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