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09090054 CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR:DO NOT USE-DUPLICATE PERMIT NO:09090054 BUILDING A,9DRESS: 1088 DERBYSHIRE DR 19307 825 CAMDEN AVE DATE ISSUED:09/09/2009 rP"'NER'S NAME: STANLEY FONG CAMPBELL,CA 95008 PHONE NO:(408)866-1800 NER'S PHONE: 4089305157 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB g Z 3 RESIDENTIAL f— COMMERCIAL License Class C_ 2,-,0( Lic. MECH Date ROOF,INSTALL 1/2" Contractor JOB DESCRIPTION: TEAR OFF(E) I hereby affirm that I am lice ed u er the provisions of Chapter 9 RATED OSB ECONOMY ROOFING (commencing with Section 7000)of ivision 3 of the Business&Professions INSTALL 50 YR COMP CLASS A 27SQ; Code and that my license is in full force and effect. RENEWD BUS LIC 9/9/9 I hereby affirm under penalty of perjury one of the following two declarations: 1 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. 1 have and will maintain Worker's Compensation Insurance,as provided for by V=$10000 Section 3700 of the Labor Code,for the performance of the work for which this rAPN t Floor Area: permit is issued. Occupancy Type: APPLICANT CERTIFICATION Number:36221042.00 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 fauthorize tiorepresentatives eu n atives ofthis city to agree to save upon the above mentioned property p purposes. PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply 180 DA S FROM LAS CALLED INSPECTION. 'rn . with all non-point source regulations per the Cupertino Municipal Code,Section �! ate: 9.18. p� Issued by: to S' _atu �] OWNER BUILDER DECLARATION RE-ROOFS: I 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 installed without first obtaining an inspection,1 agree to remove all new materials for the following two reasons: 1,as owner of the property,or my employees with wages as their sole compensation, p inspection. will do the work,and the stricture is not intended or offered for sale(Sec.7044, Date: Signature of Applicant: Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to RINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVE I hereby affirm under penalty of perjury one of the following three g�ARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 oft e performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management lthe will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 d become subject to the Worker's Compensation provisions of the Labor Code,I mus mer or aut rued agent: Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION affirm reby fl I certify that I have read this application and state that ordinances and state laws relating for ation is I ewhich this at there issued(Sec 3097 CivdC.)agency for the performance of work's correct.I agree to comply with all city and county ord to building construction,and hereby authorize representatives of this city to tto enter Lender's Name the above mentioned property for inspection purposes.(We)agree ave mify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address costs,and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Date— Licensed Professional Signature CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 4 ITEMS OF 4 COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36221042 .00 DATE ISSUED. . . . . . . 09/09/2009 RECEIPT #• • : 09000008635 " " • 09090054 REFERENCE ID # • • SITE ADDRESS 1088 DERBYSHIRE DR SUBDIVISION • • . . . . : CUPERTINO CITY . . . . . . . . . . . . IMPACT AREA . . . . . . OWNER STANLEY FONG ADDRESS 1088 DERBYSHIRE DR95014-5003 CITY/STATE/ZIP . . . : CUPERTINO CA, RECEIVED FROM . . . . : ECONOMY ROOFING, INC CONTRACTOR PAUL HORSAGER LIC # 23342 COMPANY . . . . . . . . . . DO NOT USE-DUPLICATE 19307 ADDRESS 825 CAMDEN AVE CITY/STATE/ZIP CAMPBELL, CA 95008 TELEPHONE (408) 866-1800 UNIT QUANTITY AMOUNT PD-TO-DT THIS REC --NEW-BAL- FEE ID ------ ---------- --------- ---------- ----- ---- 0 . 00 1 . 00 0 .00 10, 000 . 00 1 . 00 1, 00 0 . 00 1BCBSC VALUATION 10, 000 . 00 1 . 00 0 . 00 0 , 00 1BSEISMICR VALUATION 1 , 00 114 .00 0 .00 114 .00 0 ,00 1BUSLIC FLAT RATE 27 00 351.00 ------0_00 351. 00 1REROOFRES SQ FEET ------- ---------- 0 .00 467 . 00 0 . 00 467 . 00 TOTAL PERMIT METHOD OF PAYMENT AMOUNT --REFERENCE_NUMBER -------- ----------------- 467 . 00 #3198 CHECK TOTAL RECEIPT 467 . 00 ---- VOICE ID DESCRIPTION DESCRIPTION ---------- VOICE ID ------------------ __ ___ ---------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAI 604 ROOF IN-PROGRESS 605 FINAL REROOF 09 09 -�, CITY OF CUPERTINO REROOF CUPEkTINO PERMIT APPLICATION APN # Date: cc Building Address: Owner's Name: ��N P� Phone #: F HOA: Yes ❑ No If yes, provide letter from HOA Contractor: Phone #: Fax #: ? (P/S-7 a s S Cupertino Business Licen Contractor License #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles Asphalt Shingles 5r- Wood Shakes ❑ 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 Description: -7-e41 �� /•v S`r�// Fnrc�- 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: app licable, include in plan set & the sheet index. Valuation: ) Q 666 I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 a�mw CITY OF CUPERTINO REROOF CITYCUPEI�TINO FEE SCHEDULE Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B Z —7 1RER00FRES Re-roof Residential B 1SFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1 REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 Fax: (408)777-3333 Building Department Subject: Re-roofing policy for the City of Cupertino 1. Prior to permit issuance,you must agree to comply with 2007 IBC Standards and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino municipal code 16.04.080. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the building inspector when the re-roofing is completed. 3. All roofs shall be inspected prior to any roofing installation. 4. To receive a final sign off from the City,the following steps are required: 1) Pre-inspection and/or tear off approval. 2) In-progress inspection approval. 3) Final inspection approval. a) Spark arrester installation. 5. If plywood is installed,a plywood nail inspection is required. 6. Any roofing which is applied without first obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be performed. 7. NOTE: If you call for a plywood nail inspection and the job is not ready, you will be charged a re-inspection fee of$176.18. The re-inspection fee must be paid before another inspection can be scheduled. IMPORTANT: of 1/a "per foot slope and demonstrate 1. Flat roofs must have a minimum that there is no ponding. 2. An I.C.B.O.report is required to be on the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: S 14 N job Site Address: b Roofing Company Name: . Applicant's Signature Date: Greg Casteel Building Official Revised.07/30/08