07100218 CIT�' OF CUPERTINO '
BUIi.DING DIVISION PERMIT �����T�� ����������*. :
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PERMIT NO.
BUILDI ADDRESS:
�7�78 NORMANDY WAY LOS GA'COS ROOFING 07100218 �
PERMIT LSSUE DATE
nR'S NAME:
LING SU P 0 BO:� 1726 1 30 2007
SANITARY NO. CONTROL NO.
PHONE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: RE , RMV 2 LAYERS EXSTN
BLDG ELECT PLUMB MECH
� � 0 �
i p p LICENSED COt1fRAC1'OR'S DECLARAI'lON 3 '
; � F.. [ hcrcby afGrm thai I am licenscd undcr provisions o(Chapicr 9 (commcadne ^ ^^ - , ^ ^ ^^^ ^ ^^- ^ ^ -�o���rip�on
; Z� with Section 700(T) ot Divicion 3 of ihc Business and Profcssions Codc. and my licaac is
�� 0 . in full Corce and cf[ec a �
�� z Licensc Ia L�. #
^� p Da�c Conuactor
: ~ � ARCHI'fECI'S DECLARATION
i a
a 1 undcrswnJ my plans shall bc used as public recorcls
)yU
' u. y Liccnsed Pn�fcssional
: a a OW NER-BUILDER DECIARATION
j a� 1 hcrcby at7rm �hat 1 am cxcmpt from ihc Coniraaars Liccnsc Law far mc
. p O following rcason. (Sccuon 7031.5, Busincss and Profcssions Cadc: Any ciry or oosty
�$� which rcquires a pertnit to conswct, alter, improvc, demolich, or repair any stcoame
? Z y, prior w ils issuancc, alsu rcquires ihc applicant for such permit to filc a signcd sulr�em � Ft. Floor Area Valuation
< that hc is IianscJ pursuant to thc provisions oC thc Conuactor's Li��ensc Law ((7►ap�er 9 �] •
� F� (commcncing wiih Scction 7000) of Division 3 aC Ihc Busincss and Profcssians Cade) ar �
,�, �� that he is ezempt the�cfrom and the bazis (or �e allegcd eumpdon. Any violuiae d
Section 7031.5 by a�ry applicant for a peemit subjecu �Ae applicant to a civil pwty af APN Number Oeeupaney Type
not more thm five hund�cd dallars (5500).
❑[. u owner ot ttie property. or my cmployces with wages u their solc comp�.
witldatheworkandthesuuauceisnotintendedoreffecedfersale(Sec. Required Inspeetions
and Professions Cade: The Conuactors License Law does not apply w an oree d
property who huilds or improves thercon, and who does such work himself ar thma6h Yt
own employces, provided that such improvements are not inlended or otfered fara� I[
however, the building or improvement is sold within onc year ot compleuon, ihe a��-
builder wil! have the burden of proving that he did not build or improvc for pucpo� d
sale.).
❑ 1, as awner o( the propetty, am uclusively conuacting with ticensed coouacros b
conswct the project (Sec. 7044. Busineu and Pro(essions Code:) The Contracmrs I�-
cense Law docs oot apply to an owner of property who buitds or impmves thneos. sd .
who convacts for such pmjects with a conuactor(s) licensed pursuan[ w �he Co�auaf s
License Law.
vn exempt under Sec. . B 8c P C far Wis naso�
....na Date _ .
WORKER'S COMPENSATION DECLARATION
I hereby �rm under penalty of perjury one of the following declan�ia�
❑ t hs.�e and will maintain a CeniGcate oC Conunt to self-insure for Worker's Cmpeo-
sation, as providcd for by Secrion 3700 of Uu Labor Code, for tAe pe6armarce d drc
work for which this pertnit is issued.
❑ I have and will maintain Workers Compensation Insuancc, az rcquired by SecW ,
3700 oC Ure Labor Codc, for ihc pertormancc of �he work for which �his pc�mit is iair�.
My Workers Com ensa' n Insu nce carricr and Poliry num r are: p -�,
Cartier. � � � Paliey No.: �� a a� p�
CER7'IFICA7'E OF EXEMPI70N FROM WORKERS'
COMPENSA'C10N INSURANCE
(Chis scctian need not be completcJ if the permit is for anc hundred dotlaa (SIU0)
or Icss.)
