09070119 77777777777777..
CITY OF CUPERTINO
BUILDING DIVISION PERMIT 0RTICID.
BUILDING ADDRESS: PERMIT NO.
7513 LEEDS AVE K H ROOFING09070119
-1vNER'S NAME: PERMIT ISSUE DATE
T A T v TA[)L1-TL FuORC SEP
PHONE: SA R CONTROL NO.
(408) 2.93-2754
ABUILDING PERMIT INFO
RCHiTECT/ENGiNEER:
BLDG ELECT PLUMB MECH
(_ (�
u pQ LICENSED CONTRACTOR'S DECLARATION Job Description
U 51 hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z m with Section 70()0)of Division 3 of the Business and Professions Code,and my license is
in full force and effete t. RE-ROOF TEAR 0 F F WOOD SHAKE, BUILD DECK BY 1/2
a
D124 License Class �- Lic. .
Date ^' *�" Contractor t' OSB PLYWOOD 15LB FELT 40YR COMP CLASS A 18
NW ARCHITECTS DECLARATI N
3 I understand my plans shall be used as public records SQUARES
DA.WU
i u.E' Licensed Professional
n y, OWNER -BUILDER DECLARATION
1 hereby alThrn that 1 am exempt from the Contractor's License Law for the
p O following reason.(Section 7031.5,Business and Professions Code:Any city or county
m which requires a permit to construct,alter,improve,demolish,or repair any structure
prior 10 its issuance,also requires the applicant for such permit to file a signed statement
Cthat he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 3q.Ft.Floor Area Valuation
t- (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $6000
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mom than fire hundred dollars(M). 36616019 . 00
0 I,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(See.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of Il p
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements arc not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that be did not build or improve for purpose of
sale.).
0 1,as owner of the property.am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
0 1 am exempt under Sec. B&P C for this reason
verDate
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 I have and will maintain a Certificate of Consent to self-insure for Worker's Compcn-
sation,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 Workers Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Carrier _�-Zvw/) Policy No.;--X sus_i +
CERTIFICATE OF EXEMPnON FROM OW RKERS-
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or Icss.)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date—
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Code,you must
,J O forthwith comply with such provisions or this permit shall be deemed revoked.
z h CONSTRUCTION LENDING AGENCY
[~t ham+ I hereby affirm that there is a construction lending agency for the performance of
LY �✓ the work for which this permit is issued(Sec.3097,Civ.C.)
W ALender's Name
z Lenders Address
V C) I certify that I have mad this application and state that the above information is
[L" correct.1 agree to comply with all city and county ordinances and state laws relating to
0building construction,and hereby authorize representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes
11, (We)agree to save,indemnify and keep harmless the City of Cupertino against
fn liabilities,judgments,costs and expenses which may in any way accrue against said City
V z in consequence of the granting of this permit. Date
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIONS.
Re-roofs
Signature of Applicant/Contractor Dam Type of R sof
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
4e,Section 25532(a)? All roofs:;hall be inspected prior to any roofing material being installed.
0 Yes RNo
If a roof i:;installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new In iterials for inspection.
District?
0 Yes ZNu
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safcty Code,Sections 25505,25533 and 25534.I understand that if ttc building
docs not currently have a tenant,that it is my responsibility to notify the occupant of the
requirements which must be met prier to issuance of a certificate of occupancy. Signature of Applicant Date
All roof coverings to be Class'A"or better
Owner or authorized agent Date'
CITY OF CUPERTINO
3 ITEMS OF 3 PERMI RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: B1}:. Lot:
APN . . . . . . . . : 36616019. 00
DATE ISSUED. . . . . . . : 07/14/2009
RECEIPT #. . . . . . . . . : BS000008192
REFERENCE ID # . . . : 09070119
SITE ADDRESS . . . . . : 75_.3 LEEDS AVE
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : TA::, CHAO CHIEH
ADDRESS . . . . . . . . . . : 75:.3 LEEDS AVE
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5260
RECEIVED FROM . . . . : MH N TRAN
CONTRACTOR . . . . . . . : KHFNH TRAN LIC # 26971
COMPANY . . . . . . . . . . : K Fi ROOFING
ADDRESS . . . . . . . . . . : 1556 LITTLE ORCHARD ST
CITY/STATE/ZIP . . . : SAP1 JOSE, CA 95110
TELEPHONE . . . . . . . . : (408) 293-2754
FEE ID UNIT QUANTITY hMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- - --------- ---------- ---------- ----------
1BCBSC VALUATION 6, 000 . 00 1 .00 0. 00 1. 00 0 .00
1BSEISMICR VALUATION 6, 000 . 00 0 .60 0. 00 0 . 60 0 .00
1REROOFRES SQ FEET 18 . 00 234 .00 0 . 00 234 . 00 0 . 00
--•-------- ---------- ---------- ----------
TOTAL PERMIT 235 .60 0 . 00 235 . 60 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 235 .60 master card
---------------
TOTAL RECEIPT 235 .60
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF CUPERTINO
k REROOF
CUPEkT1NO PERMIT APPLICATION
cl
APN # oO Date: C -� r O
q.Building Address: 7-5 2. -I
Owner's Name: .-T,4 i C_ q A U C 141EN Phone#:
HOA: Yes ❑ No ❑ If yes, provide letter from HOA
Contractor: _ Phone #:L/v
� n Fax #: 110 Y' 3-05 e
Cupertino Business License #: Contractor License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles $, Asphalt Shingles
>0_' Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) ❑ Other (Specify)
Number of existing coverings ❑ Provide I.C.C.E.S. Report#
To be Removed ❑ Provide Mfgr. Installation Specs0/7 .
Job Description: J-C'_rrk Q^t �Upv ,/� - �a �' �G'/C C�Sf� vW fl
Residential Commercial ❑
Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if
Green Building Checklist & attach it to the application or if there are any restrictions: ❑
applicable, include in plan set & the sheet in&ex.
Valuation:
�j 000
I Have Read Under tand and Will Comply wits_ Cupertino's Tear-Off Policy:
61 ; /21
Signature
Revised 02/05/09
CITY OF CUPERTINO
RE,ROOF
CUPEkTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commis,,ion Fee
1BSEISMICO Seismic Commercial B
1 CJ IREROOFRES Re-roof Residential B 1SFDWLR00F
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commis.,ion Fee
I 1BSEISMICRE Seismic Residential B
1 REROOFMRES Re-roof l✓Iulti-Family B 1MFDWLROOF
1BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commis:ion Fee
1BSEISMICRE Seismic Residential B
1 BUSLIC Business License B
Community Development Department
Building Division
City of Cupertino
10300 Tone Avenue
Telephone: (408)777-3228
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 2007 IBC Standards
and manufacturers specifications on ie-roofing.All roofs are Class "A"per Cupertino
municipal code 16.04.080.
2. New roof coverings shall not be applied without first obtaining all inspection
and written approval from the buildntg inspector. A final inspection and
approval shall be obtained from the building 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 Ciiy,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 nail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of all new material down to the sheathing,
so a proper City inspection can be pei-formed.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$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/ "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: �1 - �� 14 AU C *1 E
Job Site Address:
Roofing Company Name: 1220
Applicant's Signature: ' �" Date:_�� 41, U�
C--
Greg Casteel
Building Official
Revi:,ed 07/30/08