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07100056 CIT��OF CUPERTINO ' ` ' ` BUfLDING DIVISION PERMIT ��1��.�"�'C�� I:��I4.�N+ : .., ; _ ..;:.. :. ; __:. . PERMIT NO. BUIL �� ES �INBOW DR R E ROO ING & CONSTRUCTION 07100056 . OWNER'S NAME: �- PERMTT `LSUEDATE CHANG CHIN C AND MA N 15230 C:�YDELLE AVE 10 05 2007 SANITARY NO. CONTROL NO. �NE: (408)62�-9320 BUiLDING PERMCI'INFO ARCHIT'EGTBNGINEE3t: BLDG ELECT PLUMB MECH � � 0 � i p p LICENSED CONTRACfOR'S DECLARATION JO�I D6SCrlptlOp ; V� I hcrcby affirm that I am licenscd undcr provisions of Chapicr 9(commcncing ,z� wi�hScction7000)ofDi s�on3ofthcBusincssandProkssiu dc,andmyliccnscis REMOVE :�XSTNG 1 LAYER �F COMP, INSTL IvEW 30# ASTM � 6 a in full forc and cffec� ,�"� ;,'�i [,;ce�sc � ��.a �� y FELT AN:J "LIFETIME" COMP, 35 SQS. ' O Datc : F � ARCHITE S D � 7 a e I un crstand y plans shall bc d as � cords )yU ' a F' Liccnscd Pmfcssional ' " ' `� < OWNER-BUILDER DECI.ARATION � �� 1 hcrchy at7rm that I am raccmpt from ihc Cantractor's Liccnsc Law for thc p o following rcason. (Sccaon 7U31.5. Business and Profcssions Cafc: Any city or county i°, Pi which rcquires a permit to cnnswc�, alur, improvc. dcmalish, or repair any svuamc ° Z y prior ui iLt issuancc, alsu tcquires Ihc applicant for such pertnit ta filc a signed sulemcnt V21U8L10❑ =< �hat hc is liccnscd pursuant to thc provisions o( ihc Comractur's Liccnse Law (Chaptcr 9 iq. Ft. Floor Area � F� (commencing wiih Secdon 7000) ot Division 3 of Ihc Businrss and Profcuions Cadc) or $14 5 0 0 y�� that he is ezempt thcrefrom and Urc basis for the allcgcd eumpuon. Any violauon oC Section 7031.5 by arry aQplicant for a permit subjecu ihe applicant to a civil penalty of Number Occupancy Type not more than fivc hund�cd dollars (5500). 3 6 6 5 1 0 � 3�� ❑ i, as owner of Uie proper[y, a my employces with wages u the'v solc compensation, will da thc wock and Ihe stcuctme is notintended or aRered for salc (Sec.7044. Business Required Inspections and Professions Cade: The Conuacwrs License Law does nat apply w an ownu of propeny who builds or improves Uurcon, and who doos sucA work himselCor thcougd his own employces, providcd that such improvemrn�s are not iniendeA or o[tered for sala If, however, the building or improvemmt is sold within one year o[ compledon, the owna- builder will have the burden o[ proving tha� he did not build ar improvc for purpose of sa� J. ❑ I, as awner o[ the propeny, am ezclusively convacting with ticensed convxtors w construa ihe project (Sec. 7044. Business and Profcsaons Code:) The Contnctn�s Li- cense Law does not apply �o an awner of propeny who builds or improves IAereon. and . who contrac�s Cor sucfi projects with a contractor(s) Iicensed pursuant w Uu Convactor's License Law. ❑ I am ezemp� under Sec. . 8& P C far thia rcason Owner Date „ _. WORKER'S COMPENSAI'ION DECLARATION 1 tureby aflirm under penalty of perjury one o[ We fallowing declaratioas: ❑] hsve and will main�ain a Cenifcate of Consent to selt-insme for Worircrs Campen- satian, az providcd for 6y Section 3700 af the Labor Code, for �he perfarmancc af Uu work fgr which Ihis pertnit is istued. D:I havc and will maintain Worker's Compensatian Insunnce, u required by �'on of thc Labor Codc, for e performanu of �he work (or which �his permit' ued. My Worker's-Compensatia urancc rticr and Poliry nu r arc: i � Carrier. � Polity No.: � -� ICATE OF EMPT[ON FROM ORKERS' COMPEN ATION INSURANCE (This sectian necd not bc com Ietcd if the permit is for anc hundred datlazs (S l00) orlcssJ ' � I ceni(y thas in thc performance of the worlc Cw which Wis pertnii is issucd, l sAall not employ any person in any mannc� so as to becomc wbjcct to the Workcrs' Compensation Laws of Califomia. Date Applicant NOTICE TO APPLICAM: lf, aftcr making �his Ccrtilica�e of Ezcmption, you should become subjcct ta ihc Workcr's Canpensation provisions of thc La6or Codc, you must � O forthwith comply with such pravisions w this permi� shall bc dccmcd rewkcd. z "" CONSTRUC'f10N LENDING AGENCY ��-�. I hercby afirm U�at there is a consuuction Icnding agency (ar the performancc uf . a� ihc work fur which �his permit is issucd (Scc. 3097, Civ. C.) W Q Lendcr's Narnc ' a z L.cnder's Address V � t certify that 1 havc rcad this applieation and siatc iha� thc a6ovc infocmauun is �� cortcct. I agree �o comply with all city and county onlinances and sute laws relating w � U buildiag conswction, and hctcby auihori�e represcntativcs of this city to cntcr upon thc � a atwvc-mcntioncd property for inspccuon purposes. (Wc) agrce to save, indcmnify and kcep harmless the City of Cupertino againse „F'"„� � liabilitiu, judgmen�s, costs and expenses which may in any way accruc against