issued.
APPLICANT CERTIFICATION APN Number:35618027.00 Occupancy Type:
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
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- e regu a s pert Cupertino Mgnicipal ode,S tion
9.18.
�(� 2� ULj Issued Datew,� u tet`
Sig-^gture to i /
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of Allfs shall e`' ected prior to any roofing material being installed.If a roof is
the following two reasons: installed out first ob 'tag kection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensatti6h, ins p tom:— t
will do the work,and the stricture is not intended or offered for sale(Sec.7044,! � `
Business&Professions Code) Signature of)Apli a DI: Zd
1,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
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 1 store or handle hazardous material.
permit is issued. Additionally,should 1 use equipment or devices which emit hazardous air
I certify that in the performance of the work for which this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will
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 Workey� -" ealth&Safety Code,..Se.ctions 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of ex�cfiption,1 become subject to the Worker's Compensation provisions of the Labo#Code,I must6��
e
forthwith comply with such provisions or this permit shall be deemed revoked. Date: 4 (�
APPLICANT CERTIFICATION
CONSTRUCTION L&bING AGENCY
I certify that 1 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
V he above mentioned property for inspection purposes.(We)agree to save
is .rify and keep harmless the City of Cupertino against liabilities,judgments, 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
with all non-point source regulations per the Cupertino Municipal Code,Section ARCHITECT'S DECLARATION
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 6 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35618027 . 00
DATE ISSUED. . . . . . . : 10/20/2009
RECEIPT #. . . . . . . . . BS000008965
REFERENCE ID # . . . : 09100117
SITE ADDRESS . . . . . : 21571 COLUMBUS AVE
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER YING-YING HSU
ADDRESS 21571 COLUMBUS AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4710
RECEIVED FROM . . . . : R E ROOFING & CONST
CONTRACTOR . . . . . . . : PROCTOR, PAUL LIC # 20615
COMPANY . . . . . . . . . . : R E ROOFING & CONSTRUCTION INC
ADDRESS 15230 CLYDELLE AVE
CITY/STATE/ZIP . . . : SAN JOSE, CA 95032
TELEPHONE (408) 626-9320
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 9, 000. 00 1. 00 0 . 00 1. 00 0 . 00
1BSEISMICR VALUATION 9, 000. 00 0 . 90 0 .00 0. 90 0 . 00
1REROOFRES SQ FEET 21. 00 273 . 00 0 .00 273 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 274 . 90 0. 00 274 . 90 0 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
0 /00I7
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION
APN # 2 ,, L 7.� U Date:
Q,2 01
Building Address: 61
Owner's Name: f I� _ �1 Itif(� j Phone#:
HOA: Yes ❑ No If es, provide letter from HOA �� Zc�
Contractor: Phone#:
U- �2%-932:D� C ,
Fax #: - 2� -
�0 7
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings �_ ❑ Provide I.C.C.E.S. Report #
To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: � N, 1 01Y)9 SM Alit,,
Residential Commercial ❑
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, i clude in plan set & the sheet index.
Valuation: 9( b�o ��NJ �
t l I�
I II ve Read, Uxader::jand and Will Comply with Cupertino's Tear-Off Policy:
L-�_.
Signature
Revised 02/05/09
CITY OF CUPERTINO
REROOF
CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICO Seismic Commercial B
Z r 1REROOFRES Re-roof Residential B 1SFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
' Commission Fee
1BSEISMICRE Seismic Residential B
1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
1BSEISMICRE Seismic Residential B
1 BUSLIC Business License B
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 2007 IBC Standards
and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino
municipal code 16.04.080.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the building inspector. A final inspection and
approval shall be obtained from the building inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to any roofing installation.
4. To receive a final sign off from the City,the following steps are
required:
1) Pre-inspection and/or tear off approval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed, a plywood nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of 1/ "per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O.report is required to be on the job site at the time on inspection.
I understand and will compl with the above statgd policy on re-roofing.
Homeowner's Name:
Job Site Address: U1 M R)IAAL/c,
Roofing Comp e: U��t �► ISIS '�'Z� 0�` , G
I
Applicant's Sika %F Date:
Greg Casteel
Building Official
Revised 07/30/08
- Community Development
' 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
.:UPEkTINO
Building Department
JOB ADDRESS: PERMIT#
�v1 7
OWNER'S NAME: N — t,}r. PHONE #
GENERAL CONTRACTOR: G FAX# &- -6 -716 1
I am not using any subcontrators:
- ----� e 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
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date