06030117 CITY OF CUPERTINO - �"
BUILDING DIVISION PERT CONTRACiTQR INFORMATION
BUILDING ADDRESS: _L PERMIT NO.
10332 TERRY WY
OW NER'S NAME: PERMIT ISSUE DATE
TSAI SHI-KUN AND YUH-CHING 22434 THUNAERBIRA PL 03/21/2006
14 NE: (510) 887-6964 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMFTINFO
BLDG ELELT PLUMB MECH
±o
ij LICENSED CONTRACTOR'S DECLARATION O O O
RfU I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing ■�Itt��Joaab,, Description
iW with Section]IXXs)of0iviaion3oftheBuvrw.ssardProfessinnsCodc.endmylicenseis REMOVE LAYER OF ALL COMPOSITION
i inranmrecans ■ ,,Y�■`fL�
Lieen.Class - eft_f.'I .+� �/S't I erg CLASS A
rat- Dam 3/tl / to V Contractor
ARCHITECTS DECLARATION
as< 1 understand my plans shall W used as public meet& { (� ('
�Gtn Licensed Professional ��� �• ZOUg
<5 OWNER-BUILDER m Ce Caroo ON
I I hereby maxo .(Tian Nat 1 1. exempt Iran the Contractor's :Any c taw for the
w O which
reason.(section]or L5,Business and improve,
do inns Code:Any city or county
<m which requiv a pcalso p cnnswcL pWm impmrc,demolish,fi repair any swnem
y Z i tat W its censed pursuant
requires the applicant rarsucthe Contractor's
Permit censele Law
(Chapter
(coix
< Nat mini gwitporsuanuoihcprovisionsofNCConusines andPuselaw(Chaptor9 Sq.F[. Floor Area Value Son
F 9 in.,he ,exam with Swtfrom and
of Divisiof r th al aged exampt on.Anyovi Codc)lotion or
yu r3.- thn to 7 31.5 b tacrclmm and ora aper for the alleged exempnt to Any violation of
Section 7011.5 by airy applicant fora permit subjects thus applicant to a civil penalty of ppgtatf,t�sa
not mom Nan fire hundred dollars(S500). 3,§y S y�TteF Q Q Occupancy Type
❑1,M owner of the property,or my employees with wages sa their ole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.704.,Business
and Professions Code:The Contrxtofs Liana Taw does not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himexif or through his
own c
however,
the buiprovided Nat oven imps sold within
is ase one
year deo oro@red for tile.r.
however,thebuildingorimprorcmenng that did act year of improve n.
Ne owner- -
saleI. will have tW Wrdcn of proving that W did trot Wild or improae for purpose of
salt.). .
❑I,as,owner of the property,am exclusively convening with licensed ronvactors to
mmorecl the project(Sec.7044,Business and Professions Code)The Contractor's Li-
ccnx Law does not apply to an awrter of property who Wilds or improv thereon,and
who contracts for such pmjeco with a eomnemr(s)licensed pursuant to the Conuaetor's
License law.
❑l am exempt under sec. ,B A,P C for this mason
Owncr Data
W 00.KER'S COMPENSATION DECLARATION
1 hereby aRrm under penalty of perjury one of the following declarations:
L]1 have and will maintain a CcNfimm of Cansent toself-insure far Worker'scout
station,sa provided for by section 37M of the Inbar Code.for the performance of the
work for which this permit is issued.
❑1 have and will maimain Worker's Compeosadan Insurance,as required by Section
3700 of dm labor Code,four the performance of dm work for which this pormit is issued.
My Worker's Compensation Insurance carrier and Policy number are�:L
Cain: S1ti}e dna Policy No.:i76CI251 -ZDo6
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mdo section need not W completed lithe permit is foram hundred dollars($100)
It..)
I mnifv that in the performance of the work for which this permit is mood,I shall not
cotploy any person in any mannerso u to become subject to the Worker'Compcnsatlon
LawaofCalifnnus.Date
Applicant
NOTICE TO APPLICANT:If.after making this Cendica a of Exemption,you should
become subject to the Workers Compensation previsions of the ISMir CMe,you most
.Jz forthwith comply with such previsions or this permit shall W deemed revoked.
z O CONSTRUCTION LENDING AGENCY
[-+ Ihereby affirmconstructionthoe is aconstruction lending agency for the performance of
a the work for which this North is issued(Sec.3097,Co,C.)
