09110105 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 7548 BOLLINGER RD CONTRACTOR:KNIGHT ROOFING PERMIT NO:09110105
SERVICES
-4ER'S NAME: DOMINIC GO 42035 OSGOOD RD DATE ISSUED: 11/19/2009
OWNER'S PHONE: 4087053285 FREMONT,CA 94539 PHONE NO:(510)438-9077
❑ LICENSED CONTRACTOR'S DECLARATIONr
(/ BUILDING PERMIT INFO: BLDG ELECT PLUMB
License Class J Lic.# r�`l y NQS
MECH RESIDENTIAL COMMERCIAL
Contractor �,sJ41 Date l di
I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF TEAR OFF COMP/WOOD ROOFING,INSTALL
(commencing with Section 7000)of Division 3 of the Business&Professions SHEATHING,INSTALL DURAL[TE LIGHTWEIGHT TILE CLASS
Code and that my license is in full force and effect. A 28SQ
1 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.
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 Sq.Ft Floor Area: Valuation:$14000
permit is issued.
APPLICANT CERTIFICATION APN Number:35924003.00 Occupancy Type:
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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-pour source regulations per the Cupertino Municipal Code,Section
9.18.
AIssued by;� Date//i/f' �s
5' ture !�` Date 4
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date: <</I IT
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,l shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,1
become subject to the Worker's Compensation provisions of the Labor Code,I must Own r or autl r'ztd agent:
forthwith comply with such provisions or this permit shall be deemed revoked. Date: ( t I
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
1 certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
he above mentioned property for inspection purposes.(We)agree to save
i. inify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot :
APN 35924003 .00
DATE ISSUED. . . . . . . : 11/19/2009
RECEIPT #. . . . . . . . . : BS000009232
REFERENCE ID # . . . : 09110105
SITE ADDRESS . . . . . : 7548 BOLLINGER RD
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER DOMINIC GO
ADDRESS 7548 BOLLINGER RD
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4333
RECEIVED FROM . . . . : GREG KNIGHT
CONTRACTOR . . . . . . . : DAVID RICE LIC # 27646
COMPANY . . . . . . . . . . : KNIGHT ROOFING SERVICES
ADDRESS 42035 OSGOOD RD
CITY/STATE/ZIP . . . : FREMONT, CA 94539
TELEPHONE . . . . . . . . : (510) 438-9077
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 14, 000. 00 1 . 00 0 . 00 1. 00 0 . 00
1BSEISMICR VALUATION 14, 000. 00 1 .40 0 . 00 1.40 0 . 00
1REROOFRES SQ FEET 28. 00 364 .00 0 .00 364 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 366 .40 0. 00 366 .40 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 366 .40 MC
---------------
TOTAL RECEIPT 366 .40
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
CUPEftTINO PERMIT APPLICATION
APN# _ Date:
go
Building Address:
7548 Bollinger Rd .
Owner's Name: Dominic Go Phone #: 408 705 3285
Contractor: Phone #: 510 438 9077
Knight Roofing Services
Fax#: 510 438 0604
Cupertino Business License #: 27646 Contractor License #:
844108
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
V, Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) c4 Other (Specify) (...i of we-a-h f i o'I e
Number of existing coverings 2 4 Provide I.C.B.0. Report # EI-- I(a4'1
qi To be Removed ❑ Provide Mfgr. Installation Specs.
Job Description: Tear off comp / wood roof i ng .
Install sheathing .
Install Duralite Lightweight Tile
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: ❑
Valuation: 14 , 0 0 0
I Have Read, Un erstand and Will Comply with Cupertino's Tear-Off Policy:
Signature
CITY OF CUPERTINO
REROOF
CUPERTINO FEE SCHEDULE
Number of Fee ID Fee Description Fee Permit Type
Squares Group
1REROOFCOM Re-roof Commercial B 1COMMLROOF
1BSEISMIC0 Seismic Commercial B
28 1REROOFRES Re-roof Residential B 1SFDWLR00F
1BSEISMICRE Seismic Residential B
1REROOFMRES Re-roof Multi-Family B 1MFDWLROOF
1BSEISMICRE Seismic Residential B
1BUSLIC Business License B
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 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.
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 1/4" 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: Dominic Go
Job Site Address: 7548 Bollinger Rd .
Roofing Company Name: Kniqht Roofing Services
Applicant's Signature: Date:•'/ ,el
Greg Casteel
Building Official
Revised 11/2/04
Community Development
Y10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CIV OF Fax(408)777-3333
.;UPEkTINO
Building Department
JOB ADDRESS: PERMIT# ,)q / / 0/ L J
OWNER'S NAME: ,�, 0 PHONE # 5-1 'Y 3 S,-10 7
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: '94
ignature 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
� f
Owner/C tractor Signature Date