08030188CITY OF CUPERTINO
a «:{Y::psYdq.a-B'nRaaMOM?'—
BUILDING DIVISION PERMIT„C�ONTRAC-T.,pR
I,NF,ORMAT ON '_
BUILpYr�.'TR ANFORD PL
KEITH ROOFING CO INC
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TVA188 ,
OWNER'S NAME:
PERMrr 1SSUEDATE
SAM HSIEH
920 LINCOLN AVE
03/31/2008
E:
SANITARY NO. CONTROL NO.
(408)295-8616
ARCHITECrfENGINEER:
BUILDING PERMIT INFO
BLDO ELECT PLUMB MECH
LICENSED CONIRACIOWS DECLARATION
I Job Description
P
1 hemby since Nu I am licama d under provisions of Chapter 9Immanuel {
vtlthSection TOM) of Division 3 of the Business and professions Coie,and my Imm. is
RE-RF,RMV RF&INSTL 30YR CMP RF W/30LB FLT,CLS A
m full forte and ofj�cL�
5 Llccn sl_.I _Lk.N
20SQ
i
Da1C ,7/^ao'�— Gaalraebr
ARCDEC IO N
sw
heused
1 understand my puns Mal YI W tl u public records
Licensed Pmfwional
3 OWNER -BUILDER DECLARATION
apt strata 1 am pt from theUte
E1 Touchy NcamContractors License Law for
D following mason. (Section 7031.5. Business and ProfesUans Code: Any city or county
which requires a Permit to construct, oiler imp.. demolish, or repair •ray stratum
prior To its issuance. alw requires the applicant for such Permit o rale ui'md suNmem
he is licensed to the of Ute Conuecut', License Law 9
Sq. Ft. Floor Area
Valuation
that punuum provisions (Chapter
7000) Division 3 BusinCade)
$6600
(commemms with Section of of Thew and Profwions or
S
Nat The u swept thereftmo and the basis fro the alleged esamption. Any violation of
35932033 AM Number
Occupancy e
y1YP
Section 70313 by any applicant for • Permit abroad led applicant to a civil penalty of
Out mare than fin hundred doll= IS=.
.P
❑ I. as owner of the property, m my employees with wages u their sole compensntion,
e
Required Inspections
will do The work, and theauncture Is otmtended or Olieted forsate(Sec. 7044. Business
and Profusmns Code: Tha Condamine, Lit= Law don not apply m in owner of
q P
ptePuty who buildamimp ovMUtucon,and who doessuch work hi ur3f M Wou{h his
Own emplayen, provided that each improvements art rot intended croRered f rima. If.
however. Ute building Or improvement 4 sold within one you of mmpledon. the ownm-
builder wdl have W burden of proving that TO did nut build or Improve for purpose or
save.),
❑ 1, as owns, of W property, am mmiu vely matimaing with licensed mnwctoss in
construct The project (Sea. 70x4. Business and Profession Code:) 71m Cmtsschers U.
mw Law does not apply m an Owner of Property who Wilds or improv Merton, and,
who contnN for such projects with a contrsamr(m licwed Pursuant to the Contractors
IJmna Law.
.
lamesemprumusee ,BBPCrmgisreason
Owner Dau
WORKER'S COMPENSATION DECLARATION
I hereby &Man under penalty of perjury oro of the following decleratimor
have and will maintain a certificate ofCownt an self4c um fu Workers Compare
nation, u Provided fro by Section 3700 of the Labor Code. fm me performance of Ute
wank fro whichNis Paint,u sassed.
I have and will mainWn Warker's Compensation Insurance, u required by Section
of the Labor Came. for Ute performance of The wart for which this permit is issued.
'
arlseea n Matin Ins1ymllee MRler Nd Policy num W! ale:
-f.rvs ,l Policy No.: 5n I�'i7I1
CERTIFlGTE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
-,
(Misseulm food rot W completed If dte permit Is foram hundred dollan (SIM)
or uual
1 cattily That in the performance of tui work fro which This permit is issued. l shall not
employ any person in any manner an as m how= subject to Um Workers' Compensation
Laws of California. Dau
Applicant
'
NanCE TO APPLICANT. If. after making Nis Cenifiau of Emmption, you thouW
become Subject as lha Workers Compensation partitions of The IsbM Code, you most
forthwith comply with arch ItraalMOOS or This permit Nall W domed mated.
5
yCONSTRUCTION LENDING AGENCY
1 Thereby afran Than Nem in a conjunction lending agency for The performance of
the work for which dus permit Is issued (Sec. 31097, Civ. C.)
'
Lenders Name
,
I<ndees Address
'j I certify that 1 have rad this application and sure Uw the aWw irl(omadun is
correct. I agree u, comply with 111 city and county ordinance; and NIC is” relating an
building conjunction, and hereby author= mprwnutiv of this city in enter upon the
q a Wve-mentioned property rat inspection purposes
(Wc) agar to save, indemnify and keep hmmlw the City of Cupertino &Bakal
list, IiUu, judg an ts and expenses which may in my myacme against said City
meotZos
7
rantingoflhispermit.
