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04090247 CITY OFCUPERTINO� (�+ •' �'7'+� _ iffy ]L . 'm( .}•y'�a� _ -' .BUILDING DIVISION. NII .'- PERT - L°a*+� k'WT0it BUILDING ADDRESS: - - MANADA ROOFING INC - PERMIT N%4090247 OWNER'S NAME: PERMIT ISSUE DATE - E: '- - SANITARY N . CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH cep LICENSED CONTRACT d DECLARATION - O ( O �lO O -- 1 h by affirm that I em licenxtl under pro cions of Chapter 9(commencing Job DESCrlpil •'INALED V with Sectrf�0(111)ofDivision3a(Nc Businwrofcuinns Code,utl myli sore is Dn j. infull eri.Class mac j goo77 DEMO (PARTIAL OF THE ROOF) n, Licenac Class 11 �Lic.p Dam Canoe (� n/ L a ARCHITF-CI'SD ATION OI.•T aoo 1 y ndemund my plans shall W used as is records it o� Li.enxdPn,feaaianal BUILDING OWNER-BUILDER DECLARATION +� 2 I herchy.(Sere on 1 em exempt froms an the Cantrectoode:Any c Law for Rc iOO following mason.(Section Aonstr Business end w.ilmioli Code:Any tiny or county u$ whirl us Issuance, a Permit no cnnswet,alma improv,h Pennit I or repair any ahucmte t-a9 prior mitsissuance,ensumquimsnW applicant the Co punnet mc.asignedsuumcm G thathe is mecing sedwith Pursuant rolhe of Division of theeBusinessand Prof hw(Chapter Code)at Sq.Ft..Floor Area Valuation - qq $ ,hotW1, ngwitherfor.and Me basis for the theeged Business and Profusions Cndc)ter Nae io is exempt any applicant p li and Ne bears far the alleged Gumption.Any l penalty of - ].r',.,.a, Section than five aundredicutfarapermit subjects Rc applicant roecivll penalty of 36VMT1U50PI00 OCca anC Type - Elmore than tiro hundmd dollue(SS00). p Y Typ 0 1,M owner of the property,or my employees with wages as they solcenniNnse0on, will do Rework,and the slmmum is not intended or offered forsalc(Sec.7044,Business ' and Professions Code:The Comranar's Lianas Law doss nut apply in an owner of Required Inspections property,who buildscrimproves themon,andwhodneasuch work himulf orthrough his own employees,provided Nan such Improvementsam not Intended oroRered fersaw.If. however,the building or improvement is sold within one year of completion,Ra Owner. builder will have Ne burtlen of proving Ran W did non Wild or improve for purpose of sale.). 0 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.70",Business and professions Cade:)The Conwumr's Li. cents law does not apply to an owner of property who Wilda or impmves thereon,and, who contracts for such projects with acamrumr(s)licensed pursuant in Re Conhxtofs License Law. 0 1 am exempt under Sec. .B&P C for this mum Owner Data WORKERS COMPENSATION DECLARATION I bereby affirm under penalty of perjury once of the following decimations: have and will main W n e Certificate of Consent to self-insure for Workeri Compcn- mn,as provided for by Section 3700 of Ne labor Code,for to,polurmana of the work for which this permit is issued. 0 I have and will maintain Worker's Compensation Insurance,as required by Section 7700 of the labor Code.for the performance of the work for which this Permit is issued. My W e-Com enation Insurance terrier end Policy no r am: �y-it'sto �7 CERTIFIC OMPE SATI ON AN WORKERS' COMPENSATION INSURANCE (Thu section need notbecomplewd if tW permit is faros,hundred dullars($Rm in less) 1 certify that in the perfonnanee of the work for which this Permit is issued,1 shall not employ any person in any manner so as no become subject to the Workeri Compensation Laws of California.Dam Applicant NOTICE TO APPLICANT:If.alter making this Cenifieau of Exemption,you should become subject no the Worker's Compensation previsions of Ne labor Code,you most ,JO forthwith