06090035 CITY OF CUPFyRTINO
BUILDING DIVISION PE MIT
BUILDING ADDRESS: WOODS ROOFING PERMIT NO.06090035
21436 HOLLY OAK DR
OWNER'S NAME: PERMIT ISSUE DATE
BEN LI PENG 2179 STONE AVENUE
NE: SANITARY NO. CONTROL N0.
(831) 637-5576
ARCHIECTIENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
pop LICENSED CONTRACTOR'S DECLARATION Job Description YZm F 1 lar mby anion Ilial 1 am licensed ankle,provisima of chapter 9(mmmcrcing
Uo wiNS nee dMpofDiviabn3oflACHusineva�dZr Iy�cade.aAmyranaia TEAR OFF SHAKES ADD. GERARD STEEL TILE 1 . 5# PSF
full forte and e(
ZMCI. AR-4 ~-
DanAll �' CLASS A
q A
i a I understand my plane,hall lar uuJ a public ar
i�
W
Licensed Profcalonel
)so OWNER-BUILDER m AM Cont ION
c S I hereby,Dion on 1 am exempt scum dm Comrecmo Limy c Law for Ili°
.p O following mason.(Satin 1031.5.Business mp w.doli demolish.or Any city or manly
S$ which its i s u•permh re cores;Me alter,impmvc h Iscmillor mash ay structuusermere
prim m its licensed
issuance. to ft the applicant for such p oar's License
s signed atstemal
o Z i then he is licensed puramt to the of Dislaes of cite le Buacmr'LLimvc law(Chode)9 Sq.Ft.Floor Area ValUd}iih15 Q Q
I�C
(c morning with Section 7003)of Oivtsion laf do Busimssad Professions Code)or
9 drat he is exempt therefrom and the basis for the alleged eumpdon.Any violation of
Section 70313 by any applicant for a permit subjects the applicat w a civil penalty of pPN Number Occupancy Type
not mom than five NNred dollars(M)L 3 6 202033 . 0 0
❑1,As owner arrive prop any,or my employees with wages As thebale wnpewdon,
will do the work,nd theonium It anwwnded oroRemd fonalc(San.7044,Business Required Inspections
and pwfealam Code:The Camtaemv9 License Law dote tet apply w e ns an owner of q P
property=ploym,pramimprot mh ire n,ad who dmamh aorkhimxel(or through his
how a however,
M ees,prang or improvement
mp,vem imP�me"u an:nest lnlcndrk moQared for"mcf-
however,thebuilding or Impro FaultsV voidwithin on Wild of balsams for will have the buka of proving dot be did aI bkk or balsams fm puryose of 1
Ask.). `J
Q I,As owner of rive sec.70property.,m exclusively cnuemins with:)The C mnuulurs l- /
conmNCl we prolan(Sec 70da,Business and Profudaes Code:)M Contrsemfs Ll-
who
wN cocontractsacts farr such Projects wish a cmnuanags)licensed patient b Co
sthe Cmnvsemr's S
Liven claw.
te
❑tovempt under Bee .Bk PC far thismeson
or Dau
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury tete of do following declarations:
I have and will maintain a Certificate of Conant w alf-inam for Worker's Compen-
atian,as provided for by Section 3700 of the Labor Code.for the performance of the
wort for which this permin is iaucd.
I have and will maintain Worlds CompewMon Inmraee,a required by Section
700.(Mc Inbar Coke,far the performance of the wart for which this permit u[mud.
My Wand C° atuian Rwnna euriu and Policy number art: 1
Cartier. '
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This senlon need not he cmnpwmd BIN permit Is formal hundred dollars(SIM)
m war)
I certify Net in the performance of the walk for which this Permit is tared.1"I own
employ any person in any marcrso As w become subject to ric Worleri Compensation
Laws of Celif°mia Data
Applicant
NOTICE TO APPLICANT:IL afar making this Cenifmcam of Exemption,you should
become subjects in the Warkeft Compensation provision,of Mm Labor Code,you man
.,O forthwith comply with such provisions or this permit shall be deemed revoked.
y CONSTRUCTION LENDING AGENCY
[-+ I humbly alum dun dare h scmmrudo.finding agency for the pu1mmence,of
IYi> the work for which this permit Is issued(Sec.3097,Civ.C.) ..
