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10030036 CITY OF CUPERTINO BUILDING PERMIT CONTRACTOR:H&W ROOFING PERMIT NO: 10030036 BUILDING ADDRESS: 7785 ORION PL 1890 CREWE CT DATE ISSUED:03/04/2010 OWNER'S NAME: CHAN STANLEY W AND ELEANOR Y PHONE NO:(650)964-4945 SAN JOSE,CA 95132 BIER'S PHONE: 4084722097 ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG ELECT PLUMB License Class C".36� Lic.# G�3S'oG 7 MECH r- RESIDENTIAL(_ COMMERCIAL Contractor Date J✓ JOB DESCRIPTION:TEAR OFF OLD ROOF&RE-ROOF W/ASPHALT SHINGLES I hereby affirm that I am licensed under the provisions of Chapter 9 CLASS A 30LB FELT 28SQ (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penalty of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. Valuation:$8200 I have and will maintain Worker's Compensation Insurance,as provided for by Sq.Ft Floor Area: Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. APN Number:36218047.00 Occupancy Type: APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating PERMIT EXPIRES IF WORK IS NOT STARTED to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes (We)agree to save . WITHIN 180 DAYS OF PERMIT ISSUANCE OR indemnify and keep harmless the City of Cupertino against liabilities,judgments, 180 DAYS FROM LAST CALLED INSPECTION. costs,and expenses which m accrue against said City in consequence of the granting of this permit. Ad i ionally,the applic t understands and will comply with all non-point source gulations per the C ertino Municipal Code,Section Date: 9.18. 7 Issued Signature Date RE-ROOFS: Li OWNER-BUILDER DECLARATION All roofs shall be inspected prior to an roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an i pection,I agree remove all new materials for the following two reasons: inspection. 1,as owner of the property,or my employees with wages as their sole compensation, Date: will do the work,and the structure is not intended or offered for sale(Sec.7044, Signature of Applicant: - Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for the Campl anclifornia e with the SafetyCupertino dMuni tion 25505 25533,r 9 12 and the and 25534. 1 ill m&tain performance of the work for which this permit is issued. Safety Code,Section 25532(a)should I store or handle hazardous material. 1 have and will maintain Worker's Compensation Insurance,as provided for by Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compli nce with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safe Code,Sectio 25505,25533,and 25534. not employ any person in any manner so as to become subject to the Worker's Compensation laws of California. If,after making this certificate of exemption,I Owner r thQ Ped a e Date ' become subject to the Worker's Compensation provisions of the Labor Code,I must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save Lender's Address unify and keep harmless the City of Cupertino against liabilities,judgments, ,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION Lwith ing of this permit.A itionally,the a plicant understands and will comply all non-point sourc egulations per a Cupertino Municipal Code,Section I understand my plans shall be used as public records. Licensed Professionaature Date J CITY OF CUPERTINO PERMIT RECEIPT OPERATOR: patg 3 ITEMS OF 3 COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot : APN 36218047 . 00 DATE ISSUED. . . . . . . : 03/04/2010 RECEIPT #. . . . . . . . . BS000009881 REFERENCE ID # 10030036 SITE ADDRESS 7785 ORION PL SUBDIVISION . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER CHAN STANLEY W AND ELEANOR Y ADDRESS 7785 ORION PL CITY/STATE/ZIP CUPERTINO CA, CA 95014-5078 RECEIVED FROM • " : HAINESROHARRY OOFING & LIC # 1173 CONTRACTOR . . . . . . COMPANY H & W ROOFING ADDRESS 1890 CREWE CT CITY/STATE/ZIP SAN JOSE, CA 95132 TELEPHONE (650) 964-4945 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC- - NEW-BAL- ------------- ---------- ---------- ---------- ----- 1BCBSC VALUATION 8, 200 . 00 1. 00 0 .00 1 . 00 0 • 1BSEISMICR VALUATION 8, 200 . 00 0 . 90 0 .00 0 . 90 0 . 00 1REROOFRES SQ FEET 28 .00 364 . 00 0 . 00 364 . 00 - -- -0_00 TOTAL PERMIT 365 . 90 0 . 00 365 . 90 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- -- CHECK 365 . 90 #8155 --------------- TOTAL RECEIPT 365. 90 VOICE ID DESCRIPTION VOICE ID ------DESCRIPTION -- _ - ------ -- ----------- - -- ---------- ____ 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF -�, CITY OF CUPERTINO REROOF CITY OF CUPEkTINO PERMIT APPLICATION APN # 4 Date: 7 Building Address: OR(O Z . Owner's Name: lv-n C 4 _ r Phone #: HOA: Yes ❑ No a If yes, provide letter from HOA Contractor: / Phone #: K(JC)7�O/A-/S Fax #: Cupertino Business License #: Contractor License #: 4134_0C 7 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles 4' Asphalt Shingles XWood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: ra r /c/ eo rJ� Residential Commercial Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: ❑ applicable, iqclude in plan set & the sheet index. Valuation: . C- I Have Read, Under and and Will mply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF CUPERTINO REROOF M°FFEE SCHEDULE CUPEkTINO Number of Fee ID Fee Description Fee Permit Type Squares Group 1REROOFCOM Re-roof Commercial B 1C0MMLR00F -------------------- 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Commercial B 1 REROOFRES Re-roof Residential B I SFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES ICommission Fee 1BSEISMICRE Seismic Residential B I 1RER06FMRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee IBSEISMICRE Seismic Residential B 1BUSLIC 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 2007 IBC Standards and manufacturers specifications on re-roofing.All roofs are Class "A"per Cupertino municipal code 16.04.080. 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 stat/ed policy on re-roofing. Homeowner's Name: �� 1::: tMP'-S' Ch Job Site Address: ! 7er," 0/�fyVW PL Roofing Company Name: Applicant's Signature: 4� Date: Greg Casteel Building Official Revised 07/30/08 Community Development ss10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 CITY OF �UPEkTINO Buildin De artment JOB ADDRESS: _ PERMIT # OWNER'S NAME: RS ,l PHONE GENERAL CONTRACT ;V5 FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and co m lete the followin 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 Tile Owner/Contractor Signature Date