said City V,'� in consequencc aC thc granting of Utis permit. � ►� APPCI�'A T UNDERSTANDSSIP( L COMPLY WI LL ON- INT Issued by: Date :-,f`-� � ; SOURCE. UL . � t � Il � ,•' �� Re-roofs ��' �, Signa rc u UConuac D°� T of Roof r --� #�ZkR�US MATERIALS DISCLOSURE }�� Wil( Ihc applicant or future building accupant storc or handlc harardous tcrial u defincd by Ihe Cupenino Mumci 1 Cadc. Chapter 9.12. md the Hcal�h and SaCcty coa� Scction 25532(a)? All roofs �hall be inspected prior to any roofing material being installed. ❑ Y� WiII thc applicant future building occupant usc cyuipmcn� or cicviccs which If a roof i� installed without first obtaining an inspection, I agree to remove • emii harardous air contaminants az dcfincd by the Bay Area Air Qualiry Managcment all ttew m aterials for inspection. District? .• �� / ❑ Ycs ❑ Nu , _.. _ � � � _ � L n - ' l � U� I havc rea�i the haiarGou atcrials rcyuircmcntt umicr Chap�cr 6.95 of thc Cali[oe � �� 1.��- nia Hcalih & Safcty Codc. Sc 25505, 25533 and 25534. I undcrstand U�at if ihc 6uilding'. ,� �. , � ocs rten}L� have a nanl � µ' my respansiAility to noul'y �he occvpant of �hc ' --t" ' rc • �c '"etn tpd�rw� uance [aCcniGca�co!(�k , � Signature ofApplica�it Date � -- f 1 oW��a��nort�a�p�-' p„� All roof coverings to be Class ��F3�� or better o o c� �� t� CITY OF (:UPERTINO ' .�` RE�ZOOF CUp��T�NO PERMIT APPLICATION FORM APN# �� t �' � ��. � � Date: �� P � Building Address: � � � ( u /�� ' `� ,�� p -� ��`. Owner's Name:�� I � „ �� Phone #:' ] �` _ �y� _ � I j � � �T f5 Contractor� r � License #: � 2 �� q , � �«�,� � C�,J �T-►2w�;;� � , � Cupertino Business License #: Contac � Cl� l �, � 12cl� I�1L. :;Z U 1`� Type of Roof Covering: Eatisting: Proposed: ❑ Built-Up Roof ❑ Built-Up roof � Asphalt Shingles � Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Nuinber of existing coverings 0 Provide I.C.B.O. Report # � To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Com ly With Cu �ertino's Tear Off Policy: Job Description: - �1 � l,qtit � c�F �c� P. 1�V a'(qc� �l�Lv 3� '��,�n� i,�iki i l , � r —�ti��" C�r' �5 ;, -. �S� M ��;�., ►'. Residential Commercial ❑ Fire Zone: Yes ❑ No Confirmed with Planning Dept. if � there are any restrictions: U Cost of Proj t: �� Type of Constru�,tion: Occupancy group: I'-��a , Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BLTILDING BENERGY Energy BUILDING / BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BLTILDING Community Development Department ' Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 Fax: (408) 777-3333 Building I)epartment Subject: Re-roofing policy for the City of Cupertino 1. Prior to permit issuance, you must agref� to comply with 1997 UBC Standards and manufacturers specifications on re-�•oofing. 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 bui= ding 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 appro�al. 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 matE�rial down to the sheathing, so a proper City inspection can be perfc rmed. 7. NOTE: If you call for a plywood nail irspection and the job is not ready, you will be charged a re-inspection fee ��f $176.18. The re-inspection fee must be paid before another inspection can be scheduled. IMPORTANT 1. Flat roofs must have a minimum of 1 /4 " per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be on the job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: r � � � � r ; � `� � � — Job Site Address: � � ��' �' � �� ' i �C . Roofing Company Name: � � , �v' � �'� � � � �� -----r---� '" � - �� , Applicant's �gnature: j � ��..-� - �'-�� ---------- Date: � I � � '� - Greg Casteel Building Official Revised 11/2/04 CITY OF �UPERTINO � 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN .... ..... 36651008.00 DATE ISSUED.......: 10/05/2007 RECEIPT #.........: BS000002909 REFERENCE ID # ...: 07100056 SITE ADDRESS .....: 21350 RAINBOW DR SUBDIVISION ....... CITY .............. CUFERTINO IMPACT AREA ....... � OWNER ............: CHFNG CHIN C AND MA N ADDRESS ..........: 21_'50 RAINBOW DR CITY/STATE/ZIP ...: CUF'ERTINO CA, 95014-4978 RECEIVED FROM ....: R E; ROOFING & CONST CONTR.ACTOR .......: PRC�CTOR, PAUL LIC # 20615 COMPANY ..........: R E: ROOFING & CONSTRUCTION INC ADDRESS ..........: 15�30 CLYDELLE AVE CITY/STATE/ZIP ...: SArf JOSE, CA 95032 TELEPHONE ........: (4(i$)626-9320 FEE,ID UNIT QUANTITY ��MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- -- BPERMFEE VALUATION 14,500.00 223.56 0.00 223.56 0.00 BSEISMICRE VALUATION 14,500.00 1.50 0.00 1.50 0.00 ----------- ---------- ---------- ---------- TOTAL PERMIT : 225.06 0.00 225.06 0.00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 225.06 #11409 --------------- TOTAL RECEIPT : 225.06