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11040030
CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11546 FALLCREEK SPRIN CT CONTRACTOR:CASTILLO'S ROOFING PERMIT NO: 11040030 OWNER'S NAME: HUANG DAR-JEN 1703 CATHAY DR DATE ISSUED:04/05/2011 OWNER'S PHONE: 4082513565 SAN JOSE,CA 95122 PHONE NO:(408)251-3565 400 G /LIICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT I— PLUMB License Class (� Lic.# // MECH RESIDENTIAL COMMERCIAL Contrac � Date ,.S I hereby affirm t at I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAROFF SHAKES,INSTALL 30LB FELT, (commencing with Section 7000)of Division 3 of the Business&Professions INSTALL GAF GRAND CANYON COMP SOLID ROOF SHEATING TO Code and that my license is in full force and effect. 1�� REMAIN CLASS A 15SQ 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 perfonnance 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 permit is issued. Sq.Ft Floor Area: Valuation:$6800 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:36651024.00 Occupancy Type: 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 indemnify and keep harmless the City of Cupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. CSigtta , Date 111Issued b �. � ' Date: 1 C OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is I,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to Signatu e f Ap i Date: construct the project(Sec.7044,Business&Professions Code). If I hereby affirm under penalty of perjury one of the following three ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,as provided for by California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Additionally,should I 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 not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Health&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions ofthe Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. Owner orized a n l Date: APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I hereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, Cr and expenses which may accrue against said City in consequence of the Lender's Address g of this permit.Additionally,the applicant understands and will comply wig..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 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36651024 . 00 DATE ISSUED. . . . . . . : 04/05/2011 RECEIPT #. . . . . . . . . : BS000013097 REFERENCE ID # . . . : 11040030 SITE ADDRESS . . . . . : 11546 FALLCREEK SPRIN CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : HUANG DAR-JEN ADDRESS . . . . . . . . . . : 11546 FALLCREEK SPRING CT CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-5118 RECEIVED FROM . . . . : CASTILLO'S 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 0 . 00 1.00 0. 00 1.00 0. 00 1BSEISMICR VALUATION 0 .00 0.50 0. 00 0.50 0. 00 1REROOFRES SQ FEET 15 .00 195. 00 0. 00 195.00 0. 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 196.50 0.00 196.50 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 196.50 #17001 --------------- TOTAL RECEIPT 196 .50 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 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: S a( (C-t-e k- ERMIT# —30 OWNER'S NAME: PHONE# - GENERAL CONTRACTOR: p BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: :7 *Our municipal code requires all businesses orking in the city to have a City of Cupertino usiness license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUB ONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 4L,511 - A9z:t_- I am not using any sub r Signature Date Please check applicable subcontractors d 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 REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333• building(cDcupertino.org PROJECT ADDRESS 1 51�(� OWNER NAME � L � � �( ��, P NE /`, � � E-MAIL STREET ADDRESS J ` CITY, STATE,ZIP FAX l APPLICANT NAME PHONE E-MAIL STREET ADDRESS �- ITY,STATE, ZIP ❑ OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑ TENANT CONTRACTOR NAMECiI ' AQ)S i LICENSE NUMBER 1 LICENSE TYPE BUS.LIC.# COMPANY NAME S; E-MAIL _f FAX STREET ADDRESS , ^�7� (�t , ^ CITY,ST CA qS 1o(J`9 PHONE J 2 ARCHITECT/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: [I Commercial 5 -�� Le �L v U EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES WCOOD�SHAKES C3 WOOD SHINGLES El OTHER(SPECIFY) REMOVE/REPLACE YES IF NO, PLYWOOD a<, LJ PLYWD Z`0 B PITCH: ROOF ❑NO #LAYERS: ', THICKNESS: 135/8" TYPE: 11CDX '12 CLASS: A PROPOSED ROOF TYPE: ❑BEJUILT-UP ROOF ASPHALT SHINGLES 11 WOOD SHAKES 13 WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK: r, I l � �s �s -Q 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 gree to comply with all applicable local ordinances and state laws relating to building AnMction. I authorize representatives of Cupertino tc enter the above-i tifi d prop ;for inspection purposes. Signature of Applicant/Age — Date: SUPPLEMENTAL INFO TION REQUIRED _If building is associated with a Home Owner's Association,provide letter s `peri t? To s of approval from HOA. ov>x TIM,cmm x IIIc aIw xEi�Ew A _Provide Planning approval to verify If there any restrictions. C� ExFx'ESS � � Prr1NNINGPL.4NREVIEW Provide copy of Manufacturer's Installation Specifications. sTANDxD © >TRn>PT Provide signed copy of Cupertino's Tear-Off Policy. ' �oTaF � ReroofApp_2011.doc revised 03/02/11