10080214 CITY OF CUPERTINO BUILDING PERMIT
BUILDING,ADDRkSS: 20607 PARADISE DR CONTRACTOR:DADDARIO ROOFING PERMIT NO: 10080214
OWNERS NAME: MIKE AND WINNIE KOSOLCHAROEN 1734 1VILLA WAY DATE ISSUED:08/30/2010
I' vNER'S PHONE: 4082578954 SANTA CRUZ,CA 95062 PHONE NO:(831)476-9109
LJ LICENSED CONTRACTOR'S DECLARATION
BUILDING PERMIT INFO: BLDG F ELECT r PLUMB r
License?✓lass Lie.# Y�-1 3q
MECH r- RESIDENTIAL[_ COMMERCIAL
ContractorDate d€;—3(,-e20llop
I hereby affirm that I am licensed undWthe provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF REMOVE SHAKES,INSTAL PLYWOOD FELT
(commencing with Section 7000)of Division 3 of the Business&Professions PAPER
Code and that my license is in full force and effect. 30LB 36"ASTM FELT INSTALL CERTAINTEED TL ULTIMATE
LIFETIME SHINGLES INSTALL ALUMINUM GUTTERS CLASS A
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. _ Sq.Ft Floor Area: Valuation:$9950
APPLICANT CERTIFICATION J S�
I certify that I have read this application and state that the above information is APN Number:35915011.00 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 1�;0 DAYS FROM LAST CALLED INSPECTION.
9.18. !
Signature Date C997ijO%lJIssued bq:' - _ Date .�!%�`(J
s•
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 root s 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, installer I 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, inspecti m.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to Signatu•e of Applicant;. gAADate:
construct the project(Sec.7044,Business&Professions Code). =i__ 0_2'Z
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
Compensation,as provided for by Section 3700 of the Labor Code,for the HAZARDOUS MATERIALS DISCLOSURE
performance of the work for which this permit is issued. I have r ead the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by Califor ria Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain
Section 3700 of the Labor Code,for the performance of the work for which this complif nce 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 contain nants 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 k Safety Code,Sections 25505,25533,and 25534.
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. Owner rr authorizf d agent: .
Date:�.3!'-.2v10
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 whic h 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,
s,and expenses which may accrue against said City in consequence of the Lender's Address
Jug of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. ARCHITECT'S DECLARATION
Signature Date I undersi and my plans shall be used as public records.
Licensed Professional
CITY OF `
CITY OF CU.PERTINO
REROOF
CUPERTINO PERMIT APP] ,ICATION
APN# �, - f Date:
Building Address:
p pr
Owner's Name:J1i k& Mnn o e Ctaw-eyl ksol Phone #:
HOA: Yes ❑ Noes, rovide letter from HOA
Contractor: Phone #: gimp,) T30
ddo rill koo Fax#: 53/ yl s
Cupertino Business License #: Contractor f icense #:
O
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
ar Wood Shakes a Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.C.E.S. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Job
1 Description: yt v,ovy ,JSI•a/,_e S- ),154-l/plyr, ewe R/� &er Sol b. 36"A&tA
t�S40 r CPr-4wy%A--ed TL 0-11 ►'lot,
-
O �,
d+r5 c e-c-f` "a-- Y-0 S
Residential 0 Commercial
Green Building: Please complete relevant portion of the Con.f rmed with Planning Dept. if
Green Building Checklist & attach it to the applicat:.on or if there are any restrictions: ❑
applicable, include in plan set & the sheet index.
Valuation:
I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy:
'gnature
Revised 02/05/09
M.1ndDDr Alir-Quallity and Ffinishes;
1.Use Low/No-VOC Paint 1 IACIHealth pts y=yes p
2.Use Low VOC,Water-Based Wood Finishes 2 IAC/Health pts Y--yes p
3.Use Low/No VOC Adhesives 3 IAC/Health pts y=yes p
4.Use Salvaged Materials for Interior Finishes 3 Re:;ource pts y=yes p
5,Use Engineered Sheet Goods with no added Urea
Formaldehyde 6IAC/Health pts y=yes p
6.Use Exterior Grade PlytMood for Interior Uses 1 IAC/Health pts y=yes p
7.Seal.ail Eioaed hoard or MDF 41AC/Health pts y:-3 as p
B.Use FSC Certified Materials for Interior Finish 4 Re:;ource pts y=yes p
9.Use Finger-Jointed or Recycled-Content Trim 1 Re;ource pts y=yes p
10.Install Whole House Vacuum System 3 IAC1/Health pts y--yes p
N.Flooring
1.Select FSC Certified 1Nood Flooring 6 Resc urce pts y--yes p
2.Use flapiclly Renewable Flooring Materials 4 Resc urce pts y=yes p
3.Use Recycled Content Ceramic Tiles 4 Resc urce pts y=yes p
4.Install Natural Linoleum in Place of Vinyl 5 IAQ/-lealth pts y=yes p
5,Use Exposed Concrete as Finished Floor 4 Resc irce pts y=yes p
6.Install Recycled Content Carpet with Low VOCs 4 Resoirce pts y--yesp
i 1
Total Points Available: 1401 13011- 57
Total Points Project Recelved:l 01 01 0
mg _ 30 ;o/V
Mdatalprogs/greenbuilding;Nidelineslr;modelers/greenpointsfina1212 D4proteeted.xls
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lct:
APN 35915011. 00
DATE ISSUED. . . . . . . : 08/30/2010
RECEIPT #. . . . . . . . . : BS000011324
REFERENCE ID # . . . : 10080214
SITE ADDRESS . . . . . : 20607 FARADISE DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . :
OWNER MIKE AND WINNIE KOSOLCHAROEN
ADDRESS 20607 FARADISE DR
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : DADDARIO ROOFING CO
CONTRACTOR . . . . . . . : EDGAR MONTOYA LIC # 26245
COMPANY . . . . . . . . . . : DADDARIO ROOFING
ADDRESS . . . . . . . . . . : 1734 WILLA WAY
CITY/STATE/ZIP . . . : SANTA CRUZ, CA 95062
TELEPHONE . . . . . . . . : (831) 476-9109
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 9, 950. 00 1 .00 0 .00 1. 00 0 .00
1BSEISMICR VALUATION 9, 950 . 00 1 .00 0. 00 1. 00 0. 00
1REROOFRES SQ FEET 20. 00 260 . 00 0. 00 260. 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 262 .00 0. 00 262 . 00 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --- -----------------
CHECK 262 . 00 #5130
---------------
TOTAL RECEIPT 262 .00
VOICE ID DESCRIPTION 70ICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
ALBERT SALVADOR, P.E., C.B.O., BUILDING O=FICIAL
10300 TORRE AVENUE•CUPERTINO, CA 950'4-3255
GUPERTINO
(408)777-3228• FAX(408)777-3333•building a cugertino.orq
PROJECT ADDRESS f PN#
o r
OWNER NAME PION E-MAIL
STREET ADDRES CITY, STATE, IP FAX
t
q 01q.
STJATOR NAME LICENSE UMBER LICENSE TYPE BUS.LIC.#
COMP NY NAME E-MAIL AX
.r
STREET ADDRESS ,f CITY,STATE,ZIP PEON
Co M Y-50vo 04 IJ
I UNDERSTAND AND AGREE "'O THE FOLLOWING:
1. The re-roof project shall comply with all applicable proN isions 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)777-32281 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 di y-rotted wood shall be replaced prior to this
inspection. A building inspector will be available withii one hour.
There are special hours for this service: 7:30 — 10:30am and 1:00—3:30pm (Mon—Thurs);
7:30 — 10:30am 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 obi aining all inspections and written approvals
from the building inspector. Any roofing which is appli,;d 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 items will be verified:
a. Flat roofs shall have a minimum of per foot of s ope and must demonstrate there is no ponding.
b. Listings from approved testing agencies for all pre-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 ins)ection 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 behalf. I understand and agree to comply with the re-roof policy stated above.
Signature of Applicant/Agent: Date: C�l—0—ayo
ReroofPolicy_201 0.doe revised 05/17/10
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: a e,.- PERMIT#
OWNER'S NAME: f- W/ PHONE# D
GENERAL CONTRACTOR: 020%rj,0nao , BUSINESS LICENSE#
ADDRESS: „- 50 10 CITY/ZIPCODE:
"Our municipal code requires all businesses working in the cit.r 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 SUBCONTRACTO EZS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE.
I am not using any subcontractors: wvO 4� --30 -'A0/O
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NA VIE 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
0;;- 30
Owner/Contractor Signature Date