06040127 CITY OF CUPERTINO 41- ."� ..
9UILDINc;bv)S)ON PERMIT coPJTRACTO 4WORM/A1IE)I� .i'
BUILDING ADDRESS: LOS GATOS ROOFING PFR""No.06040127
10779 BROOKWELL DR
OWNER'S NAME PEaMrI ISSUE DATE
LI-ERH WANG 888 FAULSTICH CT 04/21/2006
ONE: SANTrARY NO. CONTROL 60.
(408) 298-9399
ARCFiITECT/ENGINEFA BUILDING PERMM INFO
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1 0 LICENSEDCONTRACTUR'SDECLARATION JobDescrition
f 1 h=bl aRhm tW I ro li¢m.9 neck,pm a Clupm 9(co .InG P
win Soman 70DO)of DM&n30(thc Buvxu and Rafa"nu Codo,tool my lkcne 1.
X inmufoxcc a REMOVE EXISITING WOOD SHINGLES . INSTALL 7/1611 O
'•�� uaaC.a Lk'` -- & ROOFERS SELECT FELT. INSTALL 30 YEAR COMP.
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OW NFR-BUILDER DECLARATION
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o o falbWint nxsaa(Sntim 7031.1.3,Bvinev W Pm(mWm CahAciy:My my«cocvumy
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_z>- petr o N iuwnca Wo ltglnrty lhe,ppkan for wch pumit to fik,.ipned.utvnrnt
W nze pna
u lkciarit want ooys=of tot,c«anw
c •,L crosc Uw(CG,pm9 Sq.F[. Floor Area Valua[i
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_ inn bo a awp.tbo fmm artd the bub for tho afleted e. 1ti m My vWlat{en of
S«1rm17M"bytoryapphcwf«apmmitmbjecuthcappl toaciAI"hyof 3APN[lattllber Occupancy Type
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however,the W iWint«bnpoK�rcaa Ia wid riW n arc yev NampkWm,ma awu-
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cane lar d«a Inc•P,I,m u_weer of prapery Who W LIN or irni3Os theimo,W
rho'omen f«web pojxn with,mmracnU)Ikanzd'mous in the Coov $
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WORKERS COMPENSATION DECLARATION
I bmeby,nW Imhr pc^ity of perjury uric of the follmvint deGltotolme
1tiK WWinl forbypaCWBon of Cammn,sold-Invertf«3YUM1Ki of too
&m• r pmvitroU fp by Seetoi )7Lp of Uc Lab«Code,(«ale prfonrun¢ar the
bloat far Which this perinit is lvocd. '
1 have and v ill min Wn Wartrfs Compmadon Inmi .u nydred by Savo. .
3700 of lbs lab«Coti r«2e pmfom,rt¢of nn wart For which thu pinna la ivied.
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COMPENSATION INSURANCE a
1T1N ccdv nad Tim W compkud if ac pamB V f«am huMN mntoa 8100)
«kat)
I cmih Ihel I.nc pefonoaicc of into wart for which tNs mmi,is Wood.I"I
I not
mipky., niton I.any mmrcrwunbecmpe wbjrct W Ne Wmtrn'Cwpmmdon
tarn of Caivnimit Dam
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NGnCE TO APPLICANT:If.after mating ibis Cenina¢or Eavnplinn,yo t abmw
becmne orbic.on tW Wort«'_comm.,kn pm iaioro or on,lab«code,yap mnu
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fcM tl mroply wlN Goch prwW or Nu ponmit ohJ1 Ee dammi iewtciL
Z CONSTRUCTION LENDING AGENCY
[-.4 1lcmby,fnrrn into acre u a covuacdm ladint atoocY f«nc pmfm^• ^of
fy' > the nimf:I.which IM. tiunit b iv«d(S 3097,Civ.Q
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.7 Z ...a.rs mo
U0 I co t ry that 1 tont rcW Wit,pplicvion mJ sive nu the abosc Mramnvon to
L, cc r 1 atrrs to comply win all city and roomy oldiluncu uid sole Ian milling to ,
C) WiWint eonvmcdon.W hm,bY aunoriie mpesut,itl a of this city in cotcr upn nc
W .ho.c.mcntionW pmpny row int,n n purpous S)
fy (wet arra to uve.indemnify W Peep harmlev dm City of Cupmino.tinn
r/l li,Mlitea,judptimq.,..a•W upeaes Which may in my ray a¢tae.W tot nid city
Uz in con¢q«na of tW truvint or this permit. 2/
APPLICANT UNDERSTANDS AND WILL COMPLY WrnL
1 A .NON-POINT Issued by: Date
��SOURCE RE ONE.
