05070137 CITY OF CUPERTINO 4 .f k,5:,;Tpg'a ^`: ,�s'E `
BUILDING DIVISION PERMIT RCONTRAC�TORINFQRMATIq
BUILDING ADDRESS: T D ROOFING PERMIT NO.05070137
OWNER'S NAME: PERMIT ISSUE DATE
HUIDA DAI & JULIA ZHU 3540 MARGATE AVE n7/22/2005
SANITARY NO. CONTROL NO.
(408) 892-8872
ARC U EC AIINGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p LICENSED CONTRACTOR'S DECLARATION O �lOn
�r Fy� 1 hereby affirm Met I sm licensed ns ed under provision of Chapter 9(commca iog `
n'�tn wish Secdan 76yw.rBusinessaion 3 ofthe Business and Promaimu an
Code. d rayicameIs
in full force and effect Z
y REROOF-1 2" REIDENTIAL
Lkanm Class Lie. /
Dam Conueclar SHAKE 50 YR
3
ARCHITECTS DECLARATION —F-)47—
� 9�
o q 1 unCe'ad my pI! shall be u uhlic=end, 9000
CCCC� Lice fcaeional� L al
Sy OWNER-BUILDER DECLARATION ��'� '��
.� I hereby affirm that I am exempt from the Conuxetter's License Law for the
O o fallowing recon.permit
(Section 7(D L5,Business and Improve,
demolish,
Code:Any city s county
$ which requires•pemao re ennawe4 applicant
I t rotsu demolish,tar rtpair any umctum
pdoreI.limts ance,aiuu requires theeapions o for Contractor's
uLaw(Cigned ammenl
< thathe mingwiitpa,wanl7000)ofDivamofUm eBuacmr'auavelaw(Clupmr9 Sq.Ft.Floor Area ValuatiQly000
8 chat M is exempt
Sectionce and Me Ismaion 0 of the alleged
Business and Professon.An vi Code)at
— Nat he h exempt theacfrom and the bash for the ailegnd mmmption.Any violation of
Section 7011.5 by my applicant for a pemdt subjects the applicant 70 a civil penalty of APN Number Occupancy Type
mat mart Nan 0w hundred dollars(5500). ,
36212020 . 00
❑L u ahem clime properly,army employees with wages u theb axle cempa cation.
will do the work.and the structure is notlmmnded cera@red forale(Sec.7044,Basin em
sad Professloor Code:The Commutes Limme law door Ml apply to an owner of Required Inspections
properly who builds ser improves Urereon,and who does such work himself ar through his
awn employce s,provided Nn such Improvements are not intended oroffered formic.If,
however,the building or Improvement Is sold within an you of completion,hamster.
builder will have she burden of proving shat M did not Wild or Improve for purpose or
tile.).
❑1.as Owner of the property am exclusively wounding with limned com ucton to
construct the project(Sec.7044,Business and Professions Cade:)The Conuactots U.
come law docs not apply m an owner of property who build,or improwa thereon,and
who contract,for such projects with a contnctorf0 licensed pursuant m the Commator's
License law.
❑l am exempt under Sec. ,B&P C for this rather,
Owner Dam
WORKERS COMPENSATION DECLARATION
1 hereby alRrm under pane ty of perjury am:of she following declarations:
0 1 hero and will maintain a Certincam afCom ent to self-insure for Worke sCompcn.
sadon,as provided for by,Seedon 7700 of the labor Code,for the performance of she
work far which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as acquired by Samar,
)IDOaf Ne Labor Cade,for dm performance of the work far which this permit is issued.
My WoksSCompnation Inmnm caniu and Polley num
TCarrier ae Cdp Policy No.:�
CEfFlCATEran:
O
MMONFROM WORKERS
COMPENSATION INSURANCE
Crosse ntlon need not he completed if 0he Permit Is foram)hundred dollars($10(0
or Ices.)
1 certify that in the performance of she work for which this penni0 4laued,l shall not
employ any person in any manncr he as in became subject 70 the Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
became Subject On 00 Wo&ce'a Compensation provisions of she Labor Code,you must
Oforthwith comply with such provisions or this permit Mail W deemed revoked.
