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13090139 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10110 WESTMINISTER CT CONTRACTOR:WING'S ROOFING INC PERMIT NO:13090139 OWNER'S NAME: CUIPING WU 3243 SYDNEY WAY DATE ISSUED:09/18/2013 OWNER'S PHONE: 6266881108 CASTRO VALLEY,CA 94546 PHONE NO:(510)889-9068 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL COMMERCIAL License Class L' Lic.# (26 SQ'S)TEAR OFF(E)WOOD.SHAKE,INSTALL(N) OSB,ASPHALT SHINGLE(CLASS A) Contractor ` Date I hereby affirm that I Iam 1 censed under the provisions of Chapter 9 (commencing with Sectio 7000)of Division 3 of the Business&Professions 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. Sq.Ft Floor Area: Valuation:$8800 I have and will maintain Worker's Compensation Insurance,as provided for by ti n 3700 of the Labor Code,for the performance of the work for which this APN Number:34212113.00 Occupancy Type: permit is issued. APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS F T ED INSPECT ON. indemnify and keep harmless the City of Cupertino against liabilities,judgments, / costs,and expenses which may accrue against said City in of the Issued Date: granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Co e,Section 9.18. Q RE-ROOFS: Signature Date O All roofs shall be inspected prior to any roofing material being installed.If a roof is installed without first obtaining an inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Signature of Applicant: Date: ` I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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(Sec.7044, Business&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Secti ns 55 ,25533,and 25534. 94Z�� Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: DatE: permit is issued. 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 Worker's CONSTRUCTION LENDING AGENCY Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address 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 ARCHITECT'S DECLARATION indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date r REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION 0\ 10300 TORRE AVENUE•CUPERTINO,CA 95014-3255Lai O (408)777-322&'TAX(408)777-3333•building a.cupertino.org CUPERTINO.. PROJECT ADDRESS �� I I /�1 We-Simf ( w C[ _7N# 3 q ' 2- ( 2 OWNERNAME 1�I r i 6/I PHONE/_ E-MAIL STREET ADDRESS DVI Il0 I f (/l�rx L's+W ��. rFY, STATE,ZIP -f Ko O` FAX CONTACT NAME ! V`J ,�j+CJr PHONE / -/1 E-MAIL STREET ADDRESS CITY,STATE,ZIP ❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT CONTRACTOR NA E i %�/ LICENSE NUMBER` (� ` LIC144SE TYPE BUS.LIC.# COMPANY N , ! C/ MAIL a t FAX II'l, c STREET AD RESS CITY,STATE,ZIP_, .,O `/ /y HO ARCHITECT/ENGINEER N E LICENSE NUMBER( ' V `� BUS.LIC.# COMPANY NAME E-MAIL FAX STREET ADDRESS CITY,STATE,ZIP PHONE USE OF ❑ SFD or Duplex ❑ Multi-Family ROOF AREA: VALUATION: �� i1 STRUCTURE: ❑ Commercials V EXISTING ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY) REMOVE/REPLACE ❑YES IF NO, PLYWOOD 0 ,/.- 11PLYWD ❑OSB PITCH: ROOF ❑NO 1 #LAYERS: THICKNESS: ❑5/8" TYPE: ❑CDX :12 CLASS: A PROPOSED ROOF TYPE: ❑BUILT-UP ROOF ❑ASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER ICC-ES REPORT# DESCRIPTION OF WORK: " 'eV By my signature below,I certify to each of the ollowing: I am the property owner or authorized agent to act on the property owner's behalf. I have read this application and the information I have provide is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to bu ng c traction. I authorize representatives of Cupertino to enter the above-ident led prop rty for inspection purposes. f Signature of Applicant/Agent: Date: SUPPLEMENTAL INFORMATION REQUIRED be sa If building is associated with a Home Owner's Association,provide letter R<..a_ CE ,. oltrn�1111' of approval from HOA. vR-T sulLnmr LAnt Provide Planning approval to verify Tfthere any restrictions. xrizE '� iiiEVIE Provide copy of Manufacturer's Installation Specifications. T �' Provide signed copy of Cupertino's Tear-Off Policy. „ ReroofApp_2011.doc revised 03116111 CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION M' ADDRESS: 10110 WESTMINISTER CT DATE: 09/18/2013 REVIEWED BY: MELISSA APN: 342 12 113 BP#: "VALUATION: 1$8,800 *PERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Du lex PENTAMATION 1SFDWLR00F USE: P PERMIT TYPE: WORK 26 SQ'S TEAR OFF E WOOD SHAKE INSTALL N OSB ASPHALT SHINGLE CLASS A SCOPE FEE ID ROOF AREA s.f. 1REROOFFRES 2,600 r ukr llech. flan(.heck Phimb.Plan Check Elec.Plan(.:heck Nlech.Permit Fee: Plumb.Permit Fee: Flec. Permit Fee: Other alech.Insp. ether Plumb Insp. Li Other Flet.Insp. Ll ;t tech.Insp.I,ce: Plumb. Insp.Fee: Elec.Insp. Fee• NOTE:This estimate does not include fees due to other Departments(i.e.Planning,Public Works,Fire,Sanitary Sewer District,School District,etc.). Theseees are based on the relimina information available and are onlyan estimate. Contact the Det or addn'l info. FEE ITEMS(Fee Resolution 11-053 E . 7/1/13) FEE QTY/FEE MISC ITEMS Plan Check Fee: Suppl. PC Fee Plumb.1 fechJElec Permit Fee: $416.00 Suppl. Insp Fee Plumb.iiVech./Elec Plumb,A.Wech.%Islec Permit Fee: Construchon Tax: Administrative Fee: Work Without Permit? ®Yes (E) No $0.00 Advanced Planning Fees: Travel Doc:urnentation Fees: i Strong Motion Fee: IBSEISMICR $0.88 Select an Administrative Item Bldg Stds Commission Fee: 1BCBSC $1.00 mVNii µ ;k $417.88 $0.00 _ ., ur_ $417.88 Revised: 08/01/2013