10080093 CITY OF CUPERTINO BUILDING PERMIT
3UILDING ADDRESS: 7519 LEEDS AVE CONTRACTOR:BAY 101 ROOFING PERMIT NO: 10080093
"INFNER'S NAME: RON LAI PO BOX )25 DATE ISSUED:08/13/2010
IER'S PHONE: 4088321361 ALVISO,CA 95002 PHONE NO:(408)957-0531
LICENSED CONTRACTOR'S DECLARATION BUILDI VG PERMIT INFO: BLDG r ELECT F PLUMB r
_icense Class Lic.#_20 ,) 116 r r
O �j MECH RESIDENTIAL COMMERCIAL
:ontractor �j/] l 01�{l'7� AJ6 Die/3— U
hereby affirm that I am licensed under the provisions of Chapter 9 JOB DE 3CRIPTION:RE-ROOF TEAR OFF WOOD SHAKE PUT ON OSB BOARD
commencing with Section 7000)of Division 3 of the Business&Professions 30#
'ode and that my license is in full force and effect. FELT&L�NDMARK TL COMP CLASS A 30SQ
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.
have and will maintain Worker's Compensation Insurance,as provided for by
lection 3700 of the Labor Code,for the performance of the work for whi h0"'- Sq.Ft Floor Area: Valuation:$12600
�ernut is issued.
APPLICANT CERTIFICATION APN Nun Lber:36616020.00 Occupancy Type:
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
D building construction,and hereby authorize representatives of this city to enter
ipon the above mentioned property for inspection purposes. (We)agree to save PEI MIT EXPIRES IF WORK IS NOT STARTED
ndemnify and keep harmless the City of Cupertino against liabilities,judgments,
;osts,and expenses which may accrue against said City in consequence of the WI'CHIN 180 DAYS OF PERMIT ISSUANCE OR
,ranting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
vith all non-point sourretir gulSrytions per the Cupertino Municipal Code,Section
1.18. �_
signature "O Date Issued b ��%' Dater
OWNER-BUILDER DECLARATION
RE-ROOFS:
hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
he following two reasons: installed w ithout first obtaining an inspection,I agree to remove all new materials for
,as owner of the property,or my employees with wages as their sole compensation, inspection
vill do the work,and the structure is not intended or offered for sale(Sec.7044,
lusiness&Professions Code) Signature )f Applicant: Date:
,as owner of the property,am exclusively contracting with licensed contractors to
onstruct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
hereby affirm under penalty of perjury one of the following three
leclarations:
have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
,ompensation,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
erformance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
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 Co 1e,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
ermit is issued. contamin.nts as defined by the Bay Area Air Quality Management District I will
certify that in the performance of the work for which this permit is issued,I shall maintain,:ompliance with the Cupertino Municipal Code,Chapter 9.12 and the
of employ any person in any manner so as to become subject to the Worker's Health& Safety Code,Sections 25505,25533,and 25534.
;ompensation laws of California. If,after making this certificate of exemption,I
ecome subject to the Worker's Compensation provisions of the Labor Code,I must Owner or author id e
hrthwith comply with such provisions or this permit shall be deemed revoked. Date: v
Z
APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY
certify that I have read this application and state that the above information is I hereby at firm that there is a construction lending agency for the performance of work's
orrect.I agree to comply with all city and county ordinances and state laws relating for which 1 his permit is issued(Sec.3097,Civ C.)
building construction,and hereby authorize representatives of this city to enter Lender's Name
pon the above mentioned property for inspection purposes.(We)agree to save
�mnify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
and expenses which may accnue against said City in consequence of the
.dnting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
lith all non-point source regulations per the Cupertino Municipal Code,Section
.18. 1 understar d my plans shall be used as public records.
ignature Date Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN 36616020 . 00
DATE ISSUED. . . . . . . : 08/13/2010
RECEIPT #. . . . . . . . . BS000011180
REFERENCE ID # 10080093
SITE ADDRESS . . . . . : 7519 LEEDS AVE
SUBDIVISION . . . . . . .
CITY CUPERTINC,
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . . RON LAI
ADDRESS . . . . . . . . . . : 7519 LEEDS AVE
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : BAY 101 ROOFING INC
CONTRACTOR . . . . . . . : JOSE RAM: REZ LIC # 30420
COMPANY BAY 101 ROOFING
ADDRESS PO BOX 925
CITY/STATE/ZIP . . . : ALVISO, CA 95002
TELEPHONE (408) 951-0531
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ------- --- ---------- -----
1BCBSC VALUATION 12, 600 . 00 1 .00 0. 00 1. 00 0 .00
1BSEISMICR VALUATION 12, 600. 00 1 .30 0 .00 1.30 0 .00
1REROOFRES SQ FEET 30 . 00 390 .00 0.00 390 .00 0 . 00
------- --- ---------- ---------- ----------
TOTAL PERMIT 392 .30 0 .00 392 .30 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 392 .30 VISA
---------------
TOTAL RECEIPT 392 .30
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF CUPE RTINO
FEE ESTIMATOR- BUILDING DIVISION
a .ADDRESS: DATE: REVIEWED BY:
APN: BP#: *VALUATION: $12,600
;*PERMIT TYPE: Minor Building Permit PLAN CHEEK TYPE: Re-roof
PRIMARY 7(17',11. APPLICATION 1SFDWLR00F
USE: SFD or Duplex ���r��)1�:att1;��: TYPE:
WORK
SCOPE
FEE ID ROOF AREA
s.f.