I ceniCy thxt in �hc performance of ihc work for which this permit is issucd. l shall sat
employ any person in any manncr so az ta bccomc subjcct to the Workers' Compr�mion
Laws of California. Datc
Applicant
NOTICE TO APPLICAM: If, ahcr making �his Ccrti[icatc of Excmp�ion, you �aula
becane subject to lhe Worker's Compensadon provisions of the Lalwr Code, �w �st
� O fortAwi�h comply wi�h such provisions or this pccmil shall bc dccmcd rcvakcd.
Z "" CONSfRUCT10N LENDING AGENCY
H ��-. 1 hereby a�rm that them is a conswcuon Icnding agc�rcy Cor the perfamanez af .
�„/ �� work (ur which �his permit is issucd (Scc. 3097. Civ. CJ ,
W Q Lendcrs Narnc
� z L.cnder's Address
(� � 1 certify ihat I have rcad this applieation and s�atc ihat ihc abovc in(amatioo is
�►� cortcc� 1 agree �o comply wiU� all ciiy and counry ontinances and sute laws refau� �o
rJ U building conswction, and hcrcby authome represcntativcs of lhis city to cmcr upoa �6c
W ahovc-mcntioncd property fot inspccuon purEwses.
�'' � (Wc) agree to save, indemnify and kecp hartnless ihe City of Cupertino agai�t
H � liabilitia, judgments, cos�s and ezpeascs which may in any way accnu agaiatlsaidGry
(� z in consequence of �he granting of this permi� Date
� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-P(?II�f� Issued by: � �U ��
S U E REGULATI NS.
��� �� �,�,e. `0�3d� Re-roofs
�gn of ApplicanUConUaclor T of R�of � �_'
HAZARDOUS MA'CERIALS DISCLOSURE YPe
Wi►1 ihc applicant or Cuturc building occupant storc or handlc haiardoac maarial
:fincd by thc Cupenino Municipal Codc. Chapter 9.12, and �he Hcalth �asl Sateq
_. .ic, Scction 25532(a)? All roofs :�hall be inspected prior to any roofing material being insialled.
❑ Ycs �'�o .
Will ihc applicant or futurc building occupant ux cyuipmcnt or dcvica s6ich
If a roof i:; installed without first obtaining an inspection, I agree to remove
cmit harardous air contaminan�s at dc6�d by the Bay Arca Air Quality M��encat all new m 3terials for inspecr.ion.
D�s�;«�
❑ Y� e�
t havc rcui Uu ha�ardcws maicrials rcquircmcnts undcrChaptcr 6.95 uC�cCaliCar-
nia Hcalth & Safcty Code, Secuoas 25505, 25533 and 25534.1 undcrs�and �hatiCrhe L �/�j6 C7 �
docs noi urtcnAy havc a �cnant, ihat it is my rcsponsibitity to rrotify ihc oon�paat�oftle �' � �/L�� — 1 7
�cy n�s which must bc t prior a issu ot a Ccnificatc of Oc Sign ure of Appl icant Date
,J ,;�2� l U 3G G" All roof coverings to be Class "B" or better
Owncr r authori•r.cd agcnt
pl�` �� l � c� Z� �'
�/�� , ��j , � ( � ��
- \ 1 ' � /"1
� �� t . CITY OF �,.UPERTINO
RE 1�00F
CuPEt�T�t�O PERMIT APPI,ICATION FORM
APN # Date:
(�G� " '� — U l� �---� �� 2 � Q /
Building Address: /
� �r�r� �
Owner's Name: ��� Phone #��� ��� � �� �
Contractor: , _ License #: �,
� G-�� � S � G� /Cf �
Contact: Cupertino Business License #:
` ��fi'��� i c� �?
Type of F:oof Covering:
Ezisting: Proposed:
❑ Built-Up Roof _❑� roof
� Asphalt Shingles �` Asphalt Shingles
Wood Shakes � ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) � Other (Specify) ��d S�
Number of existing coverings Z. ❑ Provide I.C.B.O. Re ort #
� To be Removed � ❑ Provide Mfgr. Installation Specs. ��
I Have Read, Understan and Will Com 1 With Cu ertino's Tear Off Polic : ,
Job Descrj�tion: '' r�' � 7 /� �
v� Z.. ,�dr�I.x � . �� �Z--t .,
� r v'
�'�- �'' / ,�,� '. �`� � , ..,�,� � � �L.- ��
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning De�t. if
there are an restrictions: LJ
Cost of Proje�ct: �� Type of Constru�;tion: Occupancy group: �
_' , � o -P' n F � �� � �
Qty. if
A licable Fee ID Fee Descri tion Fee Grou
BPERMFEE :31d Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
CITY OF CUPERTINO
2 ITEMS OF 4 PERMI'[' RECEIPT OPER.ATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Bl.t: Lot:
APN ...... 36�17062.00
DATE ISSUED.. 10/30/2007
RECEIPT #.........: BS)00003121
REFERENCE ID # ...: 07L00218
SITE ADDRESS .....: 7578 NORMANDY WAY
SUBDIVISION .......
CITY .............. CU?ERTINO
IMPACT AREA ....... •
OWNER ............. LI:JG SU
ADDRESS ..........: 7518 NORMANDY WY
CITY/STATE/ZIP ...: CU?ERTINO CA, 95014-5223
RECEIVED FROM ....: L03 GATOS ROOFING
CONTRACTOR .......: RA:1DY BROWN LIC # 23481
COMPANY ..........: L03 GATOS ROOFING
ADDRESS ..........: P �� BOX 1726
CITY/STATE/ZIP ...: L03 GATOS, CA 95031
TELEPHONE ........: (4)8)298
FEE ID UNIT QUANTITY .�'IOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 8,364.00 158.76 0.00 158.76 0.00
BSEISMICRE VALUATION 8,364.00 0.90 0.00 0.90 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT : 159.66 0.00 159.66 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- ---------------� ----=-_--------------
CHECK 352.02 #2551
---------------
TOTAL RECEIPT : 352.02
� Community Development Departrnent
Building Division
�� � � Ciry of Cupertino
10300 Torre Avenue
CITY �F Telephone: (408) 777-3228
C U P E t�,T I N 0 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 1997 UBC Standards
and manufacturers specifications on �•e-roofing.
2. New roof coverings shall not be appL ed without first obtaining all inspection
and written approval from the buildilg inspector. A final inspection and
approval shall be obtained from the � uilding inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to a�ty roofing installation.
4. To receive a final sign off from the Ci .y, 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 na il inspection is required.
6. Any roofing which is applied withou : first obtaining an inspection,
will require the removal of all new m.�terial down to the sheathing,
so a proper City inspection can be pe��formed.
IMPORTANT
1. Flat roofs must have a m;n;mum of 1 /9 " per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be ozi the job site at the time on inspection.
I understand and will comply with the abo��e stated policy on re-roofing.
Homeowner's Name: �
�
Job Site Address � > G"L `. ` L
Roofing Company Name: .C, Q.%� �UD7 //'2-�'
� �� .
A plicant's Signature: � %ti Date: 7 G7
Greg teel
Building Official
Revi:�ed 1/30/03
Printed c m Recycled Paper
�-,��;.* Community Development
�� � a ���. � 10300 Torre Avenue
;•a�� Cupertino CA 95014
:.:�� .
� Telephone (408) 777-3228
CITY OF Fax (408) 777-3333
�UPEI�TINO
�uil�in De artn�ent
JOB ADDRESS: PERMIT �
r�� �n � / � � � � `11 Dc�� I �
OWNER'S NAME: '� � PHONE � G�� 6 S G, j
GENEI�AL CONTRACTOR , �- - � ' � FAX # � �` Z y �-: Li .3 ' ..7
n '
I am not using any subcontractors: � '' ��� �
Si;;nafure t
Plea�e check a licable subcontractors and com �lete the followin� information:
- SUBCONTRACTOR BUSII�fESS NA�IE SUSINESS LICENSE #
Cabinets & Millwork
Cement Finishin.g
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating �
Insulation
Landscaping
Lathing
Masonry
Ornaznental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
�
r � . , �� /��'/ 3G` ��
er/Contractor Signafure D t