07100217 CITY OF CUPERTINO � ` ' (� ' '
BUti,DING DIY'ISION PERNIIT 1 .:���`���� ���"�������
, ,.__
PERMIT NO.
BUILD t � v �� r � ESS SHASTA SPRING CT LOS GA'['OS ROOFING 07100217 .
.ER'S NAME: PERMiT ISSUE DATE
SAM KONG P O BO:� 1726 10 30 2007
PHONE: SANITARY NO. CON'CROL NO.
ARCHITECT/ENGiNEER: BUILDING PERMtT INFO
RE—R00 ?, RMV EXSTNG SHAKE & B��c E�.eC►' PLUMH MECH
a o 0 0
i p p LICENSED CONTRACTOR'S DECLARATION ^ ^ ^ ^ T _' � . .^. .^ ^ , _ T^ � � �� Description
; V� I hcrcby affirm Uiat I am licensed undcr provisions o( Chapicr 9(rnmmcncinS -
; z W wiU� Secuon 7000) of Division 3 of thc Busincss and Profcssions Codc, snd my Iicen9e is
�� y in full focce and cf lJ�� �'1.� /�
>�? Licenu CI s Lic. R T. `/T! T � �.
; �, � Datc Con�ractor 4.00 ��� 5 �D
� ARCHITEGTS DECLARATION �
i� Q I undentanJ my ptans shall be used as public meords
�yU
' u. y Liccnsed Pn�fcssionai
� y � OWNER-BUILDER DECLARATION
>' 1 hcrchy alTirm lhat I am cxcmpt (rom �hc Convaaor's Liccnsc L.aw far the
��-, p O following rcason. (Scction 7031.5, Business and Profectiont Code: Any city ar caunty
�,°, � which rcquires a pcnnit to conswc4 al�r, impravc, dcmalish, or repair any stnctmc
? Z} prior u� ��s isc�ancc, a�so rcquircs �hc applicant ror such permii w rIc a signcd su�i , Ft. F�oOi AI'e3 Valuation
�_ � tha� hc is IiccnscJ pursuant to thc pmvisions of thc Conuxtor's Licensc Caw (G7upicr 9 �>�]
� F- (commencing with Section 7000) nf Division 3 of �he Businiss and Pro@ssians Cade) a ,
°, �� that he is eumpt themfrom and the basis Cw the sllegcd eumption. Any violuion oC
Secuon 703 LS by arry applicant (or a pern�it subjecu �he applicant to a civil penalty of ppN Number Oeeupaney Type
not more than fivc hundmd dallars (5500).
❑ I, as owner o[ tt�e property, ar my employces wiW wages u thc'v wlc compenvti�,
willdoihewodc,andthestructureisnoeintendedoroffaedfersale(Sec.7044.Pasines� Re uired Ins ect;ons
and Professions Code: The Canuacwr's Lianse law dors not apply m an owaer of 9 P
prapeny who builds or impcoves thercon, and who daes such wrork himselCar Uuoobh his
own employccs, Qrovidcd that such improvemen�s are not in�e�ed or otfered Cw sal4 i[.
however, the building or imp�ovemen� is sotd within one year of completion, ihe owrcl-
builder will have the burden oC proving t6at he did not build w improve Cor pmpose d
sakJ.
❑ 1, as owner of the propeny, am exclusively cont�acting with licensed contrac�s w
construct the pmjea (Sec. 7044. Business and Profasions Code:)'ILe Cootnads Li-
cense Law docs not apply �o an owner of propeny w6o builds or improves Ihe�em, and ,
who convac�s Cor such projects with a conuactor(s) Gcertsed pursuant to �6e Comnaor's
t.icense Law.
' am uempt undu Sec. . B& P C for this �easan
.,.�ner Date _. ,
WORKER'S COMPENSATION DECLARATION
1 hereby aflirm under penalty of pepury one ot �he folbwing decla��+�+�r
❑ I hsve and will maintain a CertiGcate of Consent to sclf-insure for Workc�s Compen-
sation, u provided fa by Section 3700 of �he Labor Code, for the performance o[ the
work for whieh Ihis pertnit is issucd.
❑ I havc and will maintain Workcr's Compensation Insurana, as rcyuircd by Satim
3'!00 0[ the Labor Codc, for thc pcdormance oC the work for which �his permit it issued.
