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09090026 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 11663 VINEYARD SPRING CT CONTRACTOR: LOS GA"TOS PERMIT NO:09090026 ROOFING 'tWNER'S NAME: PETER PAI P O BOX 1726 DATE ISSUED:09/04/2009 ;,WNER'S PHONE: 6509658188 LOS GATOS,CA 95031 PHONE NO:(408)298-9399 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB License Class& Lic.#� f— MECH I- RESIDEN COMMERCIAL Contractor 7 fr Date 1 hereby affirm that I am licensed under the provisions o ChaptJOB DESCRIPTION: REMOVE SHAKE INSTALL 1/16" OSB er 9 (commencing with Section 7000)of Division 3 of the Business&Professions SHINGLE MATE FELT Code and that my license is in full force and effect. AND GRAND CANYON SHINGLES BY GAF/ELK CLASS A 28SQUARES 1 hereby affirm under penalty of perjury one of the following two declarations: I'lave 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:$6960 I have and will maintain!Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this APN Number:36654004.00 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 bu!!ding construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs and expenses which may accrue against said City in consequence of the Issued by Date: granting of this permit. Additionally,the applicant understands and will comply with a!I non-point source regulations per the Cupertino Municipal Code,Section 9.18. RE-ROOFS: nature — —Date�� ✓I/ v� All roofs shall be inspected prior to any roofing material being installed. if a roof is installed without first obtainin inspection,I agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION Date: ��O� Signature of Applicant. I hereby affirm that I am exempt from the Contractor's License Law for one of the billowing 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) HAZARDOUS MATERIALS DISCLOSURE 1,,as owner of the property,am exclusively contracting with licensed contractors to 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. 1 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 performance of the work for which this permit is issued. will maintain compliance with the Cupertino Muqicipal Code,Chapter 9.12 and the Health&Safety Code,Sections 2 5533,and 25534. I have,and will maintain Workers Compensation Insurance_as provided for by Section 3700 of the Labor Code,for the performance of the .vork for which this Owner or authorized agent:_ Date:._. permit is issued. 1 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 Cr 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 ceni!y that I have read this application and state that the above information is core.ct. I agree to comply with all city and county ordinances and state laws relating to bu0ding construction,and hereby authorize representatives of this city to enter ,,the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION mrify and keep harmless the City of Cupertino against;:abilities,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 understards and will comply with all non-point squice regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Sign:ature-- ---- ------Date__ -- CITY OF CUPERTINO 3 ITEMS OF 12 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec : Twp: Rng: Sub: Blk: Lot : APN 36654004 . 00 DATE ISSUED. . . . . . . : 09/04/2009 RECEIPT #. . . . . . . . . BS000008610 REFERENCE ID # . . . : 09090026 SITE ADDRESS 11663 VINEYARD SPRING CT SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER PETER PAI ADDRESS 11663 VINEYARD SPRING CT CITY/STATE/ZIP CUPERTINO CA, 95014-5135 RECEIVED FROM LOS GATOS ROOFING CONTRACTOR RANDY BROWN LIC # 23481 COMPANY LOS GATOS ROOFING ADDRESS P 0 BOX 1726 CITY/STATE/ZIP LOS GATOS, CA 95031 TELEPHONE (408) 298-9399 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- 1BCBSC VALUATION 6, 960 . 00 1 .00 0 .00 1 . 00 0 . 00 1BSEISMICR VALUATION 6, 960 . 00 0 .70 0 .00 0 . 70 0 . 00 1REROOFRES SQ FEET 28 . 00 364 . 00 0 . 00 364 . 00 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 365 .70 0 . 00 365 . 70 0 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CUPERTINO REROOF CUPEk INO PERMIT APPLICATION (pq APN # Date: Building Address: Owner's Name: Phone#: r Phone #: Contractor, Fax#: � - 9i_3r �� Cupertino Business License #: � Contracfor License #: ao 7e-l) 7 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles � Asphalt Shingles Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) Other(Specify) Number of existing coverings ElProvide I.C.B.O. eport# To be Removed )z(, Provide Mfgr. Installation Specs. 5 S .. Job Des nption: �'`C 7 /6:Ia� , JXZI',�.� /tlA-� a a_;4 ,tea & 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 index. Valuation:. I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signa r Revised 6/16/08 CITY OF CUPERTINO J REROOF "n°f C 2EKI1N0 FEE SCHEDULE Number of Fee ID . Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1COMMLROOF 1BSEISMICO Seismic Commercial B 1RER00FRES ' Re-roof Residential B 1SFDWLR00F 1BSEISMICRE Seismic Residential B 1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B Revised 6/16/08 Community Development Department Building Division City of Cupertino 10300 Torre 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 re-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 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.she athing, so a proper City inspection can be performed. 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: Job Site Address: ` a f RoofingCom Name: b PanY Applicant's Signature: "�/ �� D te: Greg Casteel Building Official Revised 07/30/08 ~ Community Development et 10300 Torre Avenue ' Cupertino CA 95014 jy_✓ Telephone(408) 777-3228 CI►YOF II Fax(408)777-3333 (UPE INO Building Depa' mem jOB ADDRESS: PERMIT = OWNER'S NAME: - PHONE GENERAL CON 11 CTO if FAX 1 am not using any subcontractors: of iren Of Signature j Dal Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS NAMEI BUSINESS LICENSEOP Cabinets &NUI work Cement Finishing Electrical ( Excavation Fencing Flooring: Carpeting Linoleum/ Wood Glass/ Glazing Heating insulation Landscaping Lathing Masoiuy I Ornamental Sheet Metal Painting/ WaLlpape_r Paving Plastering PIurnbing Roofing Septic Tank Sheet Metal (--Sheet Rock Tile 0wne Ft�ac ,o,nature Date