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CITY OF CUPERTINO
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BUILDINCDIVISION PERMIT
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BUILDING ADDRESS:
736 MILLER All
PERMIT NO. 06090056
OWNER'S NAME:
PERMIT L55UE DAM
MOO POK LEE
NE:
SANITARY N0. CONTROL NO.
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACT'OR'S DECLARATION
lob Description
I hereby affirm that I am Ilmnecd under provisions of Chapter 9 (commencing
P
with Section 70110) of Division Surge Business and Professions qat.soul my gotten is
Lr ail rmen and erfec-49.12
License otee Lic. p
REROOF-REMOVE OLD APPLY PLY ULTRA BASE SHEET
W/NAIL INSERT NEW DRAIN OUTLETS.
Dae Contraemr
public
MASTER ROOFING PAID BL 9/12/06 - 01000015482
[understand my pl.nisevl*has e used records
Licensed Professional
OWNER -BUILDER DECLARATION
1 hcmby affirm that I am exempt from the Camnnafs Licence Law for the
fallowing mason. (Section 7031.5, Business and Professions Cale: Any city or county
which requires a permit in Construct, alter Improve, demolish, or repair any svuctum
prior us its issuance, also requites the applicant for such permit to rile &signed statement
Sq. Ft. Floor Area
Valuation
that he is licensed pursuant to the provisions of the Conuacwr's Liman, Law (Chapter 9
(commencing with Section 7000) of Division 3 of the Business and Profcadom Code) or
$4000
,at he u exempt then fmm and the basin for ft alleged exemption. Any violation of
APN Number
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a Coil penalty of
not more Nan Bw hundred dollan (6300).
❑ Las owncroftne property. ormyemptoyces with wages an theirsom compensation,
00
Required Inspections
will do the work. ad the awctum la rmtimaded oraffcred purism (Sox. 7000, Business
end Frofessiam Cede: The Canmcmr's License Law does at apply b an owner of
9 P
property who builds or improw:s thereon. and who does such work himself or through his
awn employees, provided that men improvements an not intended oraRered for sale. If,
however, the building or improvement is mid within one year ofcompletian, the owner.
build. will have the burden of proving that he did oat build or improve for purpose of
sale.).
❑ 1. an war of the property, an exclusively contracting with licensed cenmcten to
conatha t Ne project (See. 7004, Busines& end Professions Code:) The Contractors U.
come Law does not apply to an owner of property who builds or Improves thereon, ad
who contracts far such projects with a contractor(s) licensed pursuant to the Contractors
Lee. I.
❑ I am exempt under Seo. , B It P C for this reason
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury ono of the following d.laadons:
❑ I ham and will maintain a CertifiCome(Caummusself-insumferWorloo'sCompen-
and n, a provided for by Section 3700 of the Labor Cade, for the performance of tiro
work for which this permit is imued.
❑ 1 have and will maintain Workers Compensation Insurance, as required by Section
3700 of Ne tabor Code. I., the pc,for... of the wok per which this permit is lased.
'
My Worker's CCoomppem,atim Insurance car end Policy number am: /
Cartier: 3` Policy No.: � b
CERTIFICATE OF EXEMPr10N FRO WORKERS'
COMPENSATION INSURANCE
Thisaclion need not W completed If the permit Is form hundred dollars (Sia,
or Inas.)
I certify hot In We paR nmence a1 tht work for which this permit is Issued. I shall not
employ any person in any matter an in became subject to the Workers' Compere adon
'
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: If. after making this CCnlDaala of Exemption, you should
become subject to the Worker's Compensation provisions of the Labe Code, you most
forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the perfunnence of
the work per which this permit Is issued (Sec. 3097, Civ. C.)
..
Lenders Name
Lender's Addma
I certify that 1 have mad this application and sum that the above information is
correct. 1 agree to comply with all city and county enhances and sate laws minting to
building construction, and hemby authorim representatives of this city to enter upon the
above-mentioned property for inspection purposes.
(We) egrte to save, inde a keep harmless Nc City of Cupertino against
Iiabili0ea.judgmenis ndexpenuaw'hmey in any w&y accrue against said City
I' eonagmncc of gnnung this permit.
S COMPLY WITH ALL NON
Issued by: Date
APPLICANT DERSTAN AND W -POINT
SOURCE
Re -roofs
12 0
Signature of App t Dem
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant ar future building occupant.Chapt starec
Health ad
2, and t
a defined by the Cupertino Munici al Code. Chapter 9.11, and Jos Health aJ Safety
Cade. Section 15531(+)?