My Worker's Com Insu e carricr and Poliry num a�� C ��
Cartier. � �CL N-Zv1 � Policy No.: �Il.� �
CERTIFiCATE OF EXEMPRON FROM WORKERS'
COMPENSATION tNSURANCE '
('Chis sectian necd iro[ bc completcd i( Ihe pecmit is Cor anc hundred dollars (SI00)
o� lcss.) '
I ceni(y th�t in thc performancc a( thc worlc Cw which �his permit is iscucd, [ shall oot
employ any person in any mamrcr so u w bccomc mbject tu ihe Workers' Cmupeasauon �
Laws oC Califomia Datc
Applicant
NOTICE TO APPLICAM: If, a(tcr makinE �his CcrtiGca�c o( Ezcmp�ion, you shauhf
become subject to Ihe Worter's Compcnsation provisions af ihe La6or Code, yau mnu
� O forthwilh comply wi�h such provisions or Nis pewnil shall hc dccmcd ccvokc4
z "" CONSiRUCT10N LENDING AGENCY
(� ��-. I hcrcby a[firm that thcre is a consuvction knding agency for thc nerfomun�x a(
p(, � thc wurk fur which ihis pertnit is issucd (Scc. 3097, Civ. C.1
W� Q L.endcr's Namc '
a z Lcnder's Address
(� � 1 ccctifY that 1 have rcad this applieation and s�aic �hat thc abovc informauun is
w � corrcct. 1 agrce to comply wi�h all city and com[y ordinances and state laws ¢IatinE to
0 U building conswttion, and hcmby authori�e reprcunutivcs of ihis city to cmcr upon �hc
� a aAovc-mcntioncd property for inspccuon purposes.
(We) agree to save, indemni(y and kecp harmless ihe City o( Cupertino abaiast
�� liabilitiu, judgmcn�s, cos�s and expenscs w6ich may in any way accruc against said Cuy
U,'� in conzequcnce oC thc gtan(ing of this permiL Da�e �
�'" APPL ANT UNDERSTANDS AND WILL COMPLY WI"I'H ALL NON-POINT Issued by: " 7
S REGULATI S.
J o Re-roofs
Sig urc of Applican�Contractor �
HAZARDOUS MA7ERIALS D[SCLOS(1RE Type of R � )Of
Will �hc applicant or fuw�c building occuparu store ar handlc ha•rardau ma�erial
]cfincd by �he Cupertino Municipal Codc. Chaptcr 9_t2, and the Hcali6 and SaCar
..odc, SccUon 25532(a)? All roofs : hall be inspected prior to any roofing material being installed.
❑ Ya �o
�II the applicant or futurc 6uilding oavpant usc equipmcnt or ticvices �rhic6 If a roof i: installed without first obtaining an inspection, I agree to remove -
cmit harardaus air contaminams as dcGncd by the Bay Arca tir Quality Mana;ewcm all new m: iterials for inspec ;IOCI.
Disuict?
❑ Ya c�
I havc rcaef ihe haiardcn�s maierials rcqurccmcius undcr Chaptcr 6.95 of tioe Cali[or-
LLT � l
niaHeal�hBcSate�yCode.Sections25505,25533aru125534.1undcrsundihatiCthe6w'Idn6 _SC�!/ w l i�i1j/�/�j✓ ���.�d fd�
docs nat curtcntly have a tenan4 that it is my rcsponsibility to noufy �he occupant of �he 'YBl1� a ,,,,�,, --
rc ui cn�s wnich musi mei cior w�ssu ata Cenit�caic of Oc Signature �f Appl icant Date
y ��"" , ' ���J'-�-�'� (° `' � All roof coverings to be Class "B" or better
Owncr or authorizcd ageni �� �
��7��n���
- CITY O]F CUPERTINO
� . �: REROOF
CITY OF
CUPEf�TINO PERMIT AP]'LICATION FORM
A.PN # Date:
�3��G --5g --Oz . c�c� rr��Z� a -�
Building Address: ,� �
/ �' y7 � a
Owner's Nam : Phone #:
`�p'�' Z_ � 2 -- C� � L. �
Contractor: Phone #: License #:
� -� � G� � - �GC� - �Q
Contact: /-, Phone ��: Cupertino Business License #:
�� � �— ` . ��
Type o1 Roof Covering:
E�isting: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ . Asphalt Shingles ❑ Asphalt Shingles
� Wood Shakes � Wood Shakes �,
❑ Wood Shinoles D Wood Shingles � � �' �"`'� '�" �
❑ Other (Specify) ,`� Other (Specify) ��. 1�1 Jn�� 5�;c�� �o il r�r� �«�
Number of existing coverings i �O Provide I.C.B.O. Report #
� To be Removed ❑ Provide Mfgr. Installation Specs. ��
� s 25 , s / � -� „
I Have Read, Unde tand and Will Com 1 With C u e ino's Tear Off Polic :
Job D�scription: �� ..C�� 4-,-�. .��u ` �,�,-,��.�� ���, �- j Y
, ��>�-� ��. .��� ,� �,,���� C.�=� ��, � � - •� ,.
� �!e „ U � � z,, (�:%'�� .4
Residential � Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning D�t. if
there are any restrictions: L�
Cost of Project: Type of Constnzcti �: Occupancy group:
� � � Q .. � �; fi_ � In� F �� ��
Qty. if
A licable Fee ID Fee Descri tion Fee Grou
BPERMFEE Bld Perm.it Fees BUILDING
BENERGY Ener BUILDING �
---- -- _ __ .
/ BSEISMICRE Seismic Fee Res BUII.DING
BSEISMICOM Seismic Commercial BUII.DING
BPLANCHK Plan Check Fee BUII.DING
BUSLIC Business License BUILDING
CITY OF CUPERTINO
2 ITEMS OF 4 PERMI�� RECEIPT OPER.ATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Bll;: Lot:
APN ..... 36t;55027.00
DATE ISSUED.......: 10,'30/2007
RECEIPT #.........: BS()00003121
REFERENCE ID # ...: 07:_00217
SITE ADDRESS .....: 11f373 SHASTA SPRING CT
SUBDIVISION .......
CITY .............. CU]'ERTINO
IMPACT AREA .......
OWNER . .. . . . . ... .. . SP,Pi KONG
ADDRESS ..........: 11f�73 SHASTA SPRING CT
CITY/STATE/ZIP ...: CUI'ERTINO CA, 95014-2672
RECEIVED FROM ....: LO:> GATOS ROOFING
CONTR.ACTOR .......: RAPIDY BROWN LIC # 23481
COMPANY ..........: LO:� GATOS ROOFING
ADDRESS ........... P C) BOX 1726
CITY/STATE/ZIP ...: LO:� GATOS, CA 95031
TELEPHONE ........: (4(�8)298-9399
FEE ID UNIT QUANTITY �S'IOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 11,970.00 191.16 0.00 191.16 0.00
BSEISMICRE VALUATION 11,970.00 1.20 0.00 1.20 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT : 192 .36 0.00 192.36 0.00
� Community Development Department
Building Division
j ' City of Cupertino
10300 Torre Avenue
C �F Telephone: (408) 777-3228
C U P E i�T I N 0 Fax: (408) 777-3333
Building Department
Subject: Re-roofing policy for the Cify of Cupertino
1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be appli �d without first obtainulg all inspection
and written approval from the buildixig inspector. A final inspection and
approval shall be obtained from the b silding inspector when the re-roofing
is completed.
3. All roofs shall be inspected prior to ar.y roofing installation.
4. To receive a final sign off from the City, the following steps are
required:
1) Pre-inspection and/or tear off app�•oval.
2) Tn-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed, a plywood nait inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new ma terial down to the sheathing,
so a proper City inspection can be per:'ormed.
� IMPORTANT
1. Flat roofs must have a min;mum 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 abov�� stated policy on re-roofing.
� Homeowner's Name: � »'L G' �'?
_ _ � �
Job Site Address: ! (-� �� . _ �<� / G� _ . ' ! Yi.
Roofing Company Name: �� � �T;'t�b�S � — 1 /1,(/`
�
A plicant's Signature: Y:u/� Da�e: ICr Z(,� "�
Greg teel
Building Official
RevisE d 1/ 30/ 03
Printed or Recyded Paper
7;`� Community Development
<:
ti� •� } 10300 Torre Avenue
�°R'`'�` Cupertino CA 95014
• Telephone (408) 777-3228
CITYOF Fax (408) 777-3333
C�1PE�TIi��
��il�i:n ��partr��.e�.�
JOB ADDRESS�� "1 � } PERMIT �
� U� �n� �`� o o I�
OWNER'S NAME: . + c` PHONE ,. Z Z-Z� ��
GENEI�AL CONTRACTOR: � ' �- F�X ,# ,2 "- �- - - �.
I am not using any subconixactors: '
Si€ nat �aL2
Please check a licable subcontractors and com le�e the followin�- information:
- SU�CONTRA.CTOR SUSIN ESS NA�E BUSINESS LICE�tSE #
Cabinets & Millwork
Cemenz Finishin g
Elecnical
Excavation
�encing
Flooring: Carpeting
Linolewn / Wood
Glass / Glazing
Heating �
Insulation
Landscaping
La�t].iing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
S.heet Rock
Tile
_ �
�
,
�� � � ��
wne Contractor,Sib ature at