10080223CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7536 DONEGAL DR
OWNER'S NAME: WILSON LIU
NER'S PHONE: 4084463024
❑ LICENSED CONTRACTOR'S DECLARATION
License Class 0— 3 / Lic. # �+ Z& l0 F
Contractor he7`U!'I fWA1224Date Qd- 3/ — /fJ
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.
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.
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.
Signature Date oJ` — 3% /C)
L. 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 structure is not intended or offered for sale (Sec.7044,
Business & Professions Code)
I, 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
nnify and keep harmless the City of Cupertino against liabilities, judgments,
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
19.18.
Signature Date
CONTPACTOR: SHELTON ROOFING PERMIT NO: 10080223
1988 Lf GHORN ST DATE ISSUED: 08/31/2010
MOUNTAIN VIEW, CA 94043 PHONE NO: (650)961-7699
BUILDING PERMIT INFO: BLDG ELECT PLUMB
MECH F RESIDENTIAL r COMMERCIAL F
JOB DESCRIPTION: RE -ROOF TEAR OFF OLD SHAKE ROOF REPLACE ANY
DRY
ROT. INSTALL NEW 40YR COMPOSITION ROOFING CLASS A
38SQ
Sq. Ft Door Area:
APN N ember: 36616056.00
Valuation: $18881
Occupancy Type:
PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
180 DAYS FROM LAST CALLED INSPECTION.
Issued by;---' Date:
RE -ROOFS:
All roo s shall be inspected prior to any roofing material being installed. If a roof is
installe. I without first obtaining an inspection, I agree to remove all new materials for
inspect on.
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
Califoi nia 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.
Additi ionally, should I use equipment or devices which emit hazardous air
contandnants as defined by the Bay Area Air Quality Management District I will
mainta in compliance with the Cupertino Municipal Code, Chapter 9.12 and the
Health & Safety Code, Sections 25505, 25533, and 25534.
,qr uth ized a e�
/ a 43ate;�
CONSTRUCTION LENDING AGENCY
I hereb y affirm that there is a construction lending agency for the performance of work's
for wh ch this permit is issued (Sec. 3097, Civ C.)
Lende -'s Name
Lende ^'s Address
ARCHITECT'S DECLARATION
I unde stand my plans shall be used as public records.
Licem ed Professional
3 ITEMS OF 3
CITY OF CUPEFTINO
PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 3661605(.00
DATE ISSUED.......: 08/31/2010
RECEIPT #......... BS000011337
REFERENCE ID # 1008022:,
SITE ADDRESS .....: 7536 DONEGAL DR
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA ......
OWNER WILSON :SIU
ADDRESS ..........: 7536 DONEGAL DR
CITY/STATE/ZIP CUPERTINO, CA 95014
OPERATOR: patg
COPY # : 1
RECEIVED FROM ....: SHELTON ROOFING CO
CONTRACTOR WRAY, RICHARD LIC # 20755
COMPANY SHELTON ROOFING
ADDRESS 1988 LEJHORN ST
CITY/STATE/ZIP ...: MOUNTAI>T VIEW, CA 94043
TELEPHONE (650)961-7699
FEE ID UNIT
QUANTITY
AMOUNT
PD -TO -DT
--------
THIS REC
NEW BAL
-----------------------
1BCBSC VALUATION
----------
18,881.00
----------
1.00
0.00
1.00
0.00
1BSEISMICR VALUATION
18,881.00
1.90
0.00
1.90
0.00
1REROOFRES SQ FEET
38.00
494.00
0.00
-------- --
----49400
------0_00
TOTAL PERMIT
----------
496.90
0.00
496.90
0.00
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
AMOUNT
---------------
496.90
---------------
496.90
VOICE ID DESCRIPTION
-------- ----------------------------
601 ROOF TEAR OFF
F.EFERENCE NUMBER
--------------------
#1I375
VOICE ID DESCRIPTION
-------- ----------------------------
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS 605 FINAL REROOF
CITY OF CUPERTINO
11,ft4
IMATOR RIT-11 DING DIVISION
ki -1 are onl an estimate. Contact the Dent for addnl into.
NOTE: These fees are based on the prelimmary in orma
FEE ITEMS (Fee Reso tion 09-051. Ff.7/1.
FEE EST j
QTY/FEE
MISC ITEMS
ADDRESS: DATE:
REVIEWED BY:
A
sappl" PC /,_02
*VALUATION: [$18,881
BP#.
APN: BP#:
Pho plan
xPEj.
RMIT TYPE: Minor Building Permit
PLAN CHECK TYPE: Re -roof
PRIMARY PENTAMATION 1SFDWLR00F
SFD or Duplex PERMIT TYPE:
USE:
WORK
SCOPE
Unil
ki -1 are onl an estimate. Contact the Dent for addnl into.
NOTE: These fees are based on the prelimmary in orma
FEE ITEMS (Fee Reso tion 09-051. Ff.7/1.
on a va
FEE
QTY/FEE
MISC ITEMS
/all Clic, A
A
sappl" PC /,_02
Pho plan
Permit Fee:
1,-/O�, h7s11, Pcc,
ki -1 are onl an estimate. Contact the Dent for addnl into.
NOTE: These fees are based on the prelimmary in orma
FEE ITEMS (Fee Reso tion 09-051. Ff.7/1.
on a va
FEE
QTY/FEE
MISC ITEMS
/all Clic, A
A
sappl" PC /,_02
Pho plan
Permit Fee:
$494.00
Sli/)I,)/, hisp FCC'
Unil
Permit Fc,",
Tax
,Icfnisiicof,
Work Without Permit? 0 Yes No
$0.00
=A
1)o,Fcc,�.,
-
Strong Motion Fee: IBSEISAHCR
$1.89
Select an Administrative Item
1
Stds Commission Fee: IBCBSC
$1.00
IBldg
SUBTOTALS:
$496.891
$0.00 TOTAL FEE -.1 — �$496,89
Revised: 8/17/2010
CITY OF
CUPEkTINO
CITY OF CU PERTINO
REROOF
PERMIT APPLICATION
APN #
Date:
Building Mdress: ��)..,�'•��
Owner's Name:
Phone #: f
/1/0 6 - y L -
HOA: Yes No If yes, provide letter from HOA
Phone #:
Contractor: A
�,1�. �' _71f
J
Fax #: ��CJ • ��-- �d
Cupertino Business License #:
2 -
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
o Other (Specify) ❑
Other (Specify)
Number of existing coverings ❑
Provide I.C.C.E.S. Report #
o To be Removed ❑
Provide Mfgr. Installation Specs.
Job Description:
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, include in plan set & the sheet index.
Valuation: # 1g, go /, M ---�373
I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy:
Revised 02/05/09
REROOF TEAR -OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMEN" • BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE • CUPERTINO, CA 91,014-3255
CUPERTINO
(408) 777-3228 •FAX (408) 777-3333 • buildinliCa)cupertino.org
PROJECT ADDRESS
OWNER NAME �
PHONE
6 -30zv
E-MAIL
STREET ADDRESS
7536 r
CITY, STATE, ZIP'
4l
FAX
CONTRACTOR NAMEe /
LICENSE NUMBER Z ` /O
LICENSE TYPE
— 3,9.
BUS. LIC #
(/ CIO 1
G
COMPANY NAME
E-MAIL
FAX
STREET ADDRESS
C
CITY, STATE, ZIP
tit t.4• yoy
PHONE
- iso) � - r
I UNDERSTAND AND AGREE TO THE FOLLOWING:
1. The re -roof project shall comply with all applicable provisions of the 2007 California Building Code.
2. You must schedule all needed inspections a minimum of one day before the requested inspection date.
Please schedule inspections online or call (408)777-3228 between 7:30-3:30 (Mon -Fri).
3. Tear -off roof inspection is required. Please call for tear -off inspection after the roof is torn off and all
the nails/fasteners have been removed. Any and all dry -rotted wood shall be replaced prior to this
inspection. A building inspector will be available within one hour.
There are special hours for this service: 7:30 — 10:3 dam and 1:00 — 3:30pm (Mon — Thurs);
7:30 — 10:3 dam and 1:00 — 2:30pm (Friday).
4. If plywood is installed, a plywood nailing inspection is required.
5. In -Progress roof inspection is required. Call for an in -progress roof inspection to verify building is
weather tight after installation of approximately 25% of the roofing material.
6. New roof coverings shall not be applied without first obtaining all inspections and written approvals
from the building inspector. Any roofing which is applied without first obtaining an approved inspection
will require the removal of all new material down to the sheathing so a proper inspection can be
performed.
7. A final inspection and approval shall be obtained from the building inspector when the re -roofing is
complete. To receive a final sign -off, the following it -,ms will be verified:
a. Flat roofs shall have a minimum of I/4" per foot o 'slope and must demonstrate there is no ponding.
b. Listings from approved testing agencies for all pr. --manufactured products used shall be available
on-site to review at the time of the inspection.
c. Proper spark arrestor installation.
8. NOTE: If you call for a tear -off or plywood nailing i ispection and the work is not complete, you will
be charged a re -inspection fee of $126.00. The re -inspection fee shall be paid before another
inspection can be scheduled.
By my signing below, I certify each of the following is true: I am the property owner or authorized agent to act
on the property owner's beha I understan and agreSW comply with the re -roof policy stated above.
Signature of Applicant/Agent: i Com""T Date: 00a
ReroofPolicy_2010.doc revised 05/17/10
CUPERTINO
CONTRACTOR / SUBCONTRACTOR LIST
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
Fax: 408-777-3333
JOB ADDRESS' '7536 PERMIT # v e0
OWNER'S NAME: PHONE # GSD - ;P6
GENERAL CONTRACTOR:,n C;:,, BUSINESS LICENSE # ZG 147
ADDRESS:) pl.4 - e S CITY/ZIPCODE: A.tovA44i c
*Our municipal code requires all businesses working in the ci �y to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPE.CTION(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:Date
Signature
DIWhorl- a"nliefihip cnheontractors and complete th ! following information:
Owner / Contractor Signature
Date
SUBCONTRACTOR
BUSINESS NYLME
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
S On f
z�
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner / Contractor Signature
Date