'Z y CONSTRUCTION LENDING AGENCY
[. 1Wmby Mm that Nem Is a construction lending agency rat the performance of
ai the work for which this permit Is issued(Sec.3097,Civ.C.)
Q Lender's Name
iD. Z Lander',Address
U O 1 eenify that 1 have mad this application and Mum shat the,bow far..dun is
corrin 1 qm m wmply wish W city and county ordinance and mm laws relating to
C) building construction.and nearbyauthorim representatives of this city to enter upon the
[57 ahow-mctiuned pmpcny(oriMNCdan purporet
(Wee)agree to save,indemnify and keep humless the City of Cupertino against
yy liabilities.juegmenn,coati and expenses which may In any my me=against aid City
In
U'< APPLICANT UNDEROr the STANDS ANof this D WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RECO ATIONS.
21"d� Re-roofs
nuumaf Ap cma Conuauor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will de,applicant or future building occupant slam ar handle hvudous material
ss defined by the Cupertino Municipal Code.Chapter 9.13.and the Health and Safely
C S Non n53z(,)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yor 64 No Will the applicant or future building mupont use equipment or devices which -If a roof is installed without first obtaining an inspection,I agree to remove
emit h zArdnus aircontamivnts ss denced by the Bay Arca Air Quality Management all new materials for inspection.
Dhuict7
❑Yex AN.
I have mW the huamnus materials requirements undar Chapmr6.95 of she Califon
ni,Hnith&SafctyCoM,Secdaa255U5,25533and05534.lundcm=dthalftha building
does not emrendy have a tenant.Not It h my respoorlNlliy la notify tint occupan0 of she
nqulmmenu which must be met priorm issuance of i Certineam of Occupuwy.
—i -1� Signature of Applicant Date
wnc,or wtha 4d asam Dam All roof coverings to be Class"B"or better
CITY OF CUPERTINO
1• 1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # : 2
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36212020.00
DATE-ISSUED. . . . . . . : 07/22/2005
RECEIPT #. . . . . . . . .. 30476
REFERENCE ID # . . . : 05070137
SITE ADDRESS . . . . . : 875 SEPTEMBER DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . :
OWNER HUIDA DAI & JULIA ZHU
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4142
RECEIVED FROM . . . . : HUIDA DAI
CONTRACTOR . . . . . . . : LESLIE HOANG LIC # 23155
COMPANY . . . . . . . . . . : T D ROOFING
ADDRESS 3540 MARGATE AVE.
CITY/STATE/ZIP . . . : 'SAN JOSE, CA 95117
TELEPHONE. . . . . . . . . : (408) 892-8872
•
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW HAL
---------- ------------- ---------- ---------- -------'-- ---------- ----------
BPERMFEE VALUATION 7, 000.00 137.16 0.00 137.16 0.00
BSEISMICRE VALUATION 7,000.00 0.70 0.00 0.70 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 137.86 0.00 137.86 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 137.86 1068
TOTAL RECEIPT : 137.86
•
CITY OF CUPERTINO
REROOF
*CUPERTINO PERMIT APPLICATION FORM
APN# Date:
36 2 —l2 — 020 :g24,2_0, 2006
Building Address:
F75 S �6e_r CA g501 y
Owner's Name: Nutdoc
Phone#:
7� u ci T&ta Y Z_" 1/08- 366 -20016
Contractor: Phone#: License#:
-rte Ro ,:� Co. �/o$- 6yd-83so G�-66zz
Contact: �Q✓'S fPo Phone#: ,/00 _2Q 3—9 Cupertino Business Lic nse#:
�?-3 :S S
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )Q Asphalt Shingles
,j 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.
A k1 Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy: 5q
MP!lob Description: _17 VW Ve"It p rood y/Z eD kb etil PYe4 _(cZ/ S e Yrs
Residential ® . .. __ . . _ -Commercial.. ❑._.
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are anrestrictions:
Cost of Project 7 Type of Construction: Occupancy group:
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