QUreces Name
z Lender's Address
U Q 1 certify that 1 have rad Nis applicauon and mute that the a Wve information is
D. correct.I agree to comply with all city and county ordinances and state laws relating to
0U building construction.and hereby mohorire representatives of this city to enter upon the
F yaWvc-mentioned pmpeny for ins ction a us.
(We)ag ce m arc Inde if p hart l ssNe City of Cup rt no mgalnsl
tq liabilitics,judgmcnts, an x ichmayinany.,.,cnmagainstsvid City
U,z Inconle ounce gr.nun t WILL
t--' APPLIC DERSfA AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 5,00L_e) Z
SOU R U 10
Re-roofs
Signa e.1 Applicant/ .mraetor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building acuiondatere or handle hvudaus material
u defined by the Cupertino unicipal Code.Chapter 9.12,and she Health and Safety
Code.Sccuom 25532(.)?
❑Yex ❑ All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection,I
Will the applicant or furore building occupant tau equipment or devices which g (� agree to remove
it haramous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes
Ihave read the hoard [,require an&,Chapter 6.95ofthe Califor-
noHealth ASafety Codc =25 5,25 art .I wdcrsmnd thuiftM Wilding
does not cmmtwh nand N d' y roe hility to noury tW occupant of the
ryuimmcnts why ran p' r ipe on certifiaam a;pacy.paney. Signature of Applicant Date
owner a amoriacd asci Z�,mOL All roof coverings to be Class "B"or better
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: bethe
COPY # 3
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 35917022.00
DATE ISSUED. . . . . . . : 03/21/2006
RECEIPT #. . . . . . . . . : 33662
REFERENCE ID # . . . : 06030117
SITE ADDRESS . . . . . : 10332 TERRY WY
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : TSAI SHI-KUN AND YUH-CHING
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : PLEASANTON CA, 94588
RECEIVED FROM . . . . : GUTTERWORKS INC
CONTRACTOR MICHAEL A FAZIO LIC # 27531
COMPANY . . . . . . . . . . : GUTTER WORKS INC
ADDRESS . . . . . . . . . . : 22434 THUNAERBIRA PL
CITY/STATE/ZIP . . . : HAYWARD, CA 94545
TELEPHONE . . . . . . . . : (510) 887-6964
OBE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
______ _____________ __________ __________ __________ __________ __________
BPERMFEE VALUATION 19, 000.00 266.76 0.00 266.76 0.00
BSEISMICRE VALUATION 19, 000.00 1.90 0.00 1.90 0.00
BUSLIC FLAT RATE 1.00 105.00 0.00 105.00 0.00
__________ __________ __________ ----------
TOTAL PERMIT 373.66 0.00 373.66 0.00
METHOD OF PAYMENT AMOUNT NUMBER
_________________ ------------ ____________-_____
OTHER 373.66 VISA
TOTAL RECEIPT 373 .66
•
Community Development
10300 Torre Avenue
SU"T,
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT # -
1 o33v )eri� 1� 6a 3 a
OWNER'S NAME: e4-f TS ct PHONE #510 - $"-6 c t�,
GENERAL CONTRACTOR: C-]v e wn FAX # 30755
i
I am not using any subcontractors: 3 At /v G
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
6wner/Contractor Signature Date
i' CITY OF CUPERTINO
e � A
REROOF
�• 0FEkTINO PERMIT APPLICATION FORM 060301/ 7
u,
i APN # 11 meq/�
✓ — 17- O.�aZ Date: 5laf( 0 (l
Building Address:
l �330� l ei^v, w c„
Owner's Name: ff Phone #:
'get I ` � Set,
Contractor: GLicense #:��� e i✓�r 1 c 65 �( lci�
Contact: ` ^^I Cupertino Business License #:
IQ 7
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
91- Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑NumbeOther r
existing
H Other(Specify)
CliYrp �Li,h (�
Number e existing coverings t 8' Provide I,C.B.O. Report#
To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Com I With Cu ertino's Tear Off Polic ❑
Job Description:
6e ov
Residential Commercial ❑
Fire Zone: Yes ❑ No 4
0 Confirmed with Planning Det. if
Cost of Project, there are an restrictions: LJ
J Ty e of Construction: Occupancy grou
Qty. if
A licable Fee ID Fee Descri tion
BPERMFEE Fee Grou
Bid Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIUSLIC Business License BUILDING
•