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09080381 (2) CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 873+HYDE AVE CONTRACTOR:KEITH ROOFING CO INC PERMIT NO:09080381 OWNER'S NAME: RICHARD HONG 1120 LINCOLN AVE DATE ISSUED:08/26/2009 ER'S PHONE: 4084971457 :;AN JOSE,CA 95126 PHONE NO:(408)295-8616 ❑ LICENSED CONTRACTOR'S DECLARATION 3UILDING PERMIT INFO: BLDG ELECT r PLUMB License Class i—)-�� Lic.# S� (/(/ MECH RESIDENTIAL COMMERCIAL Contractor �Z,I Date d_ IOB DESCRIPTION:RE-ROOF REMOVE TAR&GRAVEL ROOF I hereby affirm that I am licensed under the provisions of Chapter 9 NSTALL NEW BUILT (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. JP TAR&GRAVEL ROOF CLASS A LIKE FOR LIKE CLASS A 25 SQ 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. I have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$10000 permit is issued. APPLICANT CERTIFICATION APN Number:37541004.00 Occupancy Type: 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 to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point se regulations per the Cupertino Municipal Code,Section 9.18. Issued by. % —� �"�--` Date: Signa reDate LV OWNER-BUILDER DECLARATION RE-ROOFS: 1 hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(See.7044, G? Business&Professions Code) Signature of Applica Date: I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must Owner or authorized agent: forthwith comply with such provisions or this permit shall be deemed revoked. Date: CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name — upon the above mentioned property for inspection purposes.(We)agree to save i- nify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address c. and expenses which may accrue against said City in consequence of the grawing of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION L ll non-point s urce regulations per the Cupertino Municipal Code,Section / .r/ 1 understand my plans shall be used as public records. a Date � Licensed Professional CITY OFCUPERTINO RI1,ROOF CUPEkTINO PERMIT APPLICATION APN # Date: el Z Building Address: d-e—, Owner's Name: 1yl� Phone #: HOA: Yes ElNo provide letter from HOA If es, Contractor: _ Phone #:�9��8�� go's & Fax #: Cupertino Business License #: Contractor License #: .7 7 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.C.E.S. Report # ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: k� C CSIs �--- � ;�:- �- �:�� ❑ 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, include in plan set & the sheet in dex. Valuation: I Have , Understand and Will Comply wi th Cupertino's Tear-Off Policy: ig re Revised 02/05/09 a( --, CITY OF CLVERTINO REROOF CITY OF FEE SCHEDULE CUPEi�TINO Number of Fee ID Fee Description Fee Permit Type Squares Group 1RER00FC0M Re-roof Commercial B 1COMMLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICO Seismic Conn _iercial B 1RER00FRES Re-roof Res.dential B 1SFDWLR00F 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission Fee 1BSEISMICRE Seismic Residential B 1REROOFMRES 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 r,!-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 buildir.g inspector. A final inspection and approval shall be obtained from the b-ailding inspector when the re-roofing is completed. 3. All roofs shall be inspected prior to ar.y roofing installation. 4. To receive a final sign off from the City,the following steps are required: 1) Pre-inspection and/or tear off app-oval. 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/ "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 abo,� stated policy on re-roofing. Homeowner's Name: �Le_Job Site Address: ' Roofing Company Name: �--' Applicant's Signature: Date: Greg Casteel Building Official Revised 07/30/08 Community Development k 10300 Torre Avenue Cupertino CA 95014 CITY OF Telephone(408) 777-3228 XPEkTINO Fax(408)777-3333 Buildin DLFAX ment JOB ADDRESS: 6-73 # OWNER'S NAME: GJ�ct l # GENERAL CONTRACTOR '1 I am not using any subcontractor z �� Signature Date Please check applicable subcontractors and complete 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