comply with such provisimis or this permit shall be deemed revoked. r CONSTRUCTION LENDING AGENCY 7rE4 l hereby affirm Oat them is a construction lending agency for Ne performance of > the work for which this permit is issued(Sec.7097,Civ.C.) - Wti Q Lenders Nam. O z Lender's Adtlmes , U O I certify Rat 1 have mad this application and shote that the above information is L4 Fcorrect.l agree no comply with all tiny and county ordinances and slow laws relating in O building construction,and hereby AnthOdm Miumenutiwa of this city m enter upon Ne, G above-memioned property for impaction purposes. (hoc)agree h arae,indemnify and Ixcp harmless the City of Cupertino against ( r pd, liabilities,judgmenu.eoats and eapmeres which may in any way accrue against said City A consequence of me UNDERSTANDS of this Permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH 777���Lttl���lllON-POINT Issued by: Date SOURC EGULATIONS. Jr/ / / Re-roofs / -/ SigfflftufApplican onuactor Deu HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will Ne,applicant or future building Occupant atom or handle,havardous material as defined by the Cupertino Mmucip9l Code.Chapter 9.12,and the Health and Safety Code.SQ Yee 2ss3z(a)7 N. All roofs shall be inspected prior to any roofing material being installed. 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 i hanrdme, it conumimmis as deGnN by the Be,Arca Air Quality Management all new materials for inspection. OYcs Nu Ihawread Neharamd.M5ialsmqu.d USunder Che 95ofmc Wilding � nice Health&SafcnyCadc,Secdmts 25N15.25577 end 25534.1 un ens dthat if Nc Wilding dos o, mly haw a wont Rat it is my mspouibility ul'y me necupent of me z i m Ls Which Must anccsfaCcnicawofOccupancy. /Signature Date r - o All roof coverin s to be Class"B"or better O n rauNoriz,d agent Date g CITY OF CUPERTINO �7 7;�1rk. 4-s ., BUILDING DMSION PER*' Y W�ilndL�4T�V NN' BUILDING ADDRESS: MANADA ROOFING INC PERMITNrb4090247 OWNER'S NAME: PERMIT ISSUE DATE 41 PHONE: - SANITARY NO. CONTROL NO. ARCHITECf/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH Z. LICENSED CONTRACTOR'S DECLARATION O O O �i a horgby(B.D img hm I am littnud under pro'slam of Chaplvr 9(commencing .IDh DCSCTIpUO�I��L E wih Secli IXltl)ofDivision3of NC Business rafcasinns Code,and myli cnse is gt3y mfmlr Amer uex `w' >> DEMO (PARTIAL OF THE ROOF) g License Clus Y Dam ACHITESATION I ndcrstandmyplans hall heed E i,..,its OCT 4/'V- 2004 ;Q Licensed Professional OWNER-BUILDER DECLARATION BUILDING I hereby affirm that I am exempt from the Contractors License Law for IM1C 0 0 following mazer.(Section 71131.5,Business and Professions Code:Any city or county .2 which requires a Permit to construct,alte,improve,demmish,or repair any shu.um priono its ieuance.alsu requirmulicapplicanlforsuchpemail he rile a signed statement that he is licensed pursuant In the provisions of the Conwctnr's License Law(Chapter 9 Sq. Ft.Floor Area Valuation q $ (commencing with Section 7000)of Division 3 of the B usincss and Pretensions Code)or k'3... that he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penally of not mom Nn rive hundred dollars($50(f). 