04090247 (2) 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
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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
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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
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*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
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