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060901300 2 z C U OF 4 CITY OF CUPERTINO �NO NT"'gWe'r OR I'M I 'N VISION BUILDING DIIV11SION PERMIT PER ,'- UIL I BUILDING ADDRESS: PERMIT N0. 06090130 I CHE 10311 CHERRYTREE LA OWNER'S NAME: PERMIT ISSUE DATE BECKMAN VICTOR 09/18/2006 NE: SANITARY NO. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG LICENSED CONTRACTOR'S DECLARATION Description I hereby affirm that I Am licensed under provision of Chapter 9 (commencingJob with Section 7") orDivislon 3 ofthe Business Add Pollessions Carter, and my license is mr-lifoom REROOF- 2 FLAT ROOF AREAS ON THE HOUSE & ATTACH LWerom cli L. Dmm_cmmmmdr luar"13 GARAGE. TEAR OFF AND REPLACE SHEATHING IF NECES 24 SQUARESCLASS A ARCHITECTS DECLARATION 0 I understand my plans mail be used As public records , Licensed Professional OWNER -BUILDER DECLARATION I hereby affim that I am exempt from One Contracroes License Law for the following Mason. (Section 7031.5, Business; and POOPCISWAS Code: My City Of Worry which requires a permit to cdxbmqc4 after. improve. demolish, or repair my mosecturn prior W its issuance, also requires the APPIWAWI far Such Permit to file k3lipood WHOMCm War he is licensed We We Common's Liam Law 9 Sq. Ft. Floor Area Valuation person, to provisions of (chapter (commencing with Section M, of Division 3 of the Business and professions Code) or $10000 thent he is exempt therthmn, and the buts for the alleged c=mpdm. Any violation of Section 7031.5 by any applicuan for a permit subjects life applicant In a civil penalty of APN Number Occupancy Type Out mem dests five boaduall dollars (SM 0 �7 R R Required Inspections Mlidothc9rk.md�snaumisnotini,�oroffmdforsale(Sm.�,BiWmors and Prefixed.. Code: The commuctur's Langrame Law since Out apply m an "mer of pmpMy who builds oricapromettleareson. and w1undmanch Angie hinumfortisnough his own a pmwmats art nal Intended mo@rW (heals IL however. tho Wilding or improvement is sold within one Year ofoomple,ion. the Owner. akJ. 0 1. as Owner of the Prorrem am exclusively commucting with licensed ceemnultuall to comment, the pmjm (Sec. 70ad. Business adds Professions Code:) The Conaaeur& U. come, Law does not apply to an owner of property who hallos at Improves therman. and. who commmus for such project, with a cormucter(s) Imemed Foramen w the Comansumes License LAW. 0 1 and exempt mucluer Sen. _. B Ar PC f. this ream owner - Dow - WORKER'S COMPENSATION DECLARATION I hereby alum under penalty of perjury ned, of the following dodargions: I lgve md! w01 regmag I Certificage of C.damt to Self -inure for WOOlder'- C-andon' sation. As provided NO by Section 3700 of We Luba Code. (Of the performance Of me work for which this pemit is issued. 0 1 have and will maintain Worker's Compensation Ingranum. As required by Section 37W drum Ichor Code, for the Performance ofthe work fewhich this Permit a Wound. MyWo'kee C In. C i and Pull on Wymuntucrust. 2 82 -2 �. z - _& Cartier. S;z 7,=T Policy NO.: 614 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Crsus section need not the completed lithe Permit is (orrome hundred doItsda (SIM) or it.) I cattily that in We perfrmamn of the wart for which Nis afrol, Is issued. I Audi mx employ any Person in my marmerso As m become subject to ft WorsOrs'Compensation Laws ofCalirm.m. Case APPlkant NOTICE TO APPLICANT. If, after musing this Cenificam of Exemption, you shall become subject M the Worker's Comquegation, provisions of the Labor Code, You most rordswith comply with men provisions or this Permit $hall be dennud mveluxi. CONSTRUCTION LENDING AGENCY I hereby &ffim Nat them is a construction lending agency for the performance or the urmic for which this permit is issued (Sce, 3097, CN. C.) Lefulux's Name Lenders Add. I =try that I have mad this applicafion and am, Na the above infourratium is correct. I agree to comply with all city and county ordinances and sum laws misting to building construction, and hereby authorise mpremmufives of this city to enter opmo the above-mcmioned properly for inspection purposes. (We) agree move. indemnify and xccp ustorleas We City o(Cuportin. against liabilities judgments, costs and expenses which may many way acmes againslaid City in c.asexmoc. of Ine standing of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date SOURCE REGULATI-7 --,Iq -0 ( . Re -roofs Type of Roof Silmmus ofApplicantrCommuccur UAW HAZARDOUS MATERIALS DISCLOSURE Will LM applicant or future Wilding Occupant store or handle haxagdous material An dented by ft Cupertino Municipal Crude, Clumuc, 9. 12, And tire Health And Safety Cale, Section 25532m)7 All roofs shall be inspected prior to any roofing material being installed. 1, If a roof is installed without first obtaining an inspection, I agree to remove Will Appilcuum or future Occupant use equipment or devices which call hamid.n air contaminants a corned by the Bay Area Air Quality MmAgmsent all new materials for inspection. District? 0 Yea No I ban road the lumnlous mawriall requirements under Chapter 6.95 of the Califon- nia Hosh" Safety CcAk. Secdon, 25505 25533 and 25534.1 undcatand that cup building does .1 .=mly he. . umard, that it is my responsibility s, nosily da, Occupant or the requirements which mug be met prior On issuance of a Ccruricam of Occupancy. Signature of Applicant Date -w-a All roof coverings to be Class "B" or better I Owner or authoriumd agent Dam &m 1 of 1 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 31633057.00 DATE ISSUED.......: 09/18/2006 RECEIPT #.........: 36084 REFERENCE ID # ...: 06090130 SITE ADDRESS .....: 10311 CHE, SUBDIVISION ...... CITY .............: CUPERTINO IMPACT AREA ...... OWNER ............: BECKMAN VICTOR ADDRESS ..........: CITY/STATE/ZIP ...: , RECEIVED FROM ....: A & B ROOFING CONTRACTOR .......: LIC # COMPANY ..........: ADDRESS ..........: CITY/STATE/ZIP ...: , TELEPHONE ........: LA OPERATOR: amyw COPY # : 2 •FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL BPERMFEE VALUATION 10,000.00 169.56 0.00 169.56 0.00 BSEISMICRE VALUATION 10,000.00 1.00 0.00 1.00 0.00 BUSLIC FLAT RATE 1.00 105.00 0.00 105.00 0.00 TOTAL PERMIT : 275.56 0.00 275.56 0.00 METHOD OF PAYMENT ----------------- CHECK TOTAL RECEIPT : • AMOUNT ------------ 27S.56 275.56 NUMBER ------------------ 6583 Community Development 10300 Torre Avenue aClOF Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 #UPEkTINO Building Department • • JOB ADDRESS: PERMIT # ® 6 d d 6 OWNER'S NAME: I or ONE # 6'73 GENERAL CONTRACTOR q-8 ti FAX # 6 — 36 > — 17'> ss -- — d I am not using any subcontractors: ---6- 9-12-06 Signature Date Please check applicable subcontractors and complete the following information: Owner/ Contractor Signature Date 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 • 0 ,,CGS- CUPERTINO CUC)q 0\30 CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM APN # slw- Bldg Permit Fees Date: `7 I Building Address: Energy Owner's Name: ¢¢ I/.CrLv� Uec�cvt�a(n BSEISMICRE Phone #: 6KOq-257—/3 79 Contractor: BSEISMICOM License #: Y ZZ� Contact: BPLANCHK Cupertino Business License #: BUILDING BUSLIC Business License Type of Roof Covering: Existing: Proposed: X. Built -Up Roof X 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.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 Description: i o� ✓aoT e�/Qc�.S ah �(�� L aLlci�.abL c Residential Commercial ❑ e� — o rep axtxv.�. ;Sirecarf Fire Zone: Yes ❑ No Confirmed with Planning DNt. if there are any restrictions: U Cost of Project% � Type of Construction: /0,1600. Occupanc gro Mon Gly 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 �T