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09120006CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22045 CREEKSIDE CT 1' "NER'S NAME: MO-YUN FONG u ,vNER'S PHONE: 6503876530 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions 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. 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 permit is issued. 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 upon the above mentioned property for inspection purposes. (We) agree to save indemnify and keep harmless the City of Cupertino against liabilities, judgments, 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 9.18. Sature Date ❑ OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 1, 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, Business & Professions Code) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). 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 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 permit is issued. I certify that in the performance of the work for which this permit is issued, I shall 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 become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. 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 `he above mentioned property for inspection purposes. (We) agree to save L nify and keep harmless the City of Cupertino against liabilities, judgments, 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 9.18. Signature Date CONTRACTOR: BILL HAMILTON ROOFING PERMIT NO: 09120006 INC 740 CAMDEN AVE STE E DATE ISSUED: 12/01/2009 CAMPBELL, CA 95008 PHONE NO: (408)687-2540 BUILDING PERMIT INFO: BLDG ELECT I— PLUMB MECH r RESIDENTIAL f- COMMERCIAL f— JOB DESCRIPTION: RE -ROOF TEAR OFF EXISTING SHAKE ROOF AND INSTALL NEW 50 YR COMPOSITION SHINGLES W/RADIANT BARRIER.OSB CLASS A 20SQ Sq. Ft Floor Area: I Valuation: $8228 APN Number: 32639041.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAY FROM LAS CALLED INSPECTION. Issued by: /~" Z / 'Q / Date: RE -ROOFS: All roofs shall be inspected prior to any roofing material being installed. If a roof is installed without first obtaining an inspection, I agree to remove all new materials for inspection. 17 ,n A Signaturp o Applicant:�� Date ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air 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 Walth & Safety CodyBections 25505, 255 4, and 25534. Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professional CITY OF CUPERTINO ' REROOF CUPEkTINO PERMIT APPLICATION APN # , • � I Date: Building Address: QW45 CXce,,kS1GU C4. I Owner's Name: Mrs y '-Iu h HOA: Yes L No e1C I Contractor: gill Wa ni 1 fo .140, CCm G% h CCI. m P ke l 1 e' Cupertino Business License #: fi0n� If yes, provide letter from HOA Yt k0 p pi rig , _7—_+jG A venue , 5,4i k 17 gS0b,f :9- 3115 Type of Roof Covering: Existing: ❑ Built -Up Roof ❑ Asphalt Shingles 9"' Wood Shakes ❑ Wood Shingles ❑ Other (Specify) Number of existing coverings *1 To be Removed ,1a sq a s� Job Description: ' f ezw q� oyi',_5 ,, n � ,5-o l r L4-,.,qo si h -on Residential Phone #: ( 50_38_f _6X30 Phone #: qb� - 3-M _ 13b j Fax#: Liog - 31_fq _/30(0 Contractor License #: Proposed: ❑ Built -Up roof Asphalt Shingles ❑ Wood Shakes ❑ Wood Shingles ❑ Provide I.C.C.E.S. Report # ❑ Provide Mfgr. Installation Specs. C2�1'� S r17� Ct�ttG� i ✓15 � l� rtlt � Commercial Green Building: Please complete relevant porl ion of the Green Building Checklist & attach it to the application or if applicable, include in plan set & the sheet index. Valuation: Confirmed with Planning Dept. if there are any restrictions: ❑ I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy: Signature Revised 02/05/09 CITY OF C UPERTINO ' I --I RE1�DOF CITY OF CUPEkTINO FEE SCHEDULE Number of Squares Fee ID Fee Description Fee Group Permit Type 1REROOFCOM Re -roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B 1RER00FRES Re -roof Re:,,idential B 1SFDWLR00F 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES l 1BSEISMICRE Seismic Residential B 1 REROOFMRES Re -roof Multi -Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards Commission Fee B ALL PERMIT TYPES 1BSEISMICRE Seismic Residential B 1BUSLIC Business L:.cense B Community Development Department Building Division City of Cupertino 10300 Tone 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 a€;ree to comply with 2007 IBC Standards and manufacturers specifications on :-e-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 cin be scheduled. IMPORTANT: 1. Flat roofs must have a minimum of V, " 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 comply with the abo•,re stated policy on re -roofing. ftHomeowner's Name: Job Site Address: 2201 Creek)/ 6L C Roofing Company Name: am i V i �% ✓C. j L ✓� Applicant's Signature: hloo--.1 Date: C/ Greg Casteel Building Official Reviied 07/30/08