1 REROOFFRES 3,000
I f<<.Ir, f puri Ch,t
('fic(A !Tarr Chc('k
Tl�;nzt'�,ri'�rttr l�ae. p:'1s 3�crft+tll�,��-
4c,h, lris1> El
Otlt 1 L<tt't.Inst.
tJrc h Ir+rte. I°: Plttnth l+ syr. 7< 1"/o(,Imp. (��e
NOTE. These fees are based on the prelintinary in ormation available and are onlv an estimate. Contact the De t or addn'l info.
FEE ITEMS (Fee Resolution 09-051 Ef/.' 'il%10) FEE QTY/FEE MISC ITEMS
P/01t 01e'(�/
S111))1l. Pt
P/11111h, Platt 01cc:k:
Permit Fee: $390.00
S1f1)p 1. 111,71 FCC
Pltlrnfa 'Ic cli. `ic" f
Plllrtrh. Adc�c°1r..1:7ecc Pk unlit poet
C.on,wrnction
ICi11.Mcul 1?e1ticit Fuc:
Work Without Permit? 0 Yes 0 No $0.00
_T_=
1}1C7077tti2�7 i'E'c.: :
Trus frl t)octlJrlcrr"IfLZtitui /�cres:
Strong Motion Fee: IBSEISMICR $1.26 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $392.26 $0.00 TOTAL FEE: $392.26
Revised: 8/12/2010
CITY OF -
CITY OF CUPE,RTINO
REROOF
CUPERTINO PERMIT APPLICATION
Date:
Building Address:
Owner's Name: )Z0/i Z-191 Phone #:
HOA: Yes ❑ No ❑ If Yes, provide letter front HOA G/G ' 13
Contractor: Phone #: 1/0 8 95-) 0 5 3 1
9�v A6 ° Fax#:
Cupertino Business License #: Contractor License #:
C/o .
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
14(Asphalt Shingles O� Asphalt Shingles
Wood Shakes c Wood Shakes
Wood Shingles c Wood Shingles
❑ Other (Specify) c Other (Specify)
Number of existing coverings c Provide I.C.C.E.S. Report#
p< To be Removed c Provide Mfgr. Installation Specs.
Job Description: -j-;F,4k D AA7 U)00j) % 0 A 0 SB Lo
30 Poq6ll / 4!j0,oy12
Residential - Commercial
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the applicatic n or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation:
I Have Read, Understand and Will Cl with Cuper6-io's Tear-Off Policy:
p
Signature G�v
Revised 02/05/09
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
Is ALBERT SALVADOR,P.E.,C.B.O.,BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO,CA 95014-:;255
C U P E RT I N O40g 777-3333•building@cu�ertino•org
(408)777-3228 FAX( )
APN#
PROJECT ADDRESS
PH E-MAIL
OWNERNAME ,,j ,
FAX
CI'Y, STATti,ZIP r h 17571/
STREET ADD - S (� �✓"1 V 7
LICENS�T^PF� BUS.LIC.#
1 LICENSE NUMBER G
CONTRA R AM 2.
f
FAX
E-MAIL
COMPANY E o ��y/ y Q I
Oe f,V CITY,STATE,ZT.- �, o it PLOD i /
STREET ADD S S �•• �J
I UNDERSTAND AND AGREE TD THE FOLLOWING:
1.
The re-roof project shall comply with all applicable provisions of the 2007 California Building Code.on date.
2. You must schedule all needed inspections a minimu3228 betweenone day be30-3 30the
(Mon Fri) msp
Please schedule inspections online or call (408)777
n after the roof is torn
3.
Tear-off roof inspection is re wired. Please call for tezr-off inspecttioshall be replaced prior off this all
the nails/fasteners have been removed. Any and all dry-rotted wood
inspection. A building inspector will be available 101301r one hour.
am and 1 00— 3:30pm(Mon—Thurs);
There are special hours for this service:
7:30 — 10:30am and 1:00—2:30pm (Friday).
4. If plywood is installed, a )Iywood nailing inspection isrequired.
n-Pro ress roof ins ection is re wired. Call for n ir_-progress roofinspection to verify building is
5' I approximately 25% of the roofing material.
weather tight after installation of app Y
6. New roof coverings shall not be applied without first of taining all
in rpections t obtaining an approvand written e prd onspection
vals
from the building inspector. Any roofing which is appl.ed without
will require the removal of all new material down to the sheathing so a proper inspection can be
performed.
proval shall be obtained from the building inspector when the re-roofing is
7. A final inspection and ap
complete. To receive a final sign-off,
the following ite ns will be verified:
a. Flat roofs shall have a minimum of per foot of slope and mea demonstrate used shall be available
b. Lisings from approved testing agencies for all pre-manufactu products
on-site to review at the time of the inspection.
c. Proper spark arrestor installation. p ou will
g. NOTE: If you call for atear-off or plywood nailing inspection and the ion fee shall be ork is not paid before another
be charged a re-inspection fee of$126.00. The re-insf cc
inspection can be scheduled.
B m signing below, I certify:each of the following is true: I am the property owner or authorized agent to acty Y to ccm 1 with the re-roof policy stated above.on the property owner's behalnderstanfl d , p y
Date: U_Z_ - h------
Signature of Applicant/Agent: f
l/ / ReroofPolicy_201 0.doc revised 05/17/10
Building Department
City Of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: 408-777-3228
C O P E RT I N O Fax: 408-777-3333
CONTRACTOR/ SUBCONTRACTOR LIST
JOB ADDRESS: / � PERMIT# / U L-� U (j -
OWNER'S NAME: PHONE# �C) -- 9 3� )- G
GENERAL CONTRACTOR: &qje e0j -7;C USINESS LICENSE# — 9 O
ADDRESS: CITY/ZIPCODE:ALIO/'S () l.!�4
"Our municipal code requires all businesses working in the city to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCO TO 'S' HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. _
I am not using any subcontractors: �� f 3 " (7
Sig t re Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAI\IE 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