APPLIC U 0.5TANDS AND WILL COMPLY WI ALL NON -POINT
Issued by: Date
SOU REG TIONS 2) O
.J
Re -roofs
Type of Roof
SI{nuts Applian onDete
HAZARDOUS
S MATERIAISDISCLDSURE
Will Um applicant or forum Wilding occupant stove orhandle husrdoan material
'
U de, Carnation Municipal Code. Chapter 9.13, and The HMIN and Safety
Sec io 25 32(a)
catle, section 35533(.17 IT
All roofs shall be inspected prior to any roofing material being installed.
N
❑Yes o
If a roof is installed without first obtaining an inspection, I agree to remove
will the applicant or futu building umvpant use equipment or devices which
L hmsNnM Oir conuminanu as dcMed by that Bay A. Air Quality Mansgcmcnt
all ne a rials for inspection..
uic')
❑Yes 13 NO
w
Thareed Ute hassrdou materials reWimmanu underChapter6.95 or the Calif or
Heol sty Code,SectlaB 25505,25533 and 25534. I amicasnl llW ifUte hUldi
-
c nUY hew a umant. and it u an msponsilrililY notify tat o tupanl of
m tswnienmuuWmetpriarmiastlN(TancerlirNar�}t ey.
1 ureofApplieant Dae
{%Date
All roof coverings to be Class'%W' or better
o
rarantharizeaapem
• 2 ITEMS OF 2
CITY OF CUPERTINO
PERMIT RECEIPT
• Sec: Twp: Rng: Sub: B1k: Lot:
APN ........: 35932033:00
DATE ISSUED.......: 03/31/2008
RECEIPT #.........: BS000004319
REFERENCE ID # ...: 08030188
SITE ADDRESS .....: 7423 STANFORD PL
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OPERATOR: patg
COPY # : 1
OWNER ............: SAM HSIEH
ADDRESS ..........: 7423 STANFORD PL
CITY/STATE/ZIP ...: CUPERTINO CA, 95014-5814
RECEIVED FROM ....: ROGER BRIGHT
CONTRACTOR .......: BRIGHT, ROGER LIC # 21477
COMPANY ..........: KEITH ROOFING CO INC
ADDRESS ..........: 920 LINCOLN AVE
CITY/STATE/ZIP ...: SAN JOSE, CA 95126
TELEPHONE ........: (408)295-8616
• FEE ID UNIT - QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL
1BSEISMICR VALUATION
6,600.00
0.70
0.00 0.70 0.00
• 1REROOFRES SQ FEET
20.00
----------
260.00-
-
0_00 260.00 0.00
--------- ----------
TOTAL PERMIT
260.70
0.00 260.70 0.00
METHOD OF PAYMENT
AMOUNT
REFERENCE
NUMBER
----------------- ---------------
CREDIT CARD
260.70
--------------------
VISA
---------------
TOTAL RECEIPT
260.70
VOICE ID DESCRIPTION
VOICE ID
DESCRIPTION
-------- -----------------------------
601 ROOF TEAR OFF
--------
602
----------------------
ROOF PLYWOOD NAIL
603 ROOF BATTENS
604
ROOF IN -PROGRESS
605 FINAL REROOF
•CUPEVINO
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L.
oiO 3 0/11-
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION
APN #a 79 v 2 3, 6 (�
J
Date _
C,
Building Address:
�f
I
Owner's Name:
Phone#:
Contractor: ^
Phone
Fax #:
Cupertino Business License #- I
Contractor License #:
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
-Asphalt Shingles
� 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.
Job Description`-
4mo �r I �
3U 4 COn`0'J�riu w 3d I (a Fc I
C cC�Js
Residential
Commercial
Fire Zone: Yes ❑ No
Confirmed with Planning Dept. if
there are any restrictions: ❑
Valuation: .
OWN
I Have Read, Un§cx n� and Will Comply with Cupertino's Tear -Off Policy:
•
0
CITY OF CUPERTINO
REROOF
I OF
•CUPERTINO FEE SCHEDULE
F_
L_
4
Number of
Squares
Fee ID
Fee Description
Fee
Group
Permit Type
1REROOFCOM
Re -roof Commercial
B
1COMMLROOF
1BSEISMICO
Seismic Commercial
B
2a
1RER00FRES
Re -roof Residential
B
1SFDWLR00F
1BSEISMICRE
Seismic Residential
B
1RER00FMRES
Re -roof Multi -Family
B
1MFDWLROOF
1BSEISMICRE
Seismic Residential
B
1BUSLIC
Business License
B
•
0
•
0
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: -:�; 11M �L I c h
Job Site Address:
Roofing Company Name:
Applicant's Signa
Greg Casteel
Building Official
Revised 11/2/04
_T1.1
Date:3
9
0
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax(408)777-3333
Building Department
JOB ADDRESS: I
t l
PERMIT #
OWNER'S NAME:
PHONE #
GENERAL CONTRACTOR:
FAX #
I am not using any subcontractors:
Signature Date
Pleaaa rherk nnnlirnhle crnhrnntrartnrc and rmmnlete the following information:
6vner/ Signature
0
V
Date
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
6vner/ Signature
0
V
Date