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10090186 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7590 RAINBOW DR CONTRACTOR:M&S ROOFING CO. PERMIT NO: 10090186 OWNER'S NAME: WONG GREGORY K :08 COPCO LN DATE ISSUED:09/20/2010 NER'S PHONE: 4087251542 SAN JOSE,CA 95123 PHONE NO:(408)314-0870 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT r PLUMB r License Class Lic.# �/�d�r d MECH r RESIDENTIAL COMMERCIAL r Contractor 1121 34t�r &I)1�2 A Q Dateq5y JOB DESCRIPTION:RE-ROOF REMOVE SHAKE ROOF&INSTALL OSB& I hereby affirm that I am licensed under the provisions of Chapter 9 40YEAR (commencing with Section 7000)of Division 3 of the Business&Professions COMP CLASS A 24SQ 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. I have and will maintain Worker's Compensation Insurance,as provided for by Valuation:$8000 Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: permit is issued. APPLICANT CERTIFICATION APN Number:36611038.00 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, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FRO LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section V� 9.18. - Issued by: Date:,T _`� Signature �! v Date J 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. e will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: Date �{rj f Business&Professions Code) I,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 tions 2550 , under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain performance of the work for which this permit is issued. compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this 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,I 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,I Owner r authorized agent: n ` become subject to the Worker's Compensation provisions of the Labor Code,I mu:.t ` Date: —cam t 10 forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereb affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is Y 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 upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address '-mnify and keep harmless the City of Cupertino against liabilities,judgments, ,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION g.anting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Signature Date Licensed Professional CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . : 36611038 . 00 DATE ISSUED. . . . . . . : 09/20/2010 RECEIPT #. . . . . . . • • : BE000011504 REFERENCE ID # . . . : 1C090186 SITE ADDRESS . . . . . : 7E90 RAINBOW DR SUBDIVISION . . . . . . . CITY CL-PERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : WONG GREGORY K ADDRESS . . . . . . . . . . : 7E90 RAINBOW DR CITY/STATE/ZIP . . . : CLrPERTINO, CA 95014-4322 RECEIVED FROM . . . . : M & S ROOFING CO CONTRACTOR MIRSAD KRAJWIC LIC # 28360 COMPANY M & S ROOFING CO. ADDRESS 208 COPCO LN CITY/STATE/ZIP . . . : Sl�N JOSE, CA 95123 TELEPHONE . . . . . . . . : (2:08) 314-0870 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ----------- ---------- ---------- ------- 1BCBSC VALUATION 8, 000 . 00 1 .00 0 .00 1. 00 0 .00 1BSEISMICR VALUATION 8, 000. 00 0 .80 0.00 0 .80 0 .00 1REROOFRES SQ FEET 24 . 00 312 .00 0 .00 312 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 313 .80 0 .00 313 . 80 0 .00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CHECK 313 .80 #2489 --------------- TOTAL RECEIPT 313 .80 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- --------------------------- - -------- --------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF REROOF TEAR-OFF POLICY o COMMUNITY DEVELOPMENT DEPAR'-MENT-BUILDING DIVISION ALBERT SALVADOR, P.E., C.B.O., BUI-DING OFFICIAL CUPERTINO 10300 TORRE AVENUE•CUPERTINO CA 95014-3255 (408)777-3228• FAX(408)777-3333-Wilding Qcupertino.org PROJECT ADDRESS APN# I JIJ � ok/ OWNER NAME PHOT E E-MAIL STREET ADDRESS CITY, ST.ATE,ZIP FAX CONTRACTOR NAME i LICENSE NUMBER n / LICENSE TYPE S_ BUS.LIC# COMPANY NAME E-MAIL fV7 FAX is STREET ADDRESS �' CITY,ST/TE,ZIP ` ` PHONE a l(� I UNDERSTAND AND AGREE TO THE FOLLOWING: 1. The re-roof project shall comply with all applicable provisions of the 2007 California Building Code. 2. You must schedule all needed inspections a mini mum of one day before the requested inspection date. Please schedule inspections online or call (408)7 77-3228 between 7:30-3:30 (Mon-Fri). 3. Tear-off roof inspection is required. Please call for tear-off inspection after the roof is torn off and all the nails/fasteners have been removed. Any and all dry-rotted wood shall be replaced prior to this inspection. A building inspector will be availabl-within one hour. There are special hours for this service: 7:30 - 10:30am and 1:00- 3:30pm (Mon-Thurs); 7:30 - 10:30am and 1:00-2:30pm (Friday). 4. If plywood is installed, a plywood nailing inspe,-tion is required. 5. In-Progress roof inspection is required. Call for an in-progress roof inspection to verify building is weather tight after installation of approximately .?5% of the roofing material. 6. New roof coverings shall not be applied without first obtaining all inspections and written approvals from the building inspector. Any roofing which is applied without first obtaining an approved inspection will require the removal of all new material dow l to the sheathing so a proper inspection can be performed. 7. A final inspection and approval shall be obtainec. from the building inspector when the re-roofing is complete. To receive a final sign-off, the following items will be verified: a. Flat roofs shall have a minimum of 1/4"per f got of slope and must demonstrate there is no ponding. b. Listings from approved testing agencies for all pre-manufactured products used shall be available on-site to review at the time of the inspection. c. Proper spark arrestor installation. 8. NOTE: If you call for a tear-off or plywood nailing inspection and the work is not complete, you will be charged a re-inspection fee of$126.00. The te-inspection fee shall be paid before another inspection can be scheduled. By my signing below, I certify each of the following is true: I am the property owner or authorized agent to act on the property owner's behalf. I nderstand and agree to comply with the re-roof policy stated above. Signature of Applicant/Agent: Date: ReroofPolicy_20 10.doc revised 05/17/10 Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: ��, PERMIT# v `' OWNER'S NAME: L t PHONE# GENERAL CONTRACTOR: ^_7 BUSINESS LICENSE# ADDRESS:',L/i / .j CITY/ZIPCODE: - *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors: - ig nature Date Please check applicable subcontractors and complete the following information: V SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum /Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile O ner/Contractor Signature Date CITY OF CITY OF 1�UPERTINO REIROOF CUPERTINO PERMIT APPLICATION APN# I , �� Date: Building Address: t Owner's Name: (_� V j /\j ( Phone #: HOA: Yes ❑ No If yes, r)vide letter from HOA Contractor Phone #: ' Fax#: 7�1 - �'��"�` Contractor License #: Cupertino Business License #: Type of hoof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles R Asphalt Shingles Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings Z ❑ Provide I.C.C.E.S. Report# �L To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: '(6 tA ��f �i�i `CEJ, ')r� ,ice_ %�' ��n, Ct Residential V - 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: .�r 00 I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09