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09080407CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 21549 EDWARD WAY OWNER'S NAME: TONG DEANNE L AND GEORGE L ER'S PHONE: 4082521357 r LICENSED CONTRACTOR'S DECLARATION .cense Clas11 Li # ` " Date � n � ontractor hereby affirm that a licensed u er the provisions of Cha ter :ommencing with Section 7000) of Division 3 of the Business & Professions .ode and that my license is in full force and effect. CONTRACTOR: JIM KRAUSE ROOFING I PERMIT NO: 09080407 2310 DIANA AVE DATE ISSUED: 08/31/2009 MORGAN HILL, CA 95037 1 PHONE NO: (408)779-0704 BUILDING PERMIT INFO: BLDG ELECT T_ PLUMB MECH f— RESIDENTIAL f— COMMERCIAL J DB DESCRIPTION: RE -ROOF TO EXISTING ROOF; INSTALL 30LB FELT & 50 y R COMP SHINGLES CLASS A, 33SQ hereby affirm under penalty of perjury one of the following two declarations: have and will maintain a certificate of consent to self -insure for Worker's 'ompensation, as provided for by Section 3700 of the Labor Code, for the erformance of the work for which this permit is issued. Valuation: $12000 have and will maintain Worker's Compensation Insurance, as provided for by c q, Ft Floor Area: ection 3700 of the Labor Code, for the performance of the work for which this iermit is issued. i►PN Number: 35619003.00 Occupancy Type: APPLICANT CERTIFICATION certify that I have read this application and state that the above information is :orrect. I agree to comply with all city and county ordinances and state laws relating o building construction, and hereby authorize representatives of this city to enter PERMIT EXPIRES IF WORK IS NOT STARTED zpon the above mentioned property for inspection purposes. (We) agree to save WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities, judgments, ostsand expenses which may aearue agai t said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting , of this permit. A,ddiiio ly, t plicant understands and will comply with all non ' oint s e r ti the Cupertino Municipal Code, Section 9.18. Signature Date OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the stricture 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. 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. 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 upon the above mentioned property for inspection purposes. (We) agree to save nify and keep harmless the City of Cupertino against liabilities, judgments, c. , 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 Issued by Date: RE -ROOFS: All roofs shall be inspected prior to any r9ofing tenial being installed. If a roof is installed without first obtaining an insp o> ree to remove all new materials for inspection. Signature of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I 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 Health & Safety" : Sections 05, 25533, and 25534. Own nt: / �� 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 CUPEkT1NO APN # 3 _,:;> QP Building Address: Owner's Name: (--7 HOA: Yes U No Contractor: 1,V1_ 09 0� OLI 0-7 CITY OF CUPERTINO REROOF PERMIT APPLICATION 00-�?, L)L-> [] If yes, provide lettzr from HOA Cupertino Business License #: �/ `f ( `� Type of R3of Covering: uate: Phone #: Phone #: 4c,S�- 7 Fax # Contractor License #: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ��,�t t.; ❑ Other (Specify) Other (Specify) � .�n,(n� ❑ provide I.C.C.E.S. Report # Number of existing coverings &'To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: T _-) _ , )A _ r-, � � D Residential[' Commercial Green Building: Please complete relevant portion of the Green Building Checklist & attach it to the application or if _applicable, include in plan set & the sheet inclex. Valuation - Confirmed with Planning Dept. if there are any restrictions: I Have Read, Unders ill Comply with Cupertino's Tear -Off Policy: Signature Revised 02/05/09 CITY OF CUPERTINO RER00F CUPEkTINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1 REROOFCOM Re -roof Ccmmercial B 1COMMLROOF 1BCBSC Cal Bldg Standards ---B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B 1 REROOFRES Re -roof Re 3idential B 1 SFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commissio z Fee 1 BSEISMICRE Seismic Re;;idential B 1 REROOFMRES Re -roof Multi -Family B 1MFDWLROOF 1BCBSC Cal Bldg St;jndards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1 BUSLIC I 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 appb ed 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 app; -oval. 2) In -progress inspection approval. 3) Final inspection approval. a) Spark arrester installation. 5. If plywood is installed, a plywood nai. 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 Raid before another inspection car 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 -he job site at the time on inspection. I understand and will comply with the above stated policy on re -roofing. Homeowner's Name: Job Site Address: Roofing Company Name: �' ,�� ; ,{x(71iv- i Applicant's Signature: Date: - Greg Casteel Building Official Revised 07/30/08 Community Development 3f 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 CITY OF Fax (408) 777-3333 �UPEKTINO Building Department I am not using any subcontractors: S ignature Date Please check applicable subcontractors and corr mete the following i ,fn -, ifjn„- JOB ADDRESS: PERMIT # BUSINESS NAME Y BUSINESS LICENSE # Cabinets & Millwork OWNER'S NAME: � O -e4, PHONE # 3 -- • GENERAL CONTRACTOR: FAX # I am not using any subcontractors: S ignature Date Please check applicable subcontractors and corr mete the following i ,fn -, ifjn„- er ontractor Signature Date SUBCONTRACTOR BUSINESS NAME Y 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 er ontractor Signature Date