3 64o11 ++11160ero O ODGD ADCy LJe ❑L a owner of the peament m my emplendes with wag.u ain(role comreru mess will do the worts,ands:no ls not intended craw do tarsale(Sec.1044,Business and mywhDbu Code:no Concession'son,License Law does not apply lf an owner of Requited Inspections mantrtywhobuildsorimproveslh improvements andwho doe souchseahimsolrerthrough his however. the provided Nonsuch improvements are ne year dad m pVemd for dower, builder.the buil don a improvement is sold within one year of completing,Nepose of builder will have the burden of pressing her he did not build or improve far purpose e( sa1eJ. ❑1,az owner of the progeny,am exclusively contracting with licensed contractors in constoom the pmjca(Sec.7044.Business and Professions Code)The Contractors U. cense Law dote not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a comranor(s)licensed pursuant to he Contractor's License Law. ❑I sm exempt under Sec. .B&P C for this mason Owner Dale WORKER'S COMPENSATION DECLARATION I hereby affirm under penally of perjury one of the following declarations: ❑1 have and will maintain a Certificate ofConsenuo self-insure for WarkctsCompen- nation.as provided for by Section 3700 of the Labor Code.for the Performance of the work for which this permit is issued. ❑I have and will maintain Worker's Compensation Insurance,as requited by Section 3700 of the Labor Code,for the per(ormanee of the work rot which his remelt is issued. My W r'A Co. ..Adan Insunan^^m carrier and Polity annalig,are: �7 CERTIFICATE OFFEXEMEXEM ON P .pM WORKERS' COMPENSATION INSURANCE i (Dissecting need not uncompleted Iflhe permit la tomos hundred dollars(Slip) nor less.) I certify that in the Performance of he work fm which his pennll is issued,)shall not employ any Person in any mannerro As In become subject to the W.kors'Compensation Laws of California.Data Applicant NOTICE TO APPLICANT.If,after reeking his Cerlificam of Exemption,you should became suujam to the Worker's Compensation provisions of dm Labor Code,you mug Oforthwith comply with such provisions or his permit shall be deemed conked. 7z CONSTRUCDON LENDING AGENCY [-ems I hereby affirm hal there is a construction lending agency for he performance of ai 7 he work for which this permit is issued(Sec.3M,Civ.C) WA Lender's Name :14i �z Lender's Address _ V Q I certify Net 1 have reed this application and stale hat the be.information is W correct 1 agree in comply with all city and county ordinances and sole laws relating to O V buildingeminneedon,andherebysaberingmpresemativcaorhiscityanenteruponRe ahove-mentioned property,for inspection purposes. (We)agree In save,indemnify and keep hgmless the City of Cupertino against 4,y C4) liabilities,judgments,casts and expenses which may in any way Beams against said City \ in consequence of he granting of this permit. APPLICANT UNDERSTANDS AND WILL COMPLY WITH LON-POINT Issued by: Date SOURC EGULATIONS. J�j / f Re-roofs / / Sig to of Applicam/Cong"we" HAZARDOUS MATERIALS DISCLOSURE Dem Type of Roof Will he applicant or future building occupant stare or handle harardeus material as dented by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code,Section 25532007 All roofs shall be inspected prior to any roofing material being installed, 40 ElYns c< 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 hazardous air contaminants in defined by the Bay Area Air Quality Management all new materials for inspection. District ❑Yu No Ih& mad theherardtionsMialemquimmen.under Chej .95ef the Califon- Me S ria HCAlh&Safety Code,SCNam 8505.25533 and SSJ4.1 on fi.95. Lh o Jo.nal c n0y have a¢nano Nat h is my responsiM1ility dl'y dm acuPanl of he � Y 4 i .5 rC L9 Whish mu51 bC mel poor m' Hose r(a CCIII ICA.p(GCCapYley. \ ,r igna tare o� f Applicant � Date All roof coverings to be Class "B"or better O n �authorizcd agent Da¢ )ee RECEI VEIL SEP 2320 S f 3` 1 A r ' F xi rµS r Yt i I'LOT PLANS d DATE - �a'° e9 pans an specifications q o 'kaF en the job at al times and it is uA, mak=e any changes or, olteradon,� q sam< h:,heot written petmiss104ffo( 0 buildia„ Dept., City of Cupertino. r,.z ctarlPrIg of thin plan and specificottootf HLDG. DEPT'. WIL w0i be held to permit or,to 90 oP1 approval of the k'ioladoli of any proVrarpgn it any City'O r1mz7 Ce& Stitt tik ( �` � ',?. 