OWi Q Iandle,Name
D z Landers Address
U 0 1 comfy that I hiss:mad this Application ark sum that the above information is
G,f~ cmncct.I agave to comply with all city and county mrM. a and sum laws relating in
O V building construction,and hereby authorrerepmaentatives of this city to enter upon the
r [21 above mentioned property for inspection purposes.
0. (We)agree to ave,indemnify And keep hitlm Cay of Cupertino against
rl^i Al liabilideajudgru nle.costs and expenses which may In my way accrue againslsvd Cily
U ,zr tAPPoca CANT of EgSTA gaSthts ILL C PLY VFTH ALL NON-POINT Issued by: Date
SOURS � a
( 0� �+/V IO
9 Re-roofs
Signature of AppllcaRData
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will circ Applicant mfuubuilding aecupannomorthazardousmamJ
material
anrthe decd by CupCupertinoCupertinoMunini and Cade.Chapter 9.13.ad rive Health and Safety
Cone,Section 3553I(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes R"r
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
7ni.H.Idh&SAfcIy
mit heraknw air cmumlnats a danced by tite Bay Arta Air Quality Management all new materials for inspection.
❑Yes rs NJk—
Ihammaltheha,,Nous mawriats reyiremonuunJcrCNpmr6.95ofJc Glifr-Sccdaa 2570 533am123 4.IunJcnund thmiflN building me nal cormm a . sy terga ility w Irotify the aecapam of riteq°IDI "" `t °` yp `y Signature of Applicant Date
�6Ju
Owner or amhorixd agent All roof coverings to be Class"B"or better
� � � Dam'
Community Development
10300 Torre Avenue
Oar
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
SWUPEkTINO
Building Department
JOB ADDRESS: 2 1 3 L O PERMIT#
OWNER'S NAME: PHONE # 3a-1 - 4(.q
GENERAL CONTRACTOR: 'c FAX#
I am not using any subcontractors:up.4 �j L 10 L
Signature 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
P:4Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owne /Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Tone Avenue
N 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: ,�.a�wo
Job Site Address: 21 q3 to MaXX.�C� t. DA .
Roofing Company Name: ct)ery s ;Ep4
Applicant's Signature: Date: 'T6. 07
• Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
Im 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 3
Sec : Twp: Rng: Sub: Blk: Lot :
APN . . . . . . . . : 36202033 . 00
DATE ISSUED. . . . . . . : 09/06/2006
RECEIPT # . . . . . . . . . : 35926
REFERENCE ID # . . . : 06090035
SITE ADDRESS . . . . . : 21436 HOLLY OAK DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : BEN LI PENG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
RECEIVED FROM . . . . : BONITA JENKINS
CONTRACTOR . . . . . . . : WOOD, LAWRENCE E LIC # 20810
COMPANY . . . . . . . . . . : WOODS ROOFING
ADDRESS . . . . . . . . . . : 2179 STONE AVENUE STE 22
CITY/STATE/ZIP . . . : SAN JOSE, CA 95125
TELEPHONE . . . . . . . . : (831) 637-5576
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- --------- ---- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 15, 000 . 00 223 . 56 0 . 00 223 . 56 0 . 00
BSEISMICRE VALUATION 15, 000 . 00 1 . 50 0 . 00 1 . 50 0 . 00
------ --- ---------- ---------- ----------
TOTAL PERMIT 225 . 06 0 . 00 225 . 06 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
---- - ---- -------- ------------ ------------------
OTHER 225 . 06 VISA
TOTAL RECEIPT 225 . 06
•
CITY OF CUPERTINO
qREROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 3102 _ p2-b33 Date: q /G o G
Building Address: ,I "f,, tt I O cL t l
b /LvU... -
Owner's Name: n Phone#:
30'7 - a6 Y $
Contractor: License#:
L10p- ' s 2S I 1
Contact: !/ S Cupertino Business License #:
- �o8bes 6
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles -
�Q Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) Other(Specify) C4LaAVP S–&O tZPP–
Number of existing coverings I Provide I.C.B.O. Report#G$ 1 4 (
-)Q To be Removed ❑ Provide Mfg.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:,
Job Description: -r/0 a�Q . I•S )J&J&
V V
Residential .. Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning DMt. if
there are any restrictions: LJ 7-1
Cost of Project: v? Type of Construction: Occupancy group:
/5 00U
Qty. if
Applicable Fee ID Fee Description Fee Group
! BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
1 BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
•