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05100171 CITY OF CUPERTINO ' BUILDING DIVISION PE T_ CONTRACa'"TOR+INFURMATI© .,h. BUILDING ADDRESS: R E ROOFING & CONSTRUCTIO PLT4M005100171 0185 SUISUN DR OWNER'S NAME: PERMITISSUBDATS CHOU CT & DAPHNE JEAN 15230 CLYDELLE AVE 10/20/2005 NE: SANITARY NO. CONTROL NO. (408) 626-9320 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH �ozp LICENSED CONTRACTOR'S DECLARATION lb Description a 1 beach,effort that that I am licensed under provisions of Chapmr 9(commencing with Section 70110)of Division of the ButinuunPrefecturesan sPrefecturesCode, d myllcena" a'n1 infullfarceanddI Q9 ­72-7 9 REMOVE EXISTING 1 LAYER OF WOOD SHAKE, INSTALL j J is Lkenu Iw Dem Coevac NEW 1/2 CDX, 30# ASTM FELT AND TL RcxrlEcrsDEc COMP 1 uMlrmanJ my pia all be tend a pen corNF1* riz% ;mLkcnred Pmrcuianal iD OWNER-BUILDER DECLARATION L,F107IJ u 1 hereby.truce that 1 am exempt from the Contractor's Leen Law rot am NovC O o following mason.(Sudan 70L.S.Business and Prefetiuu Cade:Any city or county '1� ,�$ whreh rtquirea a penult m corstruck Sime,Impmw,tlemallsh,nr rtpair any stroctuen JU­ pdm m its Sentence,also requires 0m applicant far Such permit to file a signed statement F< that he is teemed pursuant m the previsions of the Contractor's Lmcom Law(Chapter 9 'Sq.Ft. Floor Areaaluation S (commencing with Section 7000)of Division 3 orthe Business and Professions Code)or I/Ip 012000 3 that he Is exempt 1Mrefrom and the basis for the alleged Mutation.Any violation or :f Y Semon 7031.5 by airy appliant for a permit subjects the applicant m a civil penalty of APN Number ecu c T tot ream am five hundred dollars(M). „ p Y YPe ❑1,u owner of the property,a my employtn with wages u the'tranle compewtim, Said do the wont and mesmctureIS notimanded or offered raraalc(Sec.70",Businda 00 Re tired Inspections and Professions Code:The Communes License Law data not apply m ns an owner of q P property who bui Ida or bmprovu menton,end wha does s uch work himself or through his barn employees,provided that Such Improvements are act intended mediated for We.if, however,the building or Improvement is sold within oat year of completion,dee owner. builder will have the income of proving Nat he did nm build or improv fm purpose of Sam). ❑1,as mover of the property,am exclusively contracting with licensed convacmn at construct the project(See'7044.business and Profuslam Cade:)The Concourse's Li. cense Law does not apply m an owner or property who breoan builds or improves then, d, who contracts for much projects WN a contractual.)liunaed PUMMI to the Cmntaux s License law. ❑1 am a menpt underSec. .B i P C roe WS recon Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby of ran under penalty of perjury am of tis,following dulara0ons: sat❑I bow and will far b in a CW fi7M ofConsem Code. funs fm Wmkeheampan- workfas provided far mi Sudan 3]00 of the labor Code.ler the Performance of the work for which Ni.permit is Issued. 1 haw and will maintain Worker's Compensation Insurance,u rtquimd by Seems 37of the labor Cad,far the performance of the work far which this permit is lstuet. My WorkeYa Compenud )raw' erand Policy number ant: ir1 Gamier. ATE PoIIry FROM CERTIFlCATEOF "MONEMPTIONPAAN WORKERS COMPE SATIONINSURANCE (Thls section need nothecomplemd if the permit is for one hundraddallara($100) m,mmol) 1 cerdh that In the performance of the work for which this permit is issued,I As]]not employ any person Inany Sumner an as m became Subject to the Workes'Compensstion Laws of Cshfomia.Data Applicmt NOTICE TO APPLICANT:IC after making this CenNcam of Exemption,you Mould become subject to the Worker's Compensation previsions of the labor Code,you mum O forthwith comply with Such provisions or this permit shall W Started revuked. Z► CONSTRUCTION LENDING AGENCY [—p I twenty alrom that Vert u a construction lending agency for the performance of ai me work for which then permit 4 issued(Sac.309].Civ.C.) [s3 Q 4ndel's Name z Lender'sAddress U0 1 unify that 1 have read this pplication and SUM that the above information Is V, contact.I&gra at comply with all city and county ordinances and Max laws Mining in 0 building construction.and hemby authodm representatives;of this city to enter upon the Ill shove-mentioned property for impaction purposes. 06 (Wes)agree to save,indemnify and keep hatmlesa the City or Cupertino against rrA liabilities.judgments,casts and expenses which may in my way accrue agaln.t Said City U APPLsegnencc of the{rmtAl NOS Aof Is permit. N WILL COMPLY WITH A NON POINT Issued by: Date Re-roofs ti Si nn Applies uConu Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof a,applicidirmt future building excepm,smre or handle hvadou material as abroad by the Cupertino Mural Cod,Chapter 9.13,and the Health and Safely Code,Sudan 25532m)? All roofs shall be inspected prior to any roofing material being installed. ❑Yu No Will then applicant m future building=opera use equipment or devices which If a roof 1$Installed without Hest obtaining an inspection,I agree IO remove emit havmdnu It canuminanu as dcfigcS by the Bay Area Air Quality Management all new materials for inspection. ❑Yes I haw read the hvardousmamrida requiremants under Chapter-6.95 or the Califon lately Cade,Stations 25505,11511 and 21534,1 mNe dem11.building does tot c rely haw a t' ihaity an really the Pmt f the runt ats It u 'be met pri u arm nifica'morol Signature of Applicant Date arixedagem 1 Date All roof coverings to be Class "B"or better , CITY OF CUPERTINO Item 1 of 1 PERMIT RECEIPT OPERATOR: christya COPY # 2 Sec: Twp: Rng: Sub: Blk: Lot: APN . . . . . . . . . 36928013 . 00 DATE ISSUED. . . . . . . : 10/20/2005 RECEIPT # . . . . . . . . . : 31681 REFERENCE ID # . . . : 05100171 SITE ADDRESS . . . . . : 20185 SUISUN DR SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : CHOU, CT & DAPHNE JEAN ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4427 RECEIVED FROM . . . . : BOBS CONTRACTOR . . . . . . . : PROCTOR, PAUL LIC # 20615 COMPANY . . . . . . . . . . : R E ROOFING & CONSTRUCTION INC ADDRESS . . . . . . . . . . : 15230 CLYDELLE AVENUE CITY/STATE/ZIP . . . : SAN JOSE, CA 95124 • TELEPHONE . . . . . . . . : (408) 626-9320 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 NUMBER ----------------- ------------ ------------------ CHECK 192 . 36 9492 TOTAL RECEIPT 192 . 36 • CITY OF CUPERTINO REROOF cUPERTINO PERMIT APPLICATION FORM APN# Z$ O/3 . oo Date: Building Address: / U 2.0«� �u15uiJ �R1vL' Owner's Name: Phone#: ab L - 212 Contractor Phone #: ��_b26—°132c� License#: '� � �uc)Y1N Contact: ����N�J Phone#: Cupertino Business License#: M� 2C>� l5 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt ShinglesAsphalt Shingles X Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ')IC Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# �{ To be Removed L3Provide Mfgr.Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description:jVdVG a(SO N(T ( l,/M0- Oy- W oJ)9. %1I kGr j NSTKI,(, 421k C'.D K 'J o *ASTM til" J Residential Commercial ❑ rU Co> IP Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dapt. if there are anrestrictions: LJ Cost of Proj ,n! Type of Construction: Occupancy group: Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Ener BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING • G �C Community Development Department Building Division aClOF City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 Fax: (408)777-3333 COPE R.TINO 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: C 1�/`�uV� Job Site Address: _"' ^ 5Lk�,l Roofing ompany e: I \ / �u Yl N Applicant's Signa re: Date: 1J Zv 0 Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper