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08030138 CITY OF CUPERTINO ?.BUILD D3vISloN PERNIIT C©NTRAGTURINFUItNTAIfI f:. _.. ate„ .Kw,ep^I». _4. ,fix _ [. BUIL 1 G D FSS: r PERMIT NO. T WESTERN DR SIMON SAYS ROOFING 08030138 NwER'S NAME: PERMrr ISSUE DATE LI-QUN RIA 3866 REXWOOD CT 03/25/2008 PHONE: SANITARY NO, CONTROL NO. (408) 531-9700 AFCHTIEC rENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 fop LICENSED CONTRACTOR'S DECLARATION Ib DeSCrUOn rd 1 hereby affirm Nat 1 w liceand n under Provision;of Chapter 9(cemmeainOI g p Sl with Section 70nWofDividon3ofdeBuumsr fudauCode.apMmyliccnxu RE-RF,T/O EXTNG 1LYR WDSHNGLSr30LBFLT,CLS A 24 SQ n p in full forte anaorte frecte -3 y!i g 3 ueenc 1 Lk.d ppp Dat TSCo.DE m Rawail b LTS DECLARATION 1 undoratanJ my P1uu mal be urnd an public mcordt J g W licensed ed Professional OWNER-BUILDER DECLARATION N <5 I hereby affirm that 11. ,Bumps s an are Contractors Licence Law for the C 6 following mars,.(game,703 1.5, t.o1w. and Predications Code:Any dry or mem. 9�'+ which its ism n Deceit re uirsuaL ars,WProw.OemmW, fl mash ed s =ni tS^ prim mitiouaene.also man,to ms theappnso for loch PumdmBk saigmN...mem ss< 1M Wencing cd pur,vam rode of Diviou of the ComrxwrYnd Proeciw(Cnodta9 Sq.Ft. Floor Area Valuation F 9 (cat he exempt Section rom and the basis n 3for of the eg dnexe roti Profunda Codd or $16685 — Net io V exempt Iany spam and the per for the alleged exemption.W Any l pHdan of Section,oats by any aP d donator a permit subject the applicant m,civil penny of Number Occupancy Type amt mom the firs hundred dollars(S500). 3 5 9110 0 7 :1319' ❑1,as comm of the property,or my employees with sego a math role CompeaWon, will do the work,and me,tnnum H not bene t or offerad for sale(See.7044,Business and Pmfoaoes Code:The Commences License law doo an,apply to an awmt of Required Inspections p umeny who builds aimproves memo,.andmadoessuch wok Mmalfar through his We employee,,provided thatsueh imp rsvemart ta an amt Imndnd oraRered fm sale If. however,W building or impmwmmt 1.add within mm yen,or completion.the Owner. builder will have the burda of proving mat he did Out build or improve for purpose or ❑1,no most of the property am oelunvely cC.=i,g with licensed onnuam a a wnawct Ute project(See 7W,Business and Profusion Cod.:)The ConuaToes W. Corte law does not apply in an owner of property who Wilde or Improves thereon,and who conuscna for town project with,eonmanor(0 licensed".at at the Commune. I.ictnm law. ❑I un exempt undo gees ,B R P C fm mid meson r Dam WORKER'S COMPENSATION DECLARATION 1 hereby atom under Penalty of perjury,aro of the following decluatimu: ❑I have atM will maintain a Certificate ofCoaucnn to alt-Im um forWorker's Cont cation,at Provided fm by Semon IM of ton,labor Cade.for the performance a(the wo for which this permit is bound. I haw ma will Claimed.Wartime,Compensation luurmce,an no dyed by Section 3700 ofthe labor Conk.for to peNarmmce afore work for which this Permit is lancd. ' My Workee�r'..CC.Cipentuiav/W)yy1�tnce curio tad Policy en-u�m�beerrue: timer:3 s'I�/ RID Palley No.: LAV tLV'4 b'r. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE rlTtmetion reed act bocompletd If the permit is fmone hundred dollen(5100) or lea) 1 cetifr the,In the performance of the work for which this Ferrol,is Issued.l mal two employ any perm,in my mannerm as to baamc subject to the Workms'Compenadan Laws of Caifurnia.Due APpllcmt NOTICE TO APPLICANn If.after making this Cemfacau or Exemption,you mould become Object m tho Worker',Corepmuaon provisions d the Iahm Cade you an u .J O forthwith comply with such previdon m mu permit mau l be dcned evoked., z., CONSTRUCTION LENDING AGENCY Er r'/1+ IWrehy affirm that mem Is a construction lending agency for the performanceor a the mark for which this permit I,issued(Sec.3097,Civ.C.) 0 Lender's Name Z)Z tender's Addma U O 1 amity mat 1 have mad ads application out mat that the me.id..0.is coma I agree to Comply with al city and county adlatwts and rot laws mlating in Wilding Construction,and hereby wthanm mpmsenutivu ofthie city to color upon me W ,Wve-mentht property fm Inspection Parpoaa (We)agree no ow.indemnify ad kap harmless tit City of Cupertino agent (ZI Iiabilina,judgments.cots and eapeua whim may In any way aced again aid City UZ in cmuequence of the granting of this permit. AP Ll ANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale SOU EGULATI NS. 7��Il,,v { >S U y Re-roofs Signatumof Appli Dat S MATERIALS DISCLOSURE Type of Roof Will f applicant or to,=Wilding acupmt more orhandle hazardous material dented by the Cupertino Municipal Cade.Chapter 9.13,and tit Heath and Safety Section 25532(1)7 All roofs shall be inspected prior to any roofing material being installed. ❑Ya �fa Will de,a,liwvm or future Wilding ataam ase cqulpmem or deem which If a roof is installed without first obtaining an inspection,I agree to remove emit husama an,comaminanu as defend by the Bay Am.Air Quak,Mmagcmcnt all new materials for inspdction. DIm4t7 ❑yes *No ' I have mad the bear beemalcriab requirement under Clupmrb.95 ofthe Callen , n nit Heal wry Cada Satiw24505.25533 and 25534.1 unaermmE thui(de building ; !' s Jou t tiny haw•want dust it' mY rapmabiliry as notify dw aampat or dw mgai iwnmumWna anL'mdflamara Signature ofApplicant Date `� f v All roof covering's to be Class or better owner or authomtd gc Dat' ' • CITY OF CUPERTINO 3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35911007 :00 DATE ISSUED. . . . . . . : 03/25/2008 RECEIPT # . . . . . . . . . : BS000004255 REFERENCE ID # . . . : 08030138 SITE ADDRESS . . . . . : 10221 WESTERN DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : LI-QUN XIA ADDRESS . . . . . . . . . . : 10221 WESTERN DR CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2944 RECEIVED FROM . . ... : EDWARD A GREGORY CONTRACTOR . . . . . . . : DARRYL SIMON LIC # 23053 COMPANY . . . . . . . . . . : SIMON SAYS ROOFING ADDRESS . . . . . . . . . . : 3866 REXWOOD CT CITY/STATE/ZIP . . . : SAN JOSE, CA 95121 • TELEPHONE . . . . . . . . : (408) 531-9700 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL -- -- ------------- ---------- ----- - ---- ---------- ---------- ---------- 1BSEISMICR VALUATION 16, 685 . 00 1 .70 0. 00 1.70 0. 00 1BUSLIC FLAT RATE 1. 00 110 . 00 0 . 00 110. 00 0. 00 1REROOFRES SQ FEET 24 . 00 312 . 00 0 . 00 312 . 00 0. 00 --------- ---------- ---------- ---------- TOTAL PERMIT 423 .70 0. 00 423 .70 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- ---- ---------- CREDIT CARD 423 . 70 MC --------------- TOTAL RECEIPT 423 .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 OEC)-3 0 1:�9 CITY OF CUPERTINO d' REROOF OCUPERJINO PERMIT APPLICATION All ��q f t Date: 3_ ZS - Zuo d' Building Address: /O Z Z l j Owner's Name: Phone#: Q u y� , q /1/p P - x'73— Contractor: so/,r Phone #: tlo8_ 53/_ 97vo Fax #:Cupertino Business Business License#: �y� Contractor License #: 7L?L/Fy�, Type of Roof Covering: �j Existing: Proposed: ^ e 3X e� yes- ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles 4 Asphalt Shingles _TL - ❑ Wood Shakes ❑ Wood Shakes Z 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:—jCis -�-�5 `Q� er t ooi S4 w6fes� -Ke QS a/ 3D/,6e 174 .3rJyn C��� S�:�sfes _ „ueu{he.-Ecf u/vod C1�_rr ResidentialLIN TV1 Commercial Fire Zone: Yes ❑ No Confirmed with Planning Dept. if there are anrestrictions: LJ Valuation: 6 6�r I Have Read,Understand and Will Comply with Cupertino's Tear-Off Policy: dAAd a�o� Signature 0 CITY OF CUPERTINO REROOF CUPERTINO FEE SCHEDULE Number of Squares Fee ID Fee Description Fee Group Permit Type REROOFCOM Re-roof Commercial B COMML-ROOF BSEISMICOM Seismic Commercial B REROOFRES Re-roof Residential B SFDWL-ROOF BSEISMICOE Seismic Residential B REROOFMRES Re-roof Multi-Family B MFDWL-ROOF BUSLIC Business License B 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: 2- i - &U.1 <�/' 57 Job Site Address: /0 -77 / !.(1W S Roofing Company Name: �� " t Sq S lid a-F,n 44 Applicant's Signature: Date: 3-25-2 • Greg Casteel Building Official Revised 11/2/04 e� Community Development peAvenue00 Torre rtino CA C95014 Telephone(408)777-3228 CITY Fax(408) 777-3333 qkU Building De artment JOB ADDRESS: / Z Z/ lc/�S tenh PERMIT # 0 D s O r 5 6 I OWNER'S NAME: L- : - Qu,� X,- ,3 PHONE # Yoa'- ?7.7- v e i - GENERAL CONTRACTOR: So s K FAX # I am not using any subcontractors �"�-�s-�PbA� Signa a 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 Plumbing Roofing Septic Tank Sheet Metal Sheet Rock dh Tile Owner/Contractor gna Date