All roofs shall be inspected prior to any roofing material being installed.
❑Yes Nu
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building occupant use equipment or devices which
troll hazardous air contaminants a ad by the Bay Area Air Quality Management
all new materials for inspection.
District?
❑Yes No
Ihave the tsmqutred nts255 under Chapmdthat
Calding
Some
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&Safmad t
Cod., M505.snd25S34.1 u, i the
Safety Cade, Secaonahe(Iti
JJvv„11„��
diesHealthtCur myr5533 truly then upern of
Jos not curtently how a tenant. Nat It is my responsibility m notify the accupmt of Nc
mntswnmynnabd tpge 'artatsaaaaanc.drmam�raeap y. /
Signature of Applicant Date
Fdagent
All roof coverings to be Class "B" or better
Owner tar authorized Dam '
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L.
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS:
d m0 ler Ave, Q,t eo CA, 1
PERMIT #
6oe?o -1
OWNER'S NAME: Moo ol-- 4 Seom Lee
PHONE # 4cs .$63, o22¢
GENERAL CONTRACTOR: �,ey
FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
e . 2•v _
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
e . 2•v _
Date
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 37542009.00
DATE ISSUED.......: 09/12/2006
RECEIPT #.........: 35997
REFERENCE ID # ...: 06090056
SITE ADDRESS .....: 736 MILLER AV
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA ......
OWNER ............: MOO POK LEE
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
0
AMOUNT
------------
105.26
105.26
OPERATOR: amyw
COPY # : 2
PD -TO -DT
ADDRESS ..........:
NEW BAL
----------
0.00
CITY/STATE/ZIP ...: ,
----------
0.00
0.00
RECEIVED FROM ....: MOO P LEE
0.00
CONTRACTOR .......:
LIC #
----------
0.00
COMPANY ..........:
ADDRESS ..........:
CITY/STATE/ZIP ...:
,
TELEPHONE ........:
,qEE
ID
UNIT QUANTITY
AMOUNT
----------
BPERMFEE
-----------------------
VALUATION 4,000.00
----------
104.76
BSEISMICRE
VALUATION 4,000.00
0.50
TOTAL PERMIT
105.26
METHOD OF PAYMENT
-----------------
CHECK
TOTAL RECEIPT :
0
AMOUNT
------------
105.26
105.26
OPERATOR: amyw
COPY # : 2
PD -TO -DT
THIS REC
NEW BAL
----------
0.00
----------
104.76
----------
0.00
0.00
0.50
0.00
----------
0.00
----------
105.26
----------
0.00
NUMBER
------------------
659
• CUPERTINO
L I
11
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
D�o9oas �
APN # � �7�- . � �
Bldg Permit Fees
BUILDING
Date•
Building Address:
BUILDING
BSEISMICRE
43
V,2
BSEISMICOM
Owner's Name:
BUILDING
BPLANCHK
Phone #:
BUILDING
BUSLIC
Business'License
BUILDING
Contractor:
License #:
Contact:
Cupertino Business License #:
Maces.(' �Locr�,
cc) .
Type of Roof Covering:
Existing:
Proposed:
919 Built -Up Roof
❑
Built -Up roof
❑ Asphalt Shingles
❑
Asphalt Shingles
❑ Wood Shakes
❑
Wood Shakes
❑ Wood Shingles
❑
¢L
Wood Shingles
other (Specify)nPd tt f I't A$ JiA-Ae t7
❑ 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: ReviLwe C.44 roef�—y AFPS ov%o ?Ir of
"01Wbo.X--4cel-.WV' V%r-kI ,I'MeVT Vle,0
dhaL . 6 PyleRig
o W ,n
`
Residential ®
Commercial ❑
Fire Zone: Yes ❑ No f�
Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Proje :I` ()OC)
Type of Cong4pction:
Occupancy roup
Qty. if
Annlirahle
Fee IT)
Fee Descriution
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 DeFartment
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 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: MOL) ?Ok. Vle-
Job Site Address: -436 MiAev AW, C40� ono, 0A, aSdy-
Roofing Company Name: ti\A ?CUr Z CC).
Applicant's Signature: Vlsa -' Date: j IO�
Greg Casteel is
Building Official
Revised 11/2/04