05100065 CITY OF CUPERTINO
a
BUILDING DIVISION PERMIT a.CONTRACT,ORINFORMATION
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BUILDING ADDRESS: PERMIT NO.05100065
7551 KIRWIN LA
'ER'S NAME: PERMIT ISSUE DATE
SHUXING SONG 10/13/2005
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ups LICENSED CONTRACTOR'S DECLARATION Job DOSCrIpI100
to 1 hereby affirm Nat I am licensed under provisions of Chapter 9(commencing
ZFW wish Section 7M )r' Division 3ofthe Business and Professions Code.and my license is
'a` inrnnromeaMeaa REROOF-REMOVE (E) REPLACE W/COMP SHINGLES
v8 z Liccnsc Class Lie.N
Cr, Dam Contractor
ZZ ARCHITECTS DECLARATION
C I understand my ]...,hall W used as Public memos
�yV
U.G Licensed Professional
5 OWNER-BUILDER DECLARATION
I hereby affirm Nal I am exempt from she Contractor's License Law for the
p 0 following reason.(Section 9131.5.Business and Professions Cade:Any city or County
which requires a permit to Conswct.aler,improve,demolish.or repair any structure $6000
-ai prior in its issuance.aro requires the applicant for such Permit On file a signed.Wummnl
r< dro he is licensed pursuant to the penvisiom of she Contractor's Liccnse Law(Charter 9 Sq.Ft.Floor Area Valuation
Wr$ (commencing with Section 7")of Division 3 of the B usinesa and Professions Code)or
.-
that he is exempt therefrom and de basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of r Occupancy Type
not mart Nan five hundred dollars(5500).
❑I,as owner Of tW property ar my employees wish wages as their sole compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044.Business Required In I ��
and Professions Code:The Contractor's License Law doeqs not apply W an owner of
property who builds orimpown Nemon,and who doessuch work himsdfor through his
own employees,provided that such improvements are not intended or offered for sale.If, a O
however.Ne Wilding or improvement is sold world one year of completion.the owner-
builder will have the burden of proving that he did not Wild or improve for purpose of
sale,. /
005
C]1,as Owner of the pmpeny,am exclusively contracting with licensed cenmcmrs to
construct the project(Sec.7644,Business and Professions Code:)The Cmdracwr's Li sl@.
ecese Law docs not apply to an Owner of propeny.who Wilds or improves thereon,and ^ a4t
who contracts for such projects with a conuacror(s)licensed pursuant m Ne Contractor'sjp�
law.
01am V A
I eacmpt�und/err S.C. .B&P C for this muco
err IiV WTX//N �/g—r Data
WORKER'SC PENSATION DECLARATION '
1 hereby aifren under penalty of perjury one of the following occlusions:
❑1 have and will maintain a Certificate of Consent to self-imum for WorkchCompcn-
satidn,as provided for by Sahara 37M of Ne IaWr Code,rat the perfor ..of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,m required by Section
37W of Use labor Code,for Ne performance Close work for which this permit is issued.
My Worker's Compensation Insursnee Cartier and Policy number am:
Cartier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thla fcctidn a ed not he ompleod if the itunth is or msc hmosed dnllars(SI W)
or less.)
I ecmfv Nat in the performance of the.,it for which this Permit is issued.I shall not
muld.yany parson in my mannerOjos orm lecuothc Workers CompmmtMm
Laws of California.Date ('ii
Applicam Z�NIt ,
NOTICE TO APPLICANT:If.after ma ng this Cenificat of Exemption.you should
become subject to the Worker's Compensation provisions or the Labor Code,you must
.,z forthwith comply with such provisions or Nis Permit shall W doomed invoked.
'Z O CONSTRUCTION LENDING AGENCY -
F+� I hereby affirm that there is a construction lending agency rot she Performance of
:4 the work for which this permit Is issued(Sec.3097,Ci,C)
Iz3 A Lender's Name
z I.cndcr's Address
U O 1 certify that I hate mad this application and state that the chose information r
(L F come,.I agme to comply with all city and county on insmas and suite laws misting to
0U building construction,and hereby amhorim reprommanws of Nis city In cnmr upon the
shave-mentioned Properly for inmeNon purposes.
HU z in consequence of the graining of Nis Permit.
a (We)agree to save,indemnify and keep harmless Use,City of Cupertino against
N liabilities.judgmcn
u,costs and tapetuman
which may in y way aaruc against said City
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.I/^
\ ��I � (03/0 Re-roofs f�M
Signature of Applicam ontracor Date
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will the applicant or future Wilding oo'uput store or handle hvarddus material
deform!by If,Cupertino Municipal Code,Chapter 9.13.and the Health and Safety
e.se r 25532(.)?
❑yoa / 4Nd All roofs shall be inspected prior to any roofing material being Installed.
Will the applicant or future Wading Occupant Use equipment or devices which -If a roof is installed without first obtaining an inspection,I agree to remove
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes AN.
1 have mad Ne haxarNnsmatcrialsisquirememu under Chapter 6.95 of the Califor-
maHealth&SafetyCode.Sectiws 25505.15533 mu 5534.1 undoxeM thsifshc Wilding
does not currently hese a tenant Nu it is my maponsibility in nosily the occupant of the
totho anis hiammtWmepdormiasu=coracedrmamdfaeUpancY Signature of Applicant Dale
ownmj. f�f/3�os All roof coverings to be Class"B" or better
Community Development
E 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408) 777-3333
PEkTINO
Build ing Department
JOB ADDRESS: PERMIT # O lD O
Zn 95�
OWNER'S NAME: / o/? PHONE # yOOt�C 6O 7
GENERAL CONTRACTOR: SoYt 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 l
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
® CITY OF CUPERTINO
I C€m 1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN 35921001.00
DATE ISSUED. . . . . . . : 10/13/2005
RECEIPT #. . . . . . . . . : 31594
REFERENCE ID # . . . : 05100065
SITE ADDRESS . . . . . : 7551 KIRWIN LA
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : SHUXING SONG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4338
RECEIVED FROM . . . . : SHUXING SONG
CONTRACTOR . . . . . . . : LIC 4
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
• TELEPHONE . . . . . . . . :
FEE 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
----------------- ------------ ----___-------__--
CHECK 126.96 1042
TOTAL RECEIPT 126 96
Community Development Department
�. Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
CITY OF Fax: (408) 777-3333
CUPEI�TINO
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:
Job Site Address: 7 5 S l /� rw�r1 Ln
Roofing Company Name:
/ I
Applicant's Signature: � f Date: 10 /31 s
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
a�(, CITY OF CUPERTINO
RE 1200 F
bF
*CUPERTINO PERMIT APPLICATION FORM
APN # 359 r2/ U O/ Date: A 3 ��
BuildingAddress:ress:75s/ ILC ��n Z_/7
Owner's Name: Phone#:
S xin S° �fD q�c6 oS�7
Contractor: Phone #: License #:
Contact: Phone #: Cupertino Business License #:
t/i 5 /`t�� itaJ yea 64/_600350C
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
,qf Wood Shingles ❑ Wood Shingles /} r ,
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report# ✓
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: 0
Job Description:
Residential Commercial ❑
Fire Zone: Yes ❑ No E) Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Proje t: Type of Construction: Occupancy oup:
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