06040075 (2) CITY OF CUPERTINO qr;�y -ro,ez t w;; �.k x}+s-W7w�5y✓,�,u„tt
BUILDING DIVISION PERMIT COPS'TI 1-r' '(1R�YI IRMA:TI'.(�,N.'.z
vd"I"Yt' P. �
BUILDING ADDRESS: MICHAEL LUNNEBORG ROOFING "B"'ITND'06040075
7474 DE FOE DR
OWNER'S NAME: PERMIT ISSUE DATE
TSAO CONRAD K AND TANNY C 1328 WHITE OAKS ED 04/1 '4 /9,006
NE: SANITARY NO. CONTROL NO.
(831) 278-1837
ARCHIIEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB
MECH
O
iOp LICENSED CONTRACTOR'S DECLARATION JbDeBGn Description
E I boreby affirm that l am licensed O
ensed under pravidoof Chapter 9(commencing p
with Section 7000)ofDivlsion 3 of the Business ad Profession,Code.and my license is
+ LmOroaande thea 7 7yy� TEAR OFF WOOD SHAIIaNSTALL LIGHTWEIGHT MET
License Clw TILE �•(��(
q
Dom V n_.�.o camD 0
f7Wu �—'� Aacxl Ecrs D
� 1 undeutand my plane odea!!h thud u Elic rtenrde c
s G Licensed Professional MA!
m OWNER-BUILDER DECLARATION sec
gI 1 hereby affirm that 1 am attempt from um Conuunofa License Law for the oo�
40 fallowing mean.(Section 7031.5.B.M.and proceed..Code:Any city or county
I3 V which mquires a permit to construct,time,.Improve,demolish,ar repair any suuuurc01111111 -
t� prier m its issuance.also requires tins applicant forsuch perckto ilk a signed stammcnt
rF, C thmheislicensedpursoanuotheProvisionsofdueComment”- Jansolaw(Chapmr9 Sq.Ft.Floor Area Valu�iiAp3495
Y5R (commencing with Section 7000)of Division 3 ofthe Budnmsand Premssloiu Code)or
that he u eumpt themm froand ere basis for the alleged eamnption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not mere sort RK bmdmd dollars(M). 35924036 . 00
❑1,a matter ofue property,as my employees wed wain u their sole compensation,
will do the work and the smcmre is m demanded ar offered foreale(Sao.70,14.Business
and Pmfeadam Cada:The Comacmr'a License law does Out apply m an.am.of Required Inspections
property who builds err Improves thctmn,and who does ouch work himelf or through hie
awn employes,provided that such improvements am not intended oroffemn for aide It.
however•the building or improvement is laid Wudn am year of completion.the owner.
boilder MB have ere burdan of proving W,M did not wild or Improve for purpose of
aide.).
O I,a owner of ere property,am mcluawly contracting with Banned conmeus,m
comarum ere project(sec.70e1,Business W Professions Cuda:)The Conuacur's U.
cen,e taw does no,apply an an owner of property who builds or improves uemen.ad.
who contracts for such project with aconumemr(s)licensed pumuent m the Contractofa
License Law.
❑1 w esempa undue Sec. .B&P C for this woo
Owner Dat
WORKERS COMPENSATION DECIMATION
I hammy&flim under Penalty o(perpuy,arm of the following deela mbacer
40 I have and will mainuin•CaNOuem of Cameos u self-lawn far WaheYsCompen-
udon,as provided for by Saloon 3700 of Use Labor Cade,for the performance of use
wart to,which this pante is broad.
C]1 have and will maintain Worker's Compensation Insurance,u required by Section
3700 of the Labor Code.fa the performance ofue work fu which this permit is issued. '
My Wormer Compen,m a Insurance camiu and Policy number are:
Carrier. -( 's�9zN Policy No.1,/7, 'erv "tV
CERTIFICATE OF EXEMP ION FROM WORKERS'
COMPENSATION INSURANCE
(This section need rot be completed I f the penal,is fm on,huntedmllass($100)
nr less)
1 certify Not In the parfommce of tin,work for which this Permit is issued.I dull rot
employ any person in any numbers,as to become subject to the Worlacce Compensation
Uwe of Cslifomia,Dam
Appliam
NOTICE TO APPLICANC If,after making this Ccninau of Exemption,you should
become object m the Waaker'a Compema ion provisions of the labor Code,you mum
O roMwiu comply with such providaos m this pem0 mi dl bo domed rtwkaQ
Z y CONSrRUc(ION LENDING AGENCY
[-a Ihereby affirm dist them is a construction lending agency for the pertumace of
C the work far which dds permit is issued(Sec.3197,Civ.C) '
W Q Lende(s Num
Lender's Addw
U Q 1 certify that I have reed this application and sum that the above Information is
IL F corns.i agree to amply with dl city and county ordinances and stat lays reBdng In
�O buildingeonswction,and hereby auuoriae mprommuaives ofthia city to arm,upnn the
W above-mcmianed properay for inspection purposes.
(We)agree to use.indemnify and keep hamlets ere City of Cupertino almost
rrAA liabilities judgment.caro and mpemos which may in try way aance agdn,t said City
()Z in cortequa=of the swung of this permit, / /?�/6
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date Y —
SOUR REGO oN
�2 Re-roofs
Si urc pplicanosCon errDam
HAZARDOUS MATFA] SURE Type of Roof
Will the applicant ar future building eau lmmaa handle haurdou material
u de0md by the Cumnina Municipal Cade.Chapter 9.13.and the Health and Safety - t
Code.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
will the applicant r future muilding oaupent lou
equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit haw2us dr contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection.
Dimim7
❑Yes
I mrsocad ere .Tia dalsmquimm ammder Chapmr6.95crth caiifm-
niaHde, 'mlde&SafclyCew25505.25533and2553e.1undcnundumifdm bciMing
dace not trenaly how•mm us mffi lily dfy oaupana of ere
mqu ntswh' rot at res ran orate cam Signature of Applicant Date
0 cr &uthoriyn agent Dans All roof coverings to be Class"B"or better I
CITY OF CUPERTINO
gem 3 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec: Twp: Rng: Sub: Blk: Lot :.
APN . . . . . . . . : 35924036 . 00
DATE ISSUED. . . . . . . : 04/13/2006
RECEIPT # . . . . . . . . . : 33979
REFERENCE ID # 06040075
SITE ADDRESS . . . . . : 7474 DE FOE DR
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : TSAO CONRAD K AND TANNY C
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4307
RECEIVED FROM . . . . : WESTERN ROOFING
CONTRACTOR . . . . . . . : MICHAEL LUNNEBORG LIC # 25896
COMPANY . . . . . . . . . . : MICHAEL LUNNEBORG ROOFING
ADDRESS . . . . . . . . . . : 1328 WHITE OAKS RD
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (831) 278-1837
*EE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 14 , 000 . 00 212 . 76 0 . 00 212 . 76 0 . 00
BSEISMICRE VALUATION 14 , 000 . 00 1 . 40 0 . 00 1 .40 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 214 . 16 0 . 00 214 . 16 0 . 00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 686 . 08 VISA
TOTAL RECEIPT 686 . 08
•
Community Development
10300 Torre Avenue
aClOF
Cupertino CA 95014
Telephone(408) 777-3228
Fax(408) 777-3333
OUPEI�TINO
Building De artment
JOB ADDRESS- PERMIT #
pG 6re-rop-7 -r
OWNER'S NAME: 1 sao PHONE #-�rqe 36P It, Za-
GENERAL CONTRACTOR:/,;4,i,iAkA ,f f FAX # I
I am not using any subcontractors: _ -,/0-06
Signature Date
Please check applicable subcontractors and complete the fo ozg 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
er/ actor Signature Date
Community Development Department
i
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: C4w2c 1�1 7T �0 O
Job Site Address: 75e 7V ///✓c Fie 6 r
Roofing Company Name:
Applicant's Signature: Date: 4c-r,?4y
• Greg Casteel
Building Official
Revised 11/2/04
o
CITY OF CUPERTINO
REROOF
• CUPERTINO PERMIT APPLICATION FORM
APN# _ n+ O r3 u Date:
Building Address d J `Y-
7,� �e zoe
Owner's Name: / Phone#:
Contractor: License#:
�59a 67F?2-Y -
Contact: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
_1�1_
Wood Shakes C3Wood Shakes
to Wood Shingles ❑ Wood Shingles T
[a Other(Specify) `! Other(Specify)rJ//P 71e Zr—
Number of existing coverings /❑ Provide I.C.B.O.Report# 4.624
To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Descri tion:r / / / L
r p/ )d slA IR 4 J ins-X/� / .C%1 4.,eir /l /Na / "7/-,/
ResidentialCommercial F-1
Fire Zone: Yes ❑ No Er Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: Type of Construction: OccuRancy group:
145'f— tom_ YL J
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
•