,� � /'Z/--0Re-roofs
Bi_-•..dAppl US MATERIALS DISCLOSURE o.m `Type of Roof
S
Win on,appnovt«funm bWldMt 0(mWt Gore«haidk baatodmm marlin
it,dcfircd by Inc Cupmmo Mwndpi Code.Chaper 9.12 W the N Ith and Way
Code.Secdnn 19332(,)7� All roofs shall be inspected prior to any roofing material being installed.
C Yu
Win ftapplkam«fouuc WIM,aavpw toe cqulpitrm ot&,I=Which If a roof IS installed without firs[obtaining an inspection,I agree t0 remove
wit haraN«a air conuumd"•m,m dcracd by ne Bay Aro Air Qmlity Mm mcm all new materials for inspection.
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nla HnMt S nily Calc,Sccrivahin It 4 my natd155X.1 u ontiryd thallfnc laiorft
d«a not m.rt^d1 haao,tuorc the It b my rapomlbility n mvfy Ih omgat of 1W
reyuiitmcrosr WmmPlot nl=1 orscmira orocctgtoicf. . Signature of Applicant Date
-2 f - All roof coverings to be Class"B"or better
Ovum tliorvc m Dae
CITY OF CUPERTINO
�m 3 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # : 2
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36921013 . 00
DATE ISSUED. . . . . . . : 04/21/2006
RECEIPT 4 . . . . . . . . . : 34089
REFERENCE ID # . . . : 06040127
SITE ADDRESS . . . . . : 10779 BROOKWELL DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : LI-ERH WANG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4024
RECEIVED FROM . . . . : LOS GATOS ROOFING
CONTRACTOR . . . . . . . : RANDY BROWN LIC # 23481
COMPANY LOS GATOS ROOFING
ADDRESS . . . . . . . . . . : 888 FAULSTICH CT
CITY/STATE/ZIP . . . : SAN JOSE, CA 95112
TELEPHONE . . . . . . . . : (408) 298-9399
WEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- ------------- ---------- ---------- ------ ------- ---
BPERMFEE VALUATION 5 , 000 . 00 115 . 56 0 . 00 115 . 56 0 . 00
BSEISMICRE VALUATION 4 , 545 . 00 0 . 50 0 . 00 0 . 50 0 . 00
TOTAL PERMIT 116 . 06 0 . 00 116 . 06 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ---------- -- --- ---------
CHECK 457 . 18 1716
TOTAL RECEIPT 457 , 18
•
CITY OF CUPERTINO I ,�
REROOF O�QOy-0 �1
CUP
CITY PERMIT APPLICATION FORM
APN# 2/^ Date:
Building Address:
29 Dov elel
Owner's Name: _ /`� Phone#:
-SZ
Contractor: hone#: O License#:
a �OO Yo
Contact: Phone#: Cupertino Business Lice e#:
2/ e,,
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
❑ Wood Shakes ❑ Wood%Shakes
A, WoodShingles ❑ Wood Shingles 71
i QS
Other(Specify) '>d Other(Specify)
Number of existing coverings _ ❑ Provide LC.B.O.R ori#
To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Polic
Job Description:&
• Resi ntial Commercial ❑
Fire Zone: Yes ❑ No Confumed with Planning De t. if.
there are an restrictions: u
Cost of Pro' t: Type o lC structi : Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE B1daPermit Fees BUILDING
BENERGY Ener BUILDING
_. _.. _. .-. . -- - - ---
T.BSEISMICRE__-_:_.�._.�. ____SersmrcFee.Res_.�_,-__.____ G _
--BSEISMIGOM---------------.SeismicEommercial--• --
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
CommunityDevelopment,
` 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
�CUPEkTINO
Buildin Ike artment
JOB ADDRESS: PERMIT #
10779 ®60 Y Oi i
OWNER'S NAME: Ll - a , Q IPHONE # `G 2-07-12- -IJ
GE L CONTRACTOR LaS
7i FAX # �g Z g=
I am not using any subcontractors':1/
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring- Carpeting
Linoleum/ Wood
• Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
L/ Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
• C e I P C��IN
I 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 re=roofing.
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 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 City, 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 performed.
111"ORTANT:
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:
-.—Job-Site-Address:-
.---_RoofingCompanyNamei –
O
A plicant's Signature: Date:
Greg teel
Building Official
• Revised 1/30/03
Printed on Recycled Paper