4 { f �i { spy v,c __ s � t ��' ",� .� �� _ � "�}'� �"tea' ;�W+�, F}f��v- �aM,�. y fr a�A� 'acs 2} � � .-� _ «'_ - '=� '��3� i - „. =„ F f ', ���, � , r o $ � , .j ��. � �,.. �.. .�; � �� � .� ._ � �� � ,r ,,. �:;� :f ; ': F� �.,`.� ' . . «.P �, ""mac. i1Y 40 ow ol { K ] P � l �I r F'. 6 �y E� •� r� 1 ? 1 � { cc 1 . � � t �f I # d �i CITY OF CUPERTINO Oem 1 of 1 PERMIT RECEIPT OPERATOR: conniew COPY # 3 Sec : Twp : Rng: Sub : Blk: Lot : APN . . . . . . . . : 36611167 . 00 DATE ISSUED. . . . . . . : 09/23/2004 RECEIPT # . . . . . . . . . : 27152 REFERENCE ID # . . . : 04090247 SITE ADDRESS . . . . . : 7685 NORMANDY WY SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER SUSAN & EIRO FRAYNE ADDRESS CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5252 RECEIVED FROM . . . . : RICARDO PEREZ CONTRACTOR, . . . . . . . : RICARDO PERES LIC # 24826 COMPANY MANADA ROOFING INC ADDRESS . . . . . . . . . . 1593 INDUSTRIAL PKWY W, 45 CITY/STATE/ZIP . . . : HAYWARD, CA 94544 • TELEPHONE . . . . . . . . : (510) 780-9517 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ----- -------- ---------- ---------- ---------- ---------- ---------- BPERMFEE VALUATION 1, 000 . 00 83 . 16 0 . 00 83 . 16 0 . 00 BPLANCHK PERMIT FEE 83 . 16 110 . 98 0 . 00 110 . 98 0 . 00 BSEISMICRE VALUATION 350 . 00 0 . 50 0 . 00 0 . 50 0 . 00 - ---------- ---------- --- ------- ---------- TOTAL PERMIT 194 . 64 0 . 00 194 . 64 0 . 00 METHOD OF PAYMENT AMOUNT NUMBER --------------- -- ------------ ------------------ OTHER 194 . 64 VISA TOTAL RECEIPT 194 . 64 VOICE ID DESCRIPTION VOICE ID DESCRIPTION 704 DEMO •CITY OF CUPERTINO• q o Z CUPEI�TINO PERMIT APPLICATION FORM ° I 7 APN# Date: 366 � l 1� 8 Building Address: Mailing Address (i different from building address): 7 K5 iC�ZJ /LICv Owner's Name: Phone#: 6 fay 7`CQ. Contractor: License#: Conta t: Phone: vo-7%9-PSI 7 Cupertino Business License#: ��py Fax:,Sia7�0--95 g Building Permit Info: Bldg Elect ❑ Plumb ❑ Mech ❑ Job Description: Residential Commercial ❑ Sq.Ft. Floor Area: $/Sq.Ft.: 03 1 Cost of Project: Occupancy Group: 3 el Type of Construction: Please check this box i project is a L)E //Ti l second-story addition: ❑ Pro'ect Size: Standard 8 Large ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILER1 Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V <= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING 1 of s WITY OF CUPERTINCO CUPEIZ`TINO PERMIT APPLICATION FORM Quantity Fee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfm MECHANICAL BREMAM AN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT _ Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL BREMFURNOV Relo Furnace> I OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance . ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Appliance ELECTRICAL 2 of 3 *ITY OF CUPERTINOO i CUPEkF PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BREMSIGNAD Rmdl Sips Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECLU Special Insection BUILDING BSWIM Swimmin Pool BUILDING "TEMP Temporary Power ELECTRICAL BTEMPPERM Tem ora BldgPermit BUILDING BTEMPSVCS Tem Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical so foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL MPERMFEE Mechanicals . foot MECHANICAL MPERMITFEE Mech Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee sq foot PLUMBING ZADDCHG Address Chane BUILDING i i 3 of 3