05070145 F.ILDR,
ITY OF CUPERTINO
BUILDING DIVISION PERMIT TORINFORMATION',-,
ADDRESS: ROOFCO OF SILICON VALLEY PERMIT N0.05070245
420565 ALVES AVE
ER'S NAME: PERMIT ISSUE DATE
LI LI 844B EARLE AVE 07/25/2005
PHONE: SANITARY NO. CONTROL NO.
(408) 795-3335
ARCHnECf/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
°00 LICENSED CONfRACTOR'S DECLARATION Job,Description
igI hereby affirm that I am licensed under provisions of Chapmr 9(commencing P
wfm Section 7010)of Division 3 of the Business and Prollesdom Code.and my licemc is nf�
; ? Ice ren ame ane 7ct REMOVE SHAKE ROOF ANDD NS 4l1LL>NEW FRC FRU
Liccnsc Clan Lic.a '
p
�FDam TSDE 11 Y
n ARCHITE ctu DECLARATION
0 I understand my plans all d public fecnrd
g Out I am CUILDER DECLARATION p�
0
2 i y I hereby affirm Out 1 em exempt from the Contractor's License Law for the (t9i�N(pry
0 0 following mason.(Seat 71)31.5.Business and Prorardons Code:Any city or county � q ��
C
m which requires a permit m cnmtrun,almf,improve.demolish,or repair any suumme (its $10000 .
OZi prior m its issuance.also requirm the applicant for such permit m rile a signed summand
Ezp thathcislicensed pursuanttothe provisionsofNcCommon's Ummum aw(chapter9 Sq.Ft.Floor Area V Valuation
eF- (commencing with Section 7")of Division 3 of the Business and Nofmsioas Cnrm)orf
i that be is exempt mcrefrom and the basis far me alleged exemption.Any violation o
Section 7031.5 by any applicant for a permit subjects Ne applicant in a civil penalty ofAPN
not more men five hundred dallan(SSW). r UT Occupancy Type
❑I,uownerofthcpmpmy,mmycmployemwiNwv wNeirmlecomNnutlon,
will do She work,and Ne Structure is not intended or offered for sale(Sea.7014,Business
and Professions Code:The CmMomim's Liar.Law docs not apply m an owner of Required Inspections
property who builds or narrows thereon,and who does such work himself or through his
awn employers.provided that such improvementsart not intended oro°ered forms.If.
however,On building or improvemem is Sold within ane year of completion.the momr-
builder will have the burden of proving Nat he did not Wild or improve for purpme of
sale.).
❑1,as Owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7061.Business and Profeuiom Code:)The Contractor's U-
ccnu Law does not apply to an owner of property who Wilds or improves thereon,and, . .
who contracts for such projects with a contactors)Hammed pursuant o me Contractors
License Law. -
❑IameaemptunderSec. ,B&PC for,thia..an "
Data
WORKER'S COMPENSATION DECLARATION - —•--
1 hereby affirm under penalty of perjury,On of be fallowing declarations:
1 ham and will maintain a Certificate of Consent to Self-insure for Worker's Compcm
cation,a provided for by Section 37W of the Labor Cade,for the performance of the
work for which this Permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by section
37W of the Labe!Code,for the radar.....of the work for which Nis permit is issued. ..
My Worker's rens Iran In oar e c oris and Policy number aa:
Cartier. Cl�� Policy No� Cl _
�i CERTIFICATE OF EXEMMON FROM WORKERS'
COMPENSATIONINSURANCE
(Thu section mad mtbccompau d if the Permit is(moot hundred dollars(SIM)
or less.)
1 comfy mat in the pmfam mine.of me work for which Nis permit is inued.1 Shell am
employ any person in any manner an as at Wcomc subject to the Workeri Compensation
Laws of California.Doc
Applicant
NOTICE TO APPLICANT:If,after making Nis Cmtifiam of Exemption,you should
become subject On me Worker's Compensation provisions of me labor Corm,you muse
.J O forthwith comply wide such prnvisions or this remit W deemed revoked. -
Z r CONSTRUCTION LENDING AGENCY
C,
cd walk
by which thi Natmert isaeomSea.30lending agency for the performance of
C' Me,work fur which this permit is issued(Sec.3097.Civ.C.)
dkiQ. Q Lcndcr'i Name
Q.
v7- Z Lender's Address '
V Q I ttnee that I hoe read this application and sure that me Show information u
W U correct 1 agree m comply with all city and county mIdwo Or and sole laws relating to
0 O building tenoned construction,and hereby aoNonm¢prcsenutives of this city to enter upon the
V) ahovcmc judgments,
dproperty forinspection.Pawum a
,r C s.
(We)agree to save,indcmni fy,and keep harmless the City of Cupertino against
V) in
of me theouosts nd cxpcascsnnit. may in any way sacra against said City
C)z in eomequenec of me granting of this permit
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NpppNNN POINT Issued by: 6a Date
SOURCEREGULATIONS -/ �
R
e-roofs�gG�arDam
HAZARDOUS
MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building e.Chapter
or handle Health and Safer i
M defined io Nc 32(a)?nn Municipal Code.Chapter 9.12.and the Health and Safety
c.section 255]2(.)7 All roofs shall be inspected prior to an roofing material bei.
❑Yea N P P Y g g installed.
WIf a roof is installed without first obtaining an inspection,I agree to remove -
Will aPPlicant or future building occupant use equipment or devices which �.
\ DiSlricl7 thmadnus air comaminanuazdcfin the Bay Area Air Quality Management new materials for inspection.
Dis
❑Yes rJ No
I have read thc haradtws maw6alsmquimmenu under Chapter 6.95 of the Caiifor �
nia Haim&Safety Code,Secuom255t15,25533md25531.lundemanddemifmc Wilding \ �7l
dors not currently haw a tenant Nat it is my responsibility to nouly the occupant of the
mIiUwmnancsw c....._TlaR9Utui ce of.Ccdfnum.(Ocecp.y eofApplicant Date
owner ar anmanund agent Dare All roof coverings to be Class"B"or better
Community Development
' R 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
0�n TY Of Fax(408) 777-3333
rC 1 Building De artment
JOB ADDRESS: PERMIT #
2e,—S&- -,o4le-las man
OWNER'S NAME: 1' 6 ' PHONE # FZ,3 &S a
GENERAL CONTRACTOR FAX # -7m-Z3 --74-5-S
I am not using any subcontractor�_�J�i�'��
Signature Date
Please check applicable subcontractors and complete the following information:
21 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
Owner/Contractor Signature Date
CITY OF CUPERTINO
m 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 1
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 32634068.00
DATE ISSUED. . . . . . . : 07/25/2005
RECEIPT #. . . . . . . . . : 30495
REFERENCE ID # . . . : 05070145
SITE ADDRESS . . . . . : 20565 ALVES AVE
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : LI LI
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . CA
RECEIVED FROM . . . . : ROOFCO OF SIL. VALLE
CONTRACTOR . . . . . . . : PHILLIP ULLIO LIC # 22345
COMPANY . . . . . .. . . . : ROOFCO OF SILICON VALLEY
ADDRESS . . . . . . . . . . : 844B EARLE AVE
CITY/STATE/ZIP . . . :' SAN JOSE, CA 95126
• TELEPHONE . . . . . . . . : (408) 795-3335
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
________ ___ __________ __________ __________
SPERMFEE VALUATION 10,000.00 169.56 0.00 169.56 0.00
BSEISMICOM VALUATION 10, 000.00 2.10 0.00 2 .10 0.00
__________ __________ __________ ----------
TOTAL PERMIT 171.66 0.00 171.66 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ -----_____-__--___
CHECK 171.66 7481
TOTAL RECEIPT 171.66
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
305 FRAME FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•
Community Development Department
Building Division
• City of Cupertino
FB1 10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEQINO
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.
To receive a final sign off from the City,'the followingsteps are
required: -
_, 1) Pre-inspection and/or tear off approval. ;.
2) In-progress inspection approval.
3) Final inspection approval.
a) Spark arrester installation.
5. 1f plywood is installed, a plywood nail inspection is_required.
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 yoii'call'for'a plywood'naifinspection 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, AI.C.B.O. report is required to be on the job site at the time on inspection.
n
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name:
Job Site Address: aU ill�e SGfl u G
Roofing Company Name:
Applicant's Signature: Date: ��L-;/04
e
Greg Casteel
Building Official
Revised 11/2/04 -
a,;ntad nn Recvcled Paper J
09D4-0i4S
CITY OF CUPERTINO
G REROOF
CITY OF
ACUPERTINO PERMIT APPLICATION FORM
APN 4 J aP _ Date:
'"
Building Address:
Owner's Name: Phone #:
C tractor/, Phone#: Lic' e #:
Contact: Phone#: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
O Built-Up Roof ❑ Built-Up roof
❑ �4sphalt Shingles El Asphalt Shingles
�/ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) UK Other(Specify) 7ru
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
41lHave Read, Understand and Will Comply With Cu ertino's Tear Off Policy: (]
Job Description:
ss`ia� a
Residential ❑ Commercial ❑�
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: Type of Cons ction: Occupancy group:
,r
Qty. i f
Applicable Fee ID Fee Description Fee Group
BPERMFEE BIdLy Permit Fees BUILDING
BENERGY Energy BUILDING
/ BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING