06080175 i
CITY OF CUPERTINOyet,N�f
BUILDING DIVISION PERMIT }:COIVTR`ACTOR INFU RMATION
BUILDING ADDRESS: PERMIT NO.0608
0175
6522 CLIFFORD DR
OWNER'S NAME: PERMITISUEDATE
DO DUNG N 8/22/20
06
E: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
�CQ LICENSED CONTRACTOR'S DECLARATION SCTI Job DaIIOD
1 hemby Aram mat I am licensed under previsions of Chapter 9(Commencing p
wire Section 70(m)of Division 3 of Na Business and Pmrcanluns Code,and my license is
mmlloom.ndeffaet. TEAR OFF OLD ROOF &, ADD NEW PLYWOOD & SHINGLES
p: LleenicClaaa Lr.» CLASS A OR B
s- Dam Contractor
ARCHnECTS DECLARATION
< 1 understand my plans shall he used As public records
16U
'G Licensed Pmfcasional
l y Oat I am excerpt
DECLARATION
i I hereby aRrm that I L exempt(mm 1Pr lemonsContractor'sCot License Law for Nefollowpopp
.o O which
mason.(Sadao 7 Construct,
ct,OV. and improve.
de oli Code:Any city or County g
$tai which requires a permit re cores the riser,improve,demnell or epoig any awctum O
thatpriohe iuiensedpdCoro to the the of for Canammuilma Laed w(Chap cm
(commencing
he is licensed pSectiol to the of
afthaeBasinmraUttueiaw(Codc)or Sq.Ft. Floor Area e Y h IB200
i 9 (eom a is exa ps Section and
of basis f r the
al eged caaand Profess vi lation of CI A.
Nn he u esempt therefrom and Lies bait for Ibe almgrA esemp0an.Any violation of ppN > �C!'
Scwon 7031.5 by any applicant for a pewit subjects the APPllcant to a Civil peulry of 3 6 9 2�Nq[pII„er 0 0 p Orcu ane e
trot ream than faro hundred dollars($5001. 692 U..11 // �Slc' yTyp
p t,,uowttuaf0 pmpmy.mmymploymwWeagmu Nehaaleeom don,
will do de work and the suuerum isnotlmmndedw offered ressw(Sec.7014,Businesses
and Profession code:The Coneracmra Liam Law dam not apply to an owner or
property who builds nrimprova thereon.and whodanauchwarkhimselfmthmugh his
awn employees,provided mat such improvements am Cobranded eroEervsi formic.If,
however,the building or Improvement is sold within am:year of oompledau,me owner.
builder will haw the hurden of proving that he did vm build ser improve rte puryase of
sale.).
❑I,see owner of the property,m exclusively contracting with limmnd cmarac errs in
construct the pmjem(Sec.7041,Business and Professions Code)The Consciences U.
cove taw does not apply an an owner of property who builds or improw.a themon,and,
who conwcu far such projects with a Conuactoms)licensed pursuant m We Contractor's
Litems Law.
❑Ire exempt ynder Sec .Bh PCfer thi
Owner w 17 sees
RK OMPENSATTON DECLARATIO
1 hereby aRiw under penalty of perjury aro of the(allowing dedarHians:
I have end will mahmin ACerdfumu or Consent u aalr-insure far Wmker'a ComPee-
ution,as provided for by Section 3700 of the labor Code,fro dm performance of the
work for which has permit is issued.
❑1 have and will maintain Woraers Compensation ha urance,As required by Section
37W of the Labor Calc,fm me performance of On work for which mu permit is Issued.
My Worker's Compensation Insurance carrier and Policy number am:
Cartier. PoI'ey No.:
CERTIFICATE OF EXEM PITON FROM WORKERS'
COMPENSATION INSURANCE
(Thusermon need nose he compleed ifde permit is foronchum ed dollar;(5100)
or less)
1 certify mat in me performance of the work for which this Pewit B issued,1 shall not
employ any Pearson in any Aurorae a
ylpJlCeam[3ub�et to eam[3ub�et toLouWarkerY Campeva0an
Laws of Cdif;5n.Data VL(Jz /U
Appilom ,p"'r— C '�
NOTICE PUCANT:If.after making mu Cenifica¢or Exemption,you should
become subject an mo Workers Compensation provisions or me tabor Cede,you most
70 faMwim comply with tach provisions ser this permit shall M deemW raveled.
tiCONSTRUCTION LENDING AGENCY
I hereby e(iirm that mart I..couuuNnn lending agency for the performauc of
Y,
the work for which this pewit is issued(Sm.3091,Civ.C.)
t3 Q IOunce,Name
L z Iand.esAddmna
0 I ttnce that I have mad this and
county
ane some Con des above information u
L,U building 1agreetocomply with all airyand caumyualial Of and numlawer upon the D U '1Wvcng construction,.d.m% and herfar by im ctic h m represenutivcs of this city m enter upon the
N W alcove-IWA) gree to AWrty indemnify
An acCip en.
(We)ague s,cove,anal espousal
and kap harmless the City Of Cupertino id City
jZIncoisequeneofftcrauind ex pis pcanich may in any wyameagsiutsud City
J z In consequence ofinegranting or mea Pcrmil. //''''
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale CF,:-
SOURCE
"
SOURCE REGULATIONS. &/2
Re-roofs
Signuurt of ApplfwOamr OntoKAZA
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de torpent m,Comm ddidCo e,Chapter 9.1 or and the Healthad
Sadsi
As deOnW by the Cupertino Mumd Code,Chapser 9.17,and site Health and Safety
Conn.Section 255324)+ All roofs shall be inspected prior to any roofing material being installed.
41 ❑Yes Na
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit huardous.11 antmiesno As ftlihned by me Bay Am Air Quality Management all new materials for inspection.
DinlrinT
❑Yes u
I have mad the hasa d.us materials requirements under Chapter 6.95 of the Califon
nim Heal"Safety Cade,Satium 25505,25533 and 25534.1 understand that if thc building
dm not currently hate a secant,Out It u My responsibility u notify the 00mmal of the
require nuwhichmuubcmetpnOruw � aa
clscamduaf4� Lz/Ob Signature of Applicant Date
/) �
Owner or authoired agent Dau All roof coverings to be Class"B" or better
aCOF
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
OUPERTINO
Building Department
JOB ADDRESS: / PERMIT# 5
(,'.5'Z2- �/ o.-� �� 4 `/NO Q V ?0
OWNER'S NAME: / Ui✓ n/ / PHONE # 7'0 -3/L/— _T/7 3
GENERAL CONTRACTOR 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
Owner/Contractor ignature Date
CITY OF CUPERTINO
am 1 of 1 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36924037 . 00
DATE ISSUED. . . . . . . : 08/22/2006
RECEIPT # . . . . . . . . . : 35712
REFERENCE ID # • : 06080175
SITE ADDRESS . . . : 6522 CLIFFORD DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER DO DUNG N
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . :
RECEIVED FROM . . . . : KATOUS FAED
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ,
TELEPHONE . . . . . . . . :
•FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---- ------ ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 3 , 000 . 00 83 . 16 0 . 00 83 . 16 0 . 00
BSEISMICRE VALUATION 2, 200 . 00 0 . 50 0 . 00 0 . 50 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 83 . 66 0 . 00 83 . 66 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
--------- - ------- ------------ ------------------
OTHER 83 . 66 MASTERCARD
TOTAL RECEIPT 83 . 66
CITY OF CUPERTINO
. Q' REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# 2, n _�M Date: (1 2 2/9 ig
Building Address: 4"52-2- 4 fll,; Ol fb A2 ll
Owner's Name: N TO Phone#: yO /�— V73
Contractor: N /� -rrz-D 1J License#: 7
Contact: /01 �/��r ( �J(/Z Cupertino Business License #:
! Type of Roof Covering:
Existin Propose ,
O mlt-Up Roof ❑ uilt-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 Polic
Job Description: „/- P /�yvo S c� ot. fig)
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning DMt. if
there are any restrictions: LJ
Cost of Project: ZiZOdee Type of Construction: Occupanc grup:
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
•
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 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 I/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: AIN 4� N -
Job Site Address: j� 52 2—
Roofing
Roofing Company Name: IV
1
Applicant's Signature: ��"T //(� Date:/�O 6
• Greg Casteel
Building Official
Revised 11/2/04
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
PTYF Fax(408)777-3333
UPERTINO
Building Department
JOB ADDRESS:
PERMIT #
�Sz Z �/ o tr7 S`
OWNER'S NAME: / Ui✓ i✓ / PHONE #7Od 3/4-/- 3/7 3
GENERAL CONTRACTOR: FAX #
am not using any subcontractors:
Stgnature 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
/
Owner/Contractor ignature Date