05070134 (2) CITY OF CUPERTINO �' * *' � ' `"' :
BUILDING DIVISION PERMIT C�NTRAGTOR INFORMATION -
,...
BUILDING ADDRESS: R E ROOFING & CONSTRUCTIO PEpA11N1...g{'r,N
0.05070134
22018 MC CLELLAN RD
OWNER'S NAME: PERMIT ISSUE DATE
TONY CHONG 15230 CLYDELLE AVENUE 07/21/2005
OPINE: SANITARY NO, CONTROL NO.
(408) 626-9320
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION Job Description
r� 1 boroby affirm Nal 1 am licensed under provisions of Chapter 9(mo meneing P
-� with Section 7(08)-fl) 1.' n3ofa Business4p P fcuiun fpyl rad eryliecnuis
in full Tome and c'm; I �,_I� REROOF-REMOVE EXISTING SHAKE/INSTALL
i'y,_ Datc;C V 1 d 1/2" CDX 30LB ASTM FELE �yr�t I �y���\T�\ILE
Dam Contrumr �11 ALJ
77 AR�Hf1ECfSDECLA 1 RNMED
< 1 rax nJ my P, sh se uudu Pub' rds
J U
G 1
Licensed Professional
OWNER-BUILDER DECLARATION
r C I Wrotryso .(Sinn that 11. ucfrom tW Cssions o :A n c Law for du 3_ 200[
ip O following roomn.(Section RIJ 1.3,t'.Business'. and ws.di eau Gude:Any city m county vI
Laim which its issa a p,mit b cnnsMe eller.impmsu thmoliih,or mash any suunum {1`((�}g.`p'
Priors its issuance.c,mite otI.Me Me for mohpermiuoflcasigned Law(Chmment M
< Hathe is mecing wit Puwam I.Me of Divionen oMae f the
Business
(Chapter Sq.Ft.Floor Area ggQ
xFS ft,he it ngwith hmefom ittfDtems n3 but adl.gd errand Professions C-x)or
.- Ihas he is eaunpt Hmcrt(rom and He bull for the alleged exemption.Any Wolation of
Section 7031.5 by any applicant for a permit subjects He applicam to a civil penalty of APN Number Occupancy Type
an, me M.five hundred doll.(M). 35608038 . 00 P y YP
El I,mowneroftheryopeny.mmyemployceswiH"rAm h mlecompenudon,
will do the work,and Hesuuctum is not intended ororered formic(Sec.7014.Business
and liMfussiou CoxTu a
:TCon cmes Licence,Law tro
Law t apply in an owner or Required Inspections
property who buildsorimproves Hereon,and who dmasuch work himulf or through his
own employes,provided Hat such improvement art notinurWed oroRere i for sale.If,
however.He building or improvement is mid within one year of completion,the manner,
builder will have He burden of proving Has he did not build,improve for puryom of
ale).
❑1,as owner of He property.am exclusively contracting with limosed contractors to
contract He pmjcct(Sec.7014.Business and Professions Cox:)The Contractors Li-
ce cs Law donot apply to in owner of properly who Wilds or improves themon,and
contracts for such projects with a conoacmKs)li¢nud pursues m He Contractor's
x Law.
I am aempt ones Sec. .B A P C for this mason
Owner Dau
WORKERS COMPENSATION DECLARATION
I bemby arum under penalty of perjury one of the following xclamtions: -
❑1 haw and will maintain a Cenifiau-f C-nsem m ulf-inseam for Worker's C-mpcn-
s oral,as provided for by Section 3700 of He labor Codc,for He performance of the
work for which His permit is isuea
1 have and will maintain Workers Compensation Insurance,as squired by Section
of He Labor Cox,for He performance of He work for which this Permit is aimed.
My Workee Compensumi mance artier and Policy no am:
Cartier. i Policy No.:nn
CERTIFICATEOF :EMMONFROMWORKERS'
COMPENSATION INSURANCE
(]Idsmainn need out becampleud if the permit is foronchundmd dollars(5100)
or less.)
1 ceNfv Hat in He performance of He work for which His Permit is issued.I shall net
employ any person in any manner m as in become subject in the WorlaKCompensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making On Cenificau of Exemption,you should
become subject to the Worker's Compensation previsions of He labor Chic,you most
.,O foMwith comply with such provision or His Permit shall be themed m
oked.
z'" CONSTRUCTION LENDING AGENCY
Ihereby affirm Hat Hirt is a conlru,ian lcndingagcney for He performance of
6i He work fm which this permit is issued(Sit.3097.Civ.CJ _
C(] leder,Name
z Lenxr's Address
U C) I certify that 1 have read His applicmion and suis Hat He abeve information is
Fcorrect.1 apes 10 cemplY with all city and county ordinances and suis laws rdalmi,to,
0U Wilding convuNon.and hereby authorise representatives of His city to enter upon He
�'[3.1 aWve-menti-nodpropertyils4og for ie peeuonpirch ma
gy (We)agree to taw,indemnify and keep harmless the City of Cupenin.against
rq liabilities,judgmentecoon and expcueswhich may In any way.ecus agalut mid City
U ue"m of He gaming-(His pUe,rmit.
APPLIC 1T U ERSTANDS A it L COMPLY WITH AL NON P01 Issued by: Date /7
SOUR EG A.Ns. Zl I o / 2
Re-roofs f
Si of Appli_HAZARDCUS Dau
\HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Hee Cupertor future building occupant gate or and M Health anmabrid
u defined by Oc Cupertino Munici YCox.Chapter 9.U.and IW Health and Safety
Code.Section 25532(.)?
❑Yes Ne All roofs shall be inspected prior to any roofing material being installed.
Will the.applicant or future Wilding If a roof is installed without first obtainingan inspection,I agree to remove
PP g«cm pant um or dcvias which P
it haiardnu air mnuminst u
Dimic,7 toed by du Bay Area Air Quality Mamgcmcm all new materials for inspection.
❑Ycx Nu
Ihave mmlthehvardousm 5505, 53 i an255 unxr CbapmrbMto(tW Califon ( I I0
nim @Safny Codc.S,don 25505,21537 and 25574.1 understand Matilda,Wilding /
ms note ly h am.Hat it t my msponibilitY b nmifY de auupmt of du
mgmi not ngg�yy�typ` of.Cemnamnfoempan�r�y-_�' tureofpppFicant Date
I U 7
Own,.r amhoriud a Dau All roof coverings to be Class"B"or better
CITY OF CUPERTINO
1 of 2 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35608038.00
DATE ISSUED. . . . . . . : 07/21/2005
RECEIPT #. . . . . . . . . : 30470
REFERENCE ID # . . . : 05070134
SITE ADDRESS . . . . . : 22018 MC CLELLAN RD
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER TONY CHONG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4060
RECEIVED FROM . . . . : R E ROOFING/CONST
CONTRACTOR . . . . . . . : PROCTOR, PAUL LIC # 20615
COMPANY R E ROOFING 6 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 19, 000.00 266.76 0.00 266.76 0.00
BSEISMICRE VALUATION 19,000.00 1.90 0.00 1.90 0.00
---------- ----------
TOTAL PERMIT 268.66 0.00 268.66 0.00
•
s Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
`UPERTINO
Building De artment
JOB ADDRESS: 220 ( (!, C�k1, AA- j 1p1`v, PERMIT# 7
O - U ( 2
OWNER'S NAME: U h1 PHONE # L4 U�- (L Z6 -I Ct 32-
GENERAL CONTRACTOR: p FAX# 0
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following ' 0 tion:
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
' e
r/Contr or Signature Date
Community Development Department
Building Division
{,),t City of Cupertino
10300 Torre Avenue
• Telephone: (408) 777-3228
CITY OF Fax: (408) 777-3333
CUPEkTINO
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 compl with the above stated policy on re-roofing.
Homeowner's ,
1 (/
- p �,
Job Site Address: �20� 8 b��, u✓
i
Roofing Com y e: - �% UCJ F l 1�1(( �II trnf C��(Zl C�� N` Nf
Applicant's ignatu Date: l2�
• Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
aun OF
RE ROO F
•CUPERTINO PERMIT APPLICATION FORM
APN # / 68-0 3 Date:
Building Address: 22 0I r, KL L Cru-,-,w
Owner's Name: �/uy boy - Phone #:
Contractor r Phone #: License #: 1
� 1Z��N w u - (�26 - c1316 7 2 Z 519
Contact:/ Phone #: Cupertino Business License#:
(0t5
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
Wood Shakes El Wood Shakes
❑ Wood Shingles ❑ Wood Shingles /�L Lq-[t W a f1
EI Other(Specify) Other(Specify) ( 5S G YL4 I I I t'�
Number of existing coverings Provide I.C.B.O. Report# IQ-:?)o 26S?6
Q7 To be Removed ❑\ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Com 1 With Cu ertino's Tear Off Polic
Job Description: 11F,eM0vt"I (f k4,rlN(t% ( 111 tq Yt_ OY— PJM A_z tNe7-T LL
N '12-l' GDx + TNt Via LA41iwtl I '
Residential Commercial
Fire Zone: Yes ❑ No Confirmed with Planning D, t. if
there are any restrictions: U
Cost of Pro=Ject ,
� VD Type of Construction: Occupancy group:
X3. 25
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEEBld Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING