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06060139 CITY OF CUPERTINO BUILDINO DIVISION PERMIT ?.,C()1VTRA 'I'OR INFQRMAfI(N BUIL DING ADDRESS: , RE SIBLE ROOFING INC PER"T"O 6060139 929 FERNGROVE DR OWNER'S NAME: PERMIT ISSUE DATE CONNIE WANG 2882 SPRING ST 06/16/2006 NE: SANITARY NO. CONTROL NO. (650) 969-6151 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG l� O PLL MECH l� aoa LICENSED CONTRACTOR'S DECLARATION Job Description I hm Nu ereby affirm 1 am menc licensed under provisions of Chirac,9(mming with Scotian 70018 of Division 7 of be Business and Professions Cods,and my license is n� in full faneandef a . TEAR OFF AND DISPOSE OF EXISTING ROOF. APPLY NE ��q o "_CI a c�", t y TAR AND GRAVEL ROOF ARCHDECPSDFLV,RATIO I understood my plan shall he wind u public records i u g 0 Licensed Professional OWNER-BUILDER m DECLARATION 9 a S I hereby a1Rm that I I. exempt from the fession Co License Law for the zap following notion. emits IID t.3,Bua icor, and profession Calc:Any city or manly zap p which nausea•permit re coreawer,pile,hnprove,h Per W,or e a sig any swoon, Z y prior n its issuance,also require the applicant for aneh Permit n fie a signed suemcm p G that heislicensedpuesumtntheprovislonofth,Contxtor'sLicenseLaw(Chapter9 Sq.Ft. Floor Area Valuat BOOO y $ (commencing with Scotian 700M of Division 3 of the Business and Professions Code)or — that he b exempt therefrom and the bub for ded alleged essmpdon.Any violation of ppN N b Section 70713 by arty applkmt for a permit subjects the applicant to a civil penally of 3 7Ti 3 9��7e�0 0 Occupancy Type more d not un five hundred di(5300). ❑Luownerofdeproperly,ormy employee with wages as thebseke compensation, will do the werit4md the ma mis not Intended Or offered forsale(Sec.7044,Business Required Inspections and Poofessiae Code:The eo anetnrs Lkrase n an,law do ,apply an owner of q P property who builds nim proves derenn,and who does such work himself or through his awn employces,provided noffesad far lde.ff. bawever,the building m bnprovement b sold within on yearof COMPielian,the owner builder wIB have de buNm of proving that he did m,ddb or improve fm purpose of sake.). ❑1,an Owner of the property,w reclusively contmming with licensed mnmanom in mntmn the project(See.7044.Business and Professions Cade:)TI.Coouaetm's U. cense law tae not apply As an owner of Property who Wilds or improves shaman.and, soba conuacu for inch puejems with a mnutatons)licemed pursuant in the contractors License Law. a lemecmptundm See .B&PCforthlamasm Owner Daac WORKERS COMPENSATION DECLARATION 1 hereby afitm under penalty of perjury one of the fallowing dtalaradow. I have and will maintain a Cudfimu ofConem an self-Insure for worecesComfort. satien,as provided for by Station 7700 of the Labor Cods,for de performance of the wmw'k'for rwwhich this permit is issued. Ly44mfie and will maintain Workes Compensation Insurance.an required by Section 7700 of the Labor Code,for the performance of the work for which do®r permit b ivied My Workers Cayce din In mumier and Polieynurobuzons Caniu. /G 10`�Policy Na.: CERTIFICATE OF EMP ION FROM WORKERS' COMPENSATION INSURANCE (This section need net be completed lithe perm,Is fmaae hundred doRass(SIM) or less) 1 mnify,that in the Performance of de work for which this permit is issued•1 shall nc, employ any person in my manner an As n become subject to de Workere CmnpcnWm Laws of Califamia.Dale Applicant, NOTICE TO APPLICANT:If.ifur making this Ceniftcaa of Exemption,you should became subject in the Workers Compensation provision of me lobar Cade.you mass z faMwith comply with inch provision or this permit shall W doemed revoked. z CONSTRUCTION LENDING AGENCY E, lhembyaffimthattMrtbaeottsumtine kndingagmxyfarthepmfomartccaf ai the work far which dib permit is WW(Sec.709E Civ.C.) W Q Landers Name z Iandees Addrov U0 1 certify Nat I have mad this application and sum that the oboes dfomadm is Uy P comet.I agree to empty with all city and county aNinenees and sue laws relating in 0U building construction,and herebyauthorim represmatives of this city is mer uPon the a above-mentioned properly fur inspection pugwes. (We)agree to ave•indemnify and kap hamlev the City of Cupcnino all ient iFy rte liabilities judgments,costs and expectant which may in any way amus against said City U Z In consequence of the granting of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCEREGUTATION — G-4;%w Re-roofs g Sintum of Applionu'Canumeher Dam HAZARDOUS MATERIALS DISCLOSURE Type of Roof WIII the applicant or future building amupamnom m handle ha urdoe material as deflncd by the Cupertino Municipal Code.cursor 9.11,and the Health and Safety Code.Statin 13371(07 All roofs shall be inspected prior to any roofing material being installed. 0Yrs IT< 41 Will tha applicam of lot=wades amu n,w n If a roof is Installed without firs[obtaining an inspection,I agree to remove g e equipmento, Mara which ems,hvardnua air contaminants u defined by the Bay Area Air Quality Management all new materials for inspection. District? ❑YesNu I have mad the hvaNms consulate requirements under Chapter 6.95 of theCelirm- .I.Health&Safe,YCade,Sees.13303,13377 ad 25534.1 understand that iftie Wilding does not currently Mn a useso .that it Is my responsibility n notify the amupint ter the requirements rswhich��eljriiorto ism.of.Ccuricum of Ocaupam.T. Signature of Applicant Date 0—,4r - 4- ���� All roof coverings to be Class"B"or better owner m authorbad igen, Dam CITY OF CUPERTINO •m 1 of 1 PERMIT RECEIPT OPERATOR: amyw COPY # : 2 Sec : Twp: Rng: Sub: Blk: Lot : APN . . . . . . . . : 37539057 . 00 DATE ISSUED. . . . . . . : 06/16/2006 RECEIPT # . . . . . . . . . : 34885 REFERENCE ID # . . . : 06060139 SITE ADDRESS . . . . . : 929 FERNGROVE DR SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : CONNIE WANG ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : , RECEIVED FROM . . . . : RESPONSIBLE ROOFING CONTRACTOR . . . . . . . : ELMORE, PAUL M. LIC # 105 COMPANY . . . . . . . . . . : RESPONSIBLE ROOFING INC ADDRESS . . . . . . . . . . : 2882 SPRING ST CITY/STATE/ZIP . . . : REDWOOD CITY, CA 94063 TELEPHONE . . . . . . . . : (650) 969-6151 �EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 8, 000 . 00 147 . 96 0 . 00 147 . 96 0 . 00 BSEISMICRE VALUATION 8, 000 . 00 0 . 80 0 . 00 0 . 80 0 . 00 ---------- ---------- ---------- ---------- TOTAL PERMIT 148 . 76 0 . 00 148 . 76 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ------------------ CHECK 148 . 76 11362 TOTAL RECEIPT 148 . 76 • Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 16UPE�TINO Building De artment JOB ADDRESS: PERMIT # -9 EiY2 Dr OWNER'S NAME: PHONE # -►'�'� - QZ(p(p 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 a Insulation Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile a gLAk 64-1 Axa Owner/Contract Signature Date Community Development Department Building Division City of Cupertino 10300 Tone Avenue CITY OF Telephone: (408)777-3228 TFax:UPERTINO (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. 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 �ab'ove stated policy on re-roofing. Homeowner's Name: Lbon I e, LkbnA Job Site Address: q 2A FeYnQI/ ive VY Roofing Company Name: Ho1 -oYl C.• A plicant's Signature: db� Date: 6/19h p • Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOF aC10F •CUPERTINO PERMIT APPLICATION FORM APN# Date: 3 - 3 -GS-1 S Ao OLP Building Address: '12-9 �evnQvove Dy. C evtiarj Aso�9 Owner's Name: Phone#: Conn 1 — — GZjOLe Contractor: Phone#: License #: SY1 G ��_ 4_5960 Conta t: Phone#: Cupertino Business License #: e Type of Roof Covering: Exigg: Proposed: TBuilt-Up Roof LY�Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings 1 ❑ Provide I.C.B.O. Report# fd"To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear-Off Polic : Job Description: JW O 4 6 j5 e O Mjz5 no3 r � " mui W i �. Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning D_pt. if there are anrestrictions: E Cost of Project: ro Type of Cons tion: Occupancy o 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 •