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10080153CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 22347 STEVENS CREEK BLVD OWNER'S NAME: NANSHE HE NER'S PHONE: 4088651581 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. 1 Signature Z y / Date J Z/C> 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) 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 -unify 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 9.18. CONT 2ACTOR: WOODS ROOFING PERMIT NO: 10080153 17700 SERENE DR DATE ISSUED: 08/23/2010 MORCAN HILL, CA 95037 PHONE NO: (831)637-5576 BUILI)ING PERMIT INFO: BLDG r- ELECT r— PLUMB r MECH r- RESIDENTIAL F COMMERCIAL r - JOB I WSCRIPTION: RE -ROOF RTEAR OFF 1 LAYER WOOD SHAKE, CLASS A 27SQ NO RE MEET & INSTALL STELL ROCK STEEL TILE Sq. Ft Floor Area: APN t umber: 32650010.00 Valuation: $17100 Occupancy Type: PLRMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 1110 D YS FRO ST LED INSPECTION. Issued by: �� e -3 � O Date: RE -ROOFS: All roc fs shall be inspected prior to any roofing material being installed. If a roof is install(d without first obtaining an inspection, I agree to remove all new materials for inspection. Signabire of Applicant: �/�3�1� 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 Califo rnia Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compl ance 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 maint, tin compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owne authorizedz/ �� ager , CONSTRUCTION LENDING AGENCY I beret y affirm that there is a construction lending agency for the performance of work's for wbich this permit is issued (Sec. 3097, Civ C.) Lender's Name Lend(r's Address ARCHITECT'S DECLARATION I unde stand my plans shall be used as public records. Signature Date I Licenned Professional LICENSED CONTRACTOR'S DECLARATION License Class L > Lic. # > L 3 Date Contractor I hereby a r t I am li under the provisions of Chapter 9 (commen h do 00) 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. 1 Signature Z y / Date J Z/C> 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) 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 -unify 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 9.18. CONT 2ACTOR: WOODS ROOFING PERMIT NO: 10080153 17700 SERENE DR DATE ISSUED: 08/23/2010 MORCAN HILL, CA 95037 PHONE NO: (831)637-5576 BUILI)ING PERMIT INFO: BLDG r- ELECT r— PLUMB r MECH r- RESIDENTIAL F COMMERCIAL r - JOB I WSCRIPTION: RE -ROOF RTEAR OFF 1 LAYER WOOD SHAKE, CLASS A 27SQ NO RE MEET & INSTALL STELL ROCK STEEL TILE Sq. Ft Floor Area: APN t umber: 32650010.00 Valuation: $17100 Occupancy Type: PLRMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 1110 D YS FRO ST LED INSPECTION. Issued by: �� e -3 � O Date: RE -ROOFS: All roc fs shall be inspected prior to any roofing material being installed. If a roof is install(d without first obtaining an inspection, I agree to remove all new materials for inspection. Signabire of Applicant: �/�3�1� 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 Califo rnia Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compl ance 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 maint, tin compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owne authorizedz/ �� ager , CONSTRUCTION LENDING AGENCY I beret y affirm that there is a construction lending agency for the performance of work's for wbich this permit is issued (Sec. 3097, Civ C.) Lender's Name Lend(r's Address ARCHITECT'S DECLARATION I unde stand my plans shall be used as public records. Signature Date I Licenned Professional CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT REC'.EIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 326500:_0.00 DATE ISSUED.......: 08/23/2010 RECEIPT #.........: BS000011244 REFERENCE ID # ...: 10080153 SITE ADDRESS .....: 22347 STEVENS CREEK BLVD SUBDIVISION ...... CITY ............. CUPERT::NO IMPACT AREA ...... OWNER JIANSHI] HE ADDRESS 22347 STEVENS CREEK BLVD CITY/STATE/ZIP ...: CUPERT::NO, CA 95014 RECEIVED FROM ....: JEFF RAINEY CONTRACTOR .......: WOOD, :jAWRENCE E LIC # 20810 COMPANY WOODS ROOFING ADDRESS ..........: 17700 :SERENE DR CITY/STATE/ZIP ...: MORGAN HILL, CA 95037 TELEPHONE ........: (831)6:37-5576 FEE ID UNIT QUANTITY AMOU& PD -TO -DT THIS REC NEW BAL ---------- ----------------------- 1BCBSC VALUATION ---------- 17,100.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 0.00 1BSEISMICR VALUATION 17,100.00 1.80 0.00 1.80 0.00 1REROOFRES SQ FEET 27.00 351.00 0.00 351.00 0.00 ---------- TOTAL PERMIT ---------- 353.80 ---------- 0.00 ---------- 353.80 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT AMOUNT --------------- 353.80 --------------- 353.80 VOICE ID DESCRIPTION -------- ---------------------------- 601 ROOF TEAR OFF ZEFERENCE NUMBER -------------------- VI 3A VOICE ID DESCRIPTION -------- ---------------------------- 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF CITY OF CITY OF CUPERTINO LM REROOF CUPERTINO PERMIT APPLICATION APN # -1 3T� �� � i C t Date: 8-23-10 Building Address: 22347 STEVENS CREEK BLVD. Owner's Name: Phone #: JIANSHE HE HOA: Yes408-865-1581 ❑ No � If es, provide letter from HOA Contractor: Phone #: 408-605-5115 WOOD'S ROOFING Fax #: 408-267-9999 Cupertino Business License #: Contractor License #: 325131 Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles • Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ® Other (Specify) STEEL ROCK STEEL TILE Number of existing coverings ❑ Provide I.C.C.E.S. Report # ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: RE-ROOF/TEAR OF 1 LAYERS WOOD SHAKE/CLASS A/27 SQUARES/NO RESHEET/INSTALL STEEL ROCK STEEL TILE Residential 0 Commercial ❑ Green Building: Please complete relevant portion c,f 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: $17,100 I Have Rgad, Understand_pd Will Comply with Cupertino's Tear -Off Policy: Revised 02/05/09 REROOF TEAR -OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUILDING OFFICIAL CUPERTINO 10300 TORRE AVENUE • CUPERTINO, CA 95)14-3255 (408) 777-3228 • FAX (408) 777-3333 • building �cupertino.orq PROJECT ADDRESS 223 �^ ! � '� i �l V APN # OWNER NAME i ` ,/ - PHONE > 6 E-MAIL STREET ADDRESSCITY, 2� 3 STATE, ZIP Cc/ rr2 7 r A,0 C f FAX C'ONTRAC'TOR NAME t LICENSE 1JJJ�BER LICEN�TYPE BUS. LIC. # COMPANY NAME E-�MMAIIL` FAX STREET ADDRESS PizCITY, STATE, ZIP I /� O PHO E L b� 4 I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re -roof project shall comply with all applicable pr(visions 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)777-32:8 between 7:30-3:30 (Mon -Fri). 3. Tear -off roof inspection is required. Please call for oar -off inspection after the roof is torn off and all the nails/fasteners have been removed. Any and all (try -rotted wood shall be replaced prior to this inspection. A building inspector will be available with n 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% o 7 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 th,; 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 ite ns will be verified: a. Flat roofs shall have a minimum of 1/4" per foot of dope 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 in ipection and the work is not complete, you will be charged a re -inspection fee of $126.00. The re-inspl;ction fee shall be paid before another inspection can be scheduled. By my signing below, I certify each f the following is true: I am the property owner or authorized agent to act on the property owner's behalf. nderstand an,,d pgree to coriply with the re -roof policy stated above. Signature of Applicant/Agent: Date: / O ReroofPolicy_2010.doc revised 05/17/10