10080088 CITY OF CUPERTINO BUILDING PERMIT
CONTRI,CTOR:T D ROOFING PERMIT NO: 10080088
BUILDING ADDRESS: 21747 MC CLELLAN RD 675 TUI LY RD DATE ISSUED:08/12/2010
OWNER'S NAME: RAYMOND CHENG
PHONE NO:(408)892-8872
ER'S PHONE: 4082555989
SAN JO iE,CA 95111
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB r
Z
License Class q Lic.# �N� S 11 ' MECH r RESIDENTIAL� COMMERCIAL
Contractor Date j v� r
JOB D ESCRIPTION:RE-ROOF REMOVE TILE,INSTALL PRESIDENTIAL COMP
1 hereby affirm that I am Ii ns cl der the provisions of Chapter 9 NO
(commencing with Section 7000)of Division 3 of the Business&Professions pLYWO:)D CLASS A 28SQ
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 Valuation:$10250
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft 17oor Area:
permit is issued.
APPLICANT CERTIFICATION
APN Number:3 571906 1.00 Occupancy Type:
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 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 1.30 DAYS FROM LAST CALLED INSPECTION.
with all non-point s rc r lations per the Cupertino Municipal Code,Section L�
Date:9 l-0
9.18. V , / Issued by.,_� –�'— ��
Signature
Date��
OWNER-BUIL DECLARATION RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All
l A shall
be inspected prior to first obtaining rt anyinsproofing materiaagree to being installed.1 new materials icor
the following two reasons:
I,as owner of the property,or my employees with wages as their sole compensation, inspec tion.
will do the work,and the structure is not intended or offered for sale(Sec.7044, Signa ure of Applicant: Date:
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 hay a read the hazardous materials requirements under Chapter 6.9the
Compensation,as provided for by Section 3700 of the Labor Code,for the California Health&Safety Code,Sections 25505,25533,and 25534. 1 I will maintain
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 Safe,y 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
permit is issued. cont iminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall malt Main compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Sa,ty de,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I Owl er ori
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 he eb 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 Y
correct.I agree to comply with all city and county ordinances and state laws relating for,vhich this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address
-nnify and keep harmless the City of Cupertino against liabilities,judgments,
,and expenses which may accrue against said City in consequence of the
g.anting 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 in derstand my plans shall be used as public records.
9.18.
Signature Date Licensed Professional
CITY OF
CITY
OF CUP ERTINO
IsREROOF
CUPERTINO PERMIT APPLICATION
EBuilding
) a Date: � ' V
ress: 'nn , f 2V
¢ /r l Phone #:
g
Ow err's N�am�e: f ��(� ��S
HOA: es ❑ No If es, provide letter from HOA
Contractor: ,' Phone #:
p ��1�
f 1 Fax#:
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles •�' ❑ Wood Shingles
O —
�. ❑ Other (Specify)
Other (Specify)
Number of existing coverings ❑ Provide I.C.C.E.S. Report#
❑ Provide Mfgr. Installation Specs.
To be Removed
-------------------
Job Description:
VN
Residential - Commercial
Green Building: Please complete relevant portion of the Confirmed with Planning t. if
Green Building Checklist & attach it to the application or if there are any restrictions•
a licable, include in plan set & the sheet index.
Valuation: , J -)
I Have Read, Under to 4 and Will Comply with Cupertino's Tear-Off Policy:
_7
Signature
Revised 02/05/09
REROOF TEAR-OFF POLICY
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
ALBERT SALVADOR,P.E., C.B.O., BUILDING OFFICIAL
10300 TORRE AVENUE•CUPERTINO,CA 95014-3255
CUPERTINO
(408)777-3228•FAX(408)777-3333•buildin �Dcupertino•org
Y^ C ( n f APN#
PROJECT D E `[ Yll 1 L-�1
P NF_-S, �� E-MAIL
OWNER NAME
CITY, STATE,ZIP FAX
STREET ADDRESS S �
O LIC SE U ' LICE C�J�TY� BUS.LIC.#
CONTRACTOR NA (� pN ` •J
FAX
E-MAIL
COMPANY NAME /
/ 1 1 ) PHONE
CITYJ P--:,
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STREET A�
I UNDERSTAND AND AGREI TO THE FOLLOWING:
1. The re-roof project shall comply with all applicable previsions 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 Lear-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 — 10:3 dam 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 fora n 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 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 the sheathing so a proper inspection can be
performed.
7. A final inspection and approval shall be obtained froi n the building inspector when the re-roofing is
complete. To receive a final sign-off, the following i gems will be verified:
a. Flat roofs shall have a minimum of per footC esmanufactured products used shalmust demonstrate there l be a s nopailabtl e
lope
b. Listings from approved testing agencies for all p
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 inspection 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 th f flowing is truf: I am the property owner or authorized agent to act
on the property owner's behalf. I and r d and gree to ;omply with the re-roof policy state al�e v
Date:
Signature of Applicant/Agent:
ReroofPo1icy_2010.d6c 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: 1 L E �� PERMIT#
OWNER'S NAME: L 1 Vl Cit. C "it O PHONE# 4 5 l
GENERAL CONTRACTOR: P--pQ BUSINESS LICENSE# _
( CITY/ZIPCODE: 9 J
ADDRESS: ( a
*Our municipal code r quires all businesses working in the pity to have a City of Cupertino business license.
NO BUILDING FINAL OR FINAL OCCUPANCY INSI'ECTION(S) WILL BE SCHEDULED UNTIL THE
GENERAL CONTRACTOR AND ALL SUBCONT CTORS HAVE OBTAINED A CITY OF CUPERTINO
BUSINESS LICENSE. i
I am not using any subcontractors: ure ate
Signat ��
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
Owner/Contractor Signature Date