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05050149 CITY OF CUPERTINO "�' BUILDING DIVISION PERMIT pCONTRACTORjNFORMATNQN BUILDING ADDRESS: T J.. CONSTRUCTION PERMIT"°05050149 OWNER'S NAME: PERMIT ISSUE DATE DAVID FUNG 470 GTRAgn RT ONE: SANITARY N0. CONTROL NO, (415) 467-7619 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 LOO LICENSED CONTRACTOR'S DECLARATION hereby,rfirm thea 1 am licensed under prowons of Chapter 9(commencing Job Descrip ® p�� n� with Section 7000)of Division 3 of lW Business and Professions Code,and my license Is ��`!Y 6 In full force and eRttL j�_ License Clazs�Lic.p ��' �7 ? -� i REROOF W/ SHINGLES p Da¢ Commetor Tom_ ARCHn'ECTS DECLARATION WU 1 understood my plans flail he used as public records �{+' Z00C 6 V 5 Lo.rand Professional 10 1 OWNER-BUILDER DECLARATION f� �� +�a 0 I Wrathy.Ruse on 1 am exempt from the Contractor's License Law for the tnq��[ yp o whichfollowing auoa(Section Non LA Business and wn.de ons Code:Any city st county m�+ which myuima a issuance.also re cmnswn,alar,improve.demolish. fl repair any structure prior miuensedpocruamquims theapplicantfor such Contractor's Nc asigned summcm that he with pursuam to the provisions of the Comracess Llc'ns'law(chapter Code) Sq.Ft. Floor Area Valuation as 1- (commcmcingwith Section IDnd of basisonlaflW Business and Professions CTM')of .. that he u tempt sMm(rom and IW bnsu far the alleged exemption.Any violation of Schon 70315 by tory red dolla fora permit subjects the applicant m a civil Penalty of 3 61(PAI er0 0 OCCU araC Type not mom than five hundred dollars r a Per, p y yp ❑I,as owm'r of the property,or my employees with wagea as their sole comp,...a... will do that work,and the structure is not intended oro@red forsale(See.7044,Business and Professions Code:The Conuactofs License law docs Out apply to an owner of Required Inspections propony who builds or improves thercoa and who does such work himself or through his own employees,provided that such improvements are not intended oroRered for sale.IL however,the building or improvement is said within one year of completion,the owner. Wilder will have she When of proving that W did nos Wild or improve for purpose of sal'.). ❑I,as owner of the property,am exclusively contracting with licensed convectors to construct the Projcn(Sec.7044,Business aced Profesimns Code)The Contractors Li- cense law docs net apply to an owner of property who Wilds or improve lhemon,and - who concocts for such pmjecu with a casornemr(A licensed pursuant in the Contractor's License taw. ❑I amexcmptund'r See ,B&PCforthismason - Owner Date WORKERS COMPENSATION DECLARATION 1 hereby of dna under penally of perjury ore of the following declarations: 1 have and will maintain a CeruOeate of Conant en self-umm for Wallace,Compere sasion,m provided fm by Section 3700 of the tabor Code,for the performance of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,aa required by Section 3700 of the labor Code,for the performance of the work for which this permit is issued. My Worker'//s Compensation^Insurance carrier and Policy number are: Gfsier. 4 /�7D Policy No.: CE IC PTION FROM WORKERS COMPENSATION INSURANCE (Thissectirm need not W compleed if tie Permit Is for one hundred dollars($1(10) or loss.) I certify that in the performance of the work for which this permit is issued,1 shall am co Ploy any Ieuen in any mannerso az in become subject in the WorkersComponamon Laws of California.Data Applicant NOTICE TO APPLICANT:If.after making this Certificate of Exemption.you should become subject to the Workers Compensation provisions of the Labor CsMc,you must 0 0 foMwith comply with such Frovisions or his permit shall he deemed revoked. Z y CONSTRUCTION LENDING AGENCY F+ I hereby affirm that Nem iso eonaunion lending agency for lW Perfamnanc'or C the work for which this Permit is issued(S..3097,Civ.C.) C Q Lender's Name Lender's nder's Address U Q 1 certify that 1 have read this application and sum that the aW W inform W un u it,t" cormcL 1 qra an comply with all city and county ordimmes and sue laws totaling in building construction.and hereby authadm rtprnsemaiM ofthis city m envy upon the U a hove-mentioned propery,for inspection purposes. F y (We)agree to ave,indemnify and keep harmless On City of Cupertino against V1 liabilities,judgments,costs and expense which may in any way accrue against acid City („),2 In consequence of the granting of this permit. " APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGULATIONS. � Signature of ApphcanUConuicmr S Data Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will tic applicant or forum Wilding occupant mom Or handle huaAous material as defined by the Cupertino Municipal Code,Chapter 9.1 i,and the Health and Safety AM&ale,Sccuon 15532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes [I No 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 7- - t W.ardnua air contaminants as defined by lW Bay Area Air Quality Management all new materials for inspection. on", ❑Yes ON. 1 have mad the havndimsmamrials requirements under Chapter6,95 of tic Califon. Health&SafnyCode.Secures 25505.25533 and 255th,l understand that if Ne Wilding s not curcmly haw a tenant Nat It u my responsibility m madly she occupant of the �� 5 _ ssuance ofa Ccnificam of Occup cy. Ignature of ApplicantDatener or aumorized agent D,m All roof coverings to be Class "B"or better Community Development 10300 Torre Avenue Its Cupertino CA 95014 Telephone(408)777-3228 coo, Fax(408) 777-3333 �UPEkTINO Building De artment JOB ADDRESS: �o Vis-&4 � PERMIT # `.3 8J Oak oSa ! t( OWNER'S NAME: PHONE # / — 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 Signature Date CITY OF CUPERTINO ( � REROOF ICUPEkTINO PERMIT APPLICATION FORM APN # � � I © o&— Date: Building Addres : �3 O ^ 1 Owner's Name: DO 4/-LA�"I Phone#: ^oQ Contractor: (� G one#(:,g License #: Contact: —Ft Phon #:C/,� p�( Cupertino Business License#: � T Type of Roo Covering: Existing: Proposed: ❑ /Built-Up Roof ❑/Built-Up roof g/ Asphalt Shingles t7 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. MI I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ Job Description: R-errt.<ry-L--ti ��Ct S �s , �S�-.u'r�-,u,Q� • S Residential ®' Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if ep there are any restrictions: Ll Cost of Project: �- Type of Construction: Occupancy group: Qty. if Applicable Fee ID Fee Descrition 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