07010162 CITY OF CUPERTINO
BUILL?lNG DIVISION PERMITCo. �T0 , I FQI
PERMIT NO.
BUILDING ADDRESS:
20S TWA -OLD-ZOLZI TRY ROOFING
TE
OWNER'S NAME:
YANG JUN 125-13 GROBRIC CT 01/26/2007
SANITARY NO. CONTROL NO.
ONE:
(707) 864-555'/
BUILDING PERMIT INFO
ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH
0 0 0
p LICENSED CONTRACTOR'S DECLARATION Job Description
'q V(= I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
=Z� with Section 7000)of Division3oftheBusinessandProfessionsCode,and ylicense is REROOFT/O EXISTING, RESHEET OS13 30LB FELT, 24
=y
in full force and effect 7 -?
j v1 Z License Class Lic.A ` ✓ SQUARES CLASS A
p Date — Con
k w ARCHITECTS DEC N
a1 understand my plans shall be used as public records
�yU
U.y Licensed Professional
n y OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
a Oyfollowing reason.(Section 703 1.5,Business and Professions Code:Any city or county
which requires a permit to construct alter,improve.demolish.or repair any structure
u'y prior to its issuance.also requires the applicant for such permit to file a signed statement Floor Valuation
S Ft.Flr Area
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 q• $12000
i�-In (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
%y that he is exempt therefrom and the basis for the alleged exemption.Any violation of permit A R Occupancy Type
Section 7031.5 by arty applicant for a peit subjects the applicant to a civil penalty of 3591305 C .1JBN Number
not more than five hundred dollars(5500).
0 1,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 Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are 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 he did not Mild 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
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
J I have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
0 I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker ampensation Insu/ra -carrier and Policy are: ��F�
Carrier. �/ y`—CW Policy.s. Policy No.:`"/ J
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
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 Worker's Compensation provisions of the Labor Code,you must
Qforthwith comply with such provisions or this permit shall be deemed revoked.
z, CONSTRUCTION LENDING AGENCY
[�C'e) I hereby affirm that there is a construction lending agency for the performance of
a> the work for which this permit is issued(Sec.3097,Civ.C.)
W A Lender's Name
L
2 cndersAddress
I certify that I have read this application and state that the above information is
U
cored I agree to comply with all city and county ordinances and state laws relating to
.J U building construction,and hereby authorise representatives of this city to enter upon the
U above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
tE"t liabilities,judgments,costs and expenses which may in any way accrue against said City
U Z in consequence of the granting of this permit. Date w�
►-i APPLI ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued bt:
so EGULA*n S. v b-,9
Re-roofs
Signature of pplic Contractor Dare Type of Roof
MATERIALS DISCLOSURE yP
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Munici al Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Cl Yes If a roof is 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 materials for inspection.
District?
❑Yes o
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
does n t currently have a tenant,that it is my responsibility to notify the occupant of the
requ- nos which mus be met , to issuance of a Certificate of Occupancy. ) S ignatur;of Applicant Date
- All roof coverings to be Class"B' or better
Owner or authorirc agent Datc
JAN-26-2007 08: 19 OLD COUNTRY ROOFING 4087828301 P.01✓01
Cotitmunity'Development Department
Building Division
City of Cupertino
10300 Torre Averue
Telephone: (408)M-3=
Faux: (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 Standexds
and manufacturers specifications on re-:oofang.
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 til i bwlding inspector when the re-roofing
is completed.
3, All roofs shall be naspected prior tc any roofing installation.
4. To receive a final sign aff from the _^.ity,the following steps are
required:
1) Pre-inspection and/or tear off a.)proval.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed,a plywood»ail inspection is required.
6. Any roofing which is applied without first obtaining an inspection,
will require the removal of aU new material down to the sheathing,
r so a proper City inspection can be performed.
I 7. NOTE: If you cAU for a plywood n;dl inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee gLust
be paid before another iunspeclWAcan be sshedWend_
TWORTANT:
1. Flat roofs must have a minimum of Y4"per foot slope and demonstrate
that there is no ponding.
2 An LCB.O.report is required to be on the job site at the time on inspection.
I understand and will comply with the ab ave stated policy on re-roofing.
Homeowner's Nairne: _Y1!4AJ(7 -ft4 A
Job Site Address:
Roofing Company Name: OCD CAV/U''(?'t / � 0 i- 1,0
Applicants Signature: Date:
Greg Casteel
Building Official
Rroised 11/2/04
TOTAL P.01
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 35913050 . 00
DATE ISSUED. . . . . . . : 01/26/2007
RECEIPT # . . . . . . . . . : BS000000328
REFERENCE ID # . . . : 07010162
SITE ADDRESS . . . . . : 20896 PEPPER TREE LA
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . . YANG JUN
ADDRESS . . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2918
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR . . . . . . . : FOLK, DIETER LIC # 20389
COMPANY . . . . . . . . . . : OLD COUNTRY ROOFING
ADDRESS . . . . . . . . . . : 125-B GROBRIC CT
CITY/STATE/ZIP . . . : SUISUN, CA 94585
TELEPHONE . . . . . . . . : (707) 864-5557
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 12, 000 . 00 191 . 16 0 . 00 191 . 16 0 . 00
BSEISMICRE VALUATION 12, 000 . 00 1 .20 0 . 00 1.20 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 192 . 36 0 . 00 192 . 36 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 192 .36 M/C PERMIT SERVICE
---------------
TOTAL RECEIPT 192 .36
G CITY OF CUPERTINO
RE ROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
3S"Clr /3 � SU 26"- v7
Building Address:
e4L Lei
Owne 's Name: Phone#:
V�ylTun 3 q:�-' - �:
Contractor License#:
o COCx-'
Contact: Cupertino Business License#:
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Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles .0 Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read,Understand and Will Comply With Cupertino's Tear Off Policy: ❑
Job Description:
Residential .2 Commercial ❑ Si
Fire Zone: Yes ❑ Nom] Confirmed with Planning Dept. if
there are any restrictions: E
Cost of Project: Type of Constru3tion: Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING