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05070098 BUILDING DIVISION PERMITCONI'RAG�"TOR INFORMATION Bu1LDINGADDRESS; MBROWN CONSTRUCTION, INC PERMIT No.05070098 W NER'S NAME: PERMIT ISSUE DATE E; SANITARY iF'lONTROL N0, ARCHITECT(ENGINEER: BUILDING PERMIT INFO BLDGELECT PLUMB MECH 0 0 0 0 O Zp LICENSED CONTRACTOR'S DECLARATION Job Description w 1 Wrcby affirm NM o Load 1 am licensed under provisions Chapter 9(commencing ,ZW with Section 7IXIU)rf Division 3of NC Busies...and Prusg�n7Codc.ad m nyliccnso is ^<^, in full forceeand�-Off License ?� � — VY G.Z ;�= e i—L".g REMOVE 2 LAYERS, INSTALL APPROX . 29 SQUARE FEET —o Daws conmaECT OF CLASS A 50 YEAR COMPOSITION 'J` sslt ARCHITECT EC RATION v�ree 1. '1.. hall Nupublic records (FLAT SECTION NOT INCLUDED) JyV T LLa Lxenxd P fdssionel Oat I am exempt from DECLARATION <E I hereby affirm than I am exempt from Ne Contractor's ra :Any c Law for the o O which moon.(Section 703L.3.Business and e.de Professions Cndr:Any city of county K m which requires a permit to construct.th Pimp resume.h Perlia or repair any structure semi priormits issuanre.alw requires the applicant for such Permit to flcasigned summcm < that hcislicensed pursuant toNcpmvWomofOrContracmhLittnmLaw(Chapmr9 Sq. Ft. Floor Area Valuation YFG (commencing with Section VOW)of Division 3 of the Business and Professions Code)or p,�^ i that he is exempt therefrom and to bssu for the alleged exemption.Any violation of Section 7031.3 by any applicant for a permit subjects the applicant o a civil penalty of APN Number t'-` Occupancy Type not more than five hundred della.($SM), .,sfa 01.as owner of the popped,or my employes ewith wages as their wiz compensation, a' �'s n will do the work,and the moderate is not immodcd or offered for sale(Sec.Ram,Business , 00 and Professions Code:The Com rxctnfs License law docs not apply w an owner of Required Ins CC ns�V;{ property who builds or improves thereon,and who doessmh work himselfor through his p[b'� Own employ=,provided that such improvements art not intended or offered for mile.If. � however.the building or improvement is sold within one year of completion.the owner. builder will have than Wrdcn of proving Out he did not build or improve(w Purpose Of zees natal. ❑1.as owner of Ne pmpmny,am exclusively contracting with lieeomed crnmuears to C construct the project(Sec.7064.Business and Professions Code:)The Conuacwls Li. �f cense law does not apply to an owner of property who builds or improves Nemo.,and (� /}mow ma .e who comcts for such projects with aeontmr(s)licensed pursuant w Ove Comm ictofs If License Law. Fl I am exempt under Sec. .B h P C for this mason Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following deellamliome I lmm and will maintain a Certificate of Consent o self-insum for Worma's Compcm nation,as provided for by Section 37M of the labor Code.for the performance of Ne work for which this permit is issued. ❑1 have and will maintain Worker Compensation Insurance,as required by Section 37W of Ne labor Code.for the peffarnimme of Ne work for which this permit is issued. My Wmkefs Cmm bu'on Insurance cam.e,and Policy number am: �7 Cartier: �. 'g-�ys gi/ Policy No.: II J' ja __7/ RTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE pTumdic n rued not W complOmd if Use permit is Inform hundred dollars(SIM) or Irm.) 1 certify Nat in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workcri Compensation Laws of Califrmla.Dare Applicant NOTICE TO APPLICANT:If,arm,making Nis COmEcam of Ezcmptirn,you should become subject in the Workers Compensation p mvtsiom of Oe Iavar Code,you mum .J O foMwith comply with such prnvism.or this permit shall be decmcd ranked. Z CONSTRUCTION LENDING AGENCY (–sem IWmby affirm Wt there is a construction lending agency or the performance of C the work for which Nis pennot is issued(Sec.3097.Civ.C.1 fig] 0 lender's Namc _,� Lcndera Add= U C) I certify that 1 have read this application and sum Nat use above information is r correct I agree w comply wish all city and county ordinances and some laws relating to C U building construction.and hereby airborne,mpresenatives of this city to enter upon the W above mentioned property for inspection purposes ,r C (We)agree to more,indemnify and keep harmless the City of Cupertino against N liabilities,judgmenserims and,apenxes which may in any way scenic sgmus,said City U Z APPOof me training I L CANTUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE ULATIO . – ' ? C'( O J Re-roofs Signature f pplinnUConuacwr Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof W th applicant or forum Wilding occupant mom or handle hazardous material as defincil by the Cupertino Municipal Cndc,Chapter 9,1 2.and the Hc.lO and Safmy oda.Securnz55320)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yrs Will the alrylicam or inure building occupam um cyuipmcm or Jcvitts which If a roof is installed without first obtaining an inspection,I agree to remove it hazardous air contaminants as defined by than Bay Arca Air Quality Management all new materials for inspection. micR 71 Yes � Ihavc read the Wrsrd,m aurialsrequinents undcrCMper6.95 ofthe Califon- ria Heal"Safety Code,Secti 25YJ5,3553 mand 2553x.lundc.und thatifNe Wilding does not currently have a bu am,Onto i* responsibility to notify the occupant of the .quimmcnts n hmpmbcmetpri maurm,of.CcmfimamofOcm Signature icant. Date I d JS All roof coverings to be Class "B" or better Owner or l dived agent Doc CITY OF CUPERTINO 1 of 1 PERMIT RECEIPT OPERATOR: kiersaw COPY # 3 Sec: Twp: Rng: Sub: Elk: Lot: APN . . . . . . . . : 36917052.00 DATE ISSUED. . . . . . . : 07/18/2005 RECEIPT #. . . . . . . . . : 30405 REFERENCE ID # . . . : 05070098 SITE ADDRESS . . . . . : 6354 BLACKWOOD DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : IAN AND MYOUNG KANG ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4617 RECEIVED FROM . . . . : MBROWN CONSTRUCTION CONTRACTOR . . . . . . . : CHRIS BROWN LIC # 25108 COMPANY . . . . . . . . . . : MBROWN CONSTRUCTION, INC ADDRESS . . . . . . . . . . : 702 S. DANIEL WAY CITY/STATE/ZIP . . . : SAN JOSE, CA 95128 TELEPHONE . . . . . . . . : (408)260-1260 E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 6, 000.00 126.36 0.00 126.36 0.00 BSEISMICRE VALUATION 6, 000.00 0.60 0.00 0.60 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 126.96 0.00 126.96 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ OTHER 126.96 AMEX TOTAL RECEIPT 126.96 x Community Development 10300 Torre Avenue ' Cupertino CA 95014 Telephone(408) 777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building De artment JOB ADDRESS: ufer1-wO� PERMIT # &3csdLjnd 12. cf-�, OSo-?vo q- cf� OWNER'S NAME: fM PHONE # SS- GENERAL CONTRACTOR: . c FAX # I am not using any subcontractors: Signature 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 Tile ner/Contractor Signature Date Community Development Department - A� Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 U P E IST I N O 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: Myr• q, firs, Lgpl� 2Wd - Q • J 1Job Site Address: Roofing Company Name: M & 2n CoASA-'Uclicl , JMC - Applicant's Signature: Date: of Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper tig CITY OF CUPERTINO �� REROOF CUPEkTINO PERMIT APPLICATION FORM APN # Date: 3cdl� ��-osa� -�_ � �•d� Building Address- 63 ddress:G s� I� � ,�. J•w Owner's Name: Phone#: a�I c o�N ,�a✓L py• 293 i265� Contra r: Phon License#: A-K-61-04Cmpsl✓o ,,d�. Jnr . 41 . Z 2- Contact:,, Contact: Ph ne#: Cupertino Business License#: mus a - uv• 06 (0 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof K Asphalt Shingles K Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing covering ❑ Provide I.C.B.O.Report# To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job" es Description: n 2 1-9 I-- 01 l0 I r�v'- Residential Commercial ❑ ut (1—VA+ S-eG{-kin 0o4" inJjQeC( Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if there are any restrictions: LJ Cost of Projecg Type of Con stjuction:r Occupancy group: S Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING