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10080068 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10410 IMPERIAL AVE CONTA ACTOR:M&S ROOFING CO. PERMIT NO: 10080068 OWNER'S NAME: CHAMPION CHEN 208 CO ICO LN DATE ISSUED:08/10/2010 NER'S PHONE: 4085291188 SAN JOSE,CA 95123 PHONE NO:(408)314-0870 ❑ LICENSED CONTRACTOR'S DECLARATION BUILT;ING PERMIT INFO: BLDG r ELECT I— PLUMB r License Class—C-1 07 Lic.# SO Ale r I- r MECH RESIDENTIAL COMMERCIAL r Contractor(n ( ;()_ ir�� Date 1 C) l I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF REMOVE EXT SHORE ROOF&INSTALL 1/2"OSB (commencing with Section 7000)of Division 3 of the Business&Professions CLASS.\32SQ&40 YEAR COMP 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 Sq.Ft I loor Area: Valuation:$12000 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN N,rmber:35719093.00 Occupancy Type: 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, V�ITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DA OM LAST CALLED INSPECTION. 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. Issued by: — Date: Signature Date OWNER-BUILDER DECLARATION RE-ROOFS: All roof s shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installe,I without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspecti an. 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, Signature of Applicant Date:(S Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have •ead the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compli once 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 Addith finally,should I use equipment or devices which emit hazardous air contan inants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the 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 Owner authori'ked agent: become subject to the Worker's Compensation provisions of the Labor Code,I must _ Date: forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereb i affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for whi-,h this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address ^demnify and keep harmless the City of Cupertino against liabilities,judgments, ,,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION _sting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I under Stand my plans shall be used as public records. 9.18. 6 Licens:d Professional Signature Date J CITY OF CITY OF CUPIKRTINO 13 REROOF CUPERTINO PERMIT APPLICATION 1 oog OC�c.Q � APN # Date: ,357 19 0943 • g O ► U Building Address: py I p Owner's Name: CAVLmPkQ�(� Phone #: HOA: Yes ❑ No b( If yes, provide letter from HOA S29 � , Contractor: Phone #: 3 Fax#: Cupertino Business License #: Contractor License #: �j Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof :i Built-Up roof ❑ Asphalt Shingles phalt Shingles �ood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) N mber of existing coverings I ❑ Provide I.C.C.E.S. Report# `a7To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: f �,ry-Lc>ve. 5>Y1cm,ke Pc5r�' t 12. 32, S-rj a nA P Residential Commercial Green Building: Please complete relevant portion of the Confirmed 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: j ,21cpo I Have Read, Understand and Will Comply with Cuper-.ino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF CUPE ZTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lo:. APN . . . . . . . . : 35719093 .00 DATE ISSUED. . . . . . . : 08/10/2)10 RECEIPT #. . . . . . . . . : BS00001L140 REFERENCE ID # . . . : 10080063 SITE ADDRESS . . . . . : 10410 IMPERIAL AVE SUBDIVISION . . . . . . CITY . . . . . . . . . . . . . . CUPERTI:JO IMPACT AREA . . . . . . OWNER . . . . . . . . . . . . : CHAMPION CHEN ADDRESS . . . . . . . . . . : 10410 IMPERIAL AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : M & S ROOFING CO CONTRACTOR . . . . . . . : MIRSAD CRAJWIC LIC # 28360 COMPANY . . . . . . . . . . : M & S ROOFING CO. ADDRESS . . . . . . . . . . : 208 COP-"O LN CITY/STATE/ZIP . . . : SAN JOSE, CA 95123 TELEPHONE . . . . . . . . : (408) 311-0870 FEE ID UNIT QUANTITY AMOUNP PD-TO-DT THIS REC NEW BAL ------ --- ------------- ---------- ------ ---- ---------- ---------- ---------- 1BCBSC VALUATION 12, 000. 00 L. 00 0.00 1. 00 0 .00 1BSEISMICR VALUATION 12, 000. 00 L.20 0.00 1.20 0 .00 1REROOFRES SQ FEET 32 . 00 415 . 00 0 .00 416 . 00 0 .00 ------ ---- ---------- ---------- ---------- TOTAL PERMIT 413 .20 0 .00 418 .20 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- --- ----------------- CHECK 418 .20 #2458 --------------- TOTAL RECEIPT 418 .20 VOICE ID DESCRIPTION 'IOICE ID DESCRIPTION -------- ---------------------------- -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CUPERTINO FEE ESTIMATOR-BUI.LDING DIVISION ADDRESS: DACE: 08/10/2010 REVIEWED BY: gs APN: BP#: *VALUATION: 1$12,000 R:PERMITTYPE: Minor Building Permit PLAN CHE CK TYPE: Re-roof PRIMARY SFD or Duplex lex . )l 11. APPLICATION 1 SFDWLROOF USE: F/0OR"I I'll:.t. TYPE: �g w a a 00 3 � FEE ID ROOF AREA s.f. 1 REROOFFRES 3,200 Pltw C 7r1:'% Fr::FT71 .�_.., t<o•ri`I t'e_ i,l<'c / '�txi 1'.'<' T71 T-7 NOTE: Thesefees are based on the preliminary information-availabli and are of an estimate. Contact the De t or addn'l info, FEE ITEMS (F'ee Resolution 09-051 EYT 7,1:Y)9) FEE QTY/FEE MISC ITEMS P an t hc'•."ti. FE'f" P{ 1 ,c Pitittit�J, lj=s?7 Permit Fee: $416.00 T'Crrllct' tI c.St i_r'c< �'e','trlit FCC', 1 c,ix F-1 Icr�trstitcrl Rci iclt.1 c Work Without Permit? 0 Yes 0 No $0.00 �t'.tl`c'1 1.)t7CZd937C'771tf'I+�li'1't:'C'S: Strong Motion Fee: 1BSEISMICR $1.20 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 SUBTOTALS: $418.20 $0.00 TOTAL FEE: $418.20 Revised: 8/06/2010 REROOF TEAR-OFF POLICY COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O.,BUILDING C,FFICIAL 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255 CUPERTINO (408)777-3228 FAX(408)777-3333•buildin c)cupertino.orq PROJECT ADDRESS4PN# i 1_ J OWNER NAME j PHONE E-MAIL STREET ADDRESS CITY, STATE,ZIP FAX CONTRACTOR NAME r/ "/ I �1C.. Y LICENSE NUMBER I LICENSE TYPE_„ BUS.LIC.# COMPANY NAME E-MAIL FAX M 4 4� L)a 6 1 STREET ADDRESS CITY,STATE,ZIP,., `© I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable pro✓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)777-3228 between 7:30-3:30 (Mon-Fri). 3. Tear-off roof inspection is required. Please call for tf ar-off inspection after the roof is torn off and all the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced prior to this inspection. A building inspector will be available within one hour. There are special hours for this service: 7:30 — 10:30am and 1:00— 3:30pm (Mon—Thurs); 7:30 — 10:30arn and 1:00—2:30pm (Friday). 4. If plywood is installed, a plywood nailing inspection E required. 5. In-Progress roof inspection is required. Call for an iii-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 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 thc sheathing so a proper inspection can be performed. 7. A final inspection and approval shall be obtained from he 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;;lope 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;pection and the work is not complete, you will be charged a re-inspection fee of$126.00. The re-inspmtion fee shall be paid before another inspection can be scheduled. By my signing below, I certify each of the following is true: 1 am the property owner or authorized agent to act on the property owner's behalf. I un erstan4 and agree to cor iply with the re-roof policy stated above. Signature of Applicant/Agent: Date: to ReroofPolicy_2010.doc revised 05/17/10 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# 0 0 OWNER'S NAME: PHONE# GENERAL CONTRACTOR: BUSINESS LICENSE# ADDRESS: CITY/ZIPCODE: C - *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPf CTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. , o � , I am not using any subcontractors: �-' 'gnaturc Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAME 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 ) D Date Owner %Cntractor Signature