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06010052 (2) CITY OF CUPERTINO 17777-1 xY+ x '_• •:�. .i BUILDING DlvjsjoN ATION a' PERMIT CON,TR "CTOR INFORM T ,x FORMI BUILDING ADDRESS: PERMIT N0,06010052 810 PEPPER TRT7.F T.A EWS NAME: PERMIT ISSUE DATE MICHELE LUM 01/10/2006 NE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG EISCT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION O O O i H 1 hereby affirm Nat 1 am liceved under provisions of Chapin 9(commencing Job Description n�1i nith Sation]atlll)af Divii of the and Prof mien Code.an myliccnm is - orn follfMndcrfc / G r REROOF—DECK COATED W HOT MOP OR BITUTHENE t z License, as T7� � / W/ HOT Dam Contocmr 1/10/6 CREATIVE HOMES PD FOR BUS LIC C ITECI'S DECLARATION s< 1 un rwnd y plias shall M uxd u Puhlic records D U Is o Liecroed Pm(essional x g OWNER-BUILDER DECLARATION I Wmhy affirm that I am cacmp,from the Crematories Lccnm law for be O O following reason.(Section p01.5.Business and Profession Code:Any city of county K m r which requires a Permit to cnnmuct,alter,improve,demolish,or mine any structure pd.,to its issuance.also requires tMappluma far such permitta fleasigocdmentemt ESG dm M uliconmd pursuant to Ban provision of the Consent's Liana Law(Chapter 9 Sq.Ft. Floor Area Valuati dL500 yF (commending withScetion7")of Division J of NC Business and Profession Codc)Or y that he is eumpt tMmfrom and the,buts for the alleged exemption.Any violation of section 7031.5 by airy applicant for if permit subjects the applicant toacivil penalty of APN Number Occupancy rant more than five limed Balla s($!5(a)). 35911041 . 00 P Cy Type ❑I,uowner oftM property,or my employees with wgcaudreu role compcnuslan. will do the work and the structure isnot intended in offered for sato(See.]OW,Businw and Profession Cade:The Ci ntracmts License Law docs not apply in an owner of Required Inspections propenywhn Wilds simper.dernif to d wWdonmich work himself or through his own employees,provided that such imprownican an not intended aroffered for sale.If, p however.me building or improvement is sold within ane year ofcompletion,the owner. Wilder will have thc burden of proving that M did not Wild or improve for purpose of fid Cl/.y x ry sale.). Illlllll �a �ejj f F .� ❑1,as owner of dm property,am eaclusively contracting with licemed contacted;to coronet the pmjca(Sec.]Oad,Business and Profcssion Code:)The Commumm's U. r• ffjj�` come Law don not pply m an owner of propeny.wW Wilds or improves demon.and ZOG6 who contracts for such projects with a eonc actm(s)licered pursuant to she Contractor Lice.Law. MM ❑I am exempt under See ,B 6 P C for this moan [[grrggqAAAn����f ((l,((1 1rp��+a ffL@@g6((, (LL '%yq; Date �' v � ✓ tl �`` WORKER'S COMPENSATION DECLARATION 1 Mrcby affirm under penalty of perjury ane of the following elimination: I'll'y1m. s¢and will maintain a Cenlficam of Consent m self-insum for Wurkeri Compen- ,u provided for by Section 3]00 of the Labor Code.for Ne performance of the W for which this permit is issued. ove and will maintain Worker's Compensation Insurance,u rtyuircd by Section of Ne labor code,for the performance of the work for which this permit is issued. orker's Compensation Insurance career and Policy number art: r: Polity No.: _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Thu section need not M completed if tM)omit Is franc hundred unit=($Iao or less.) 1 certify Nm in the performance of the work for which Nis permit is issued,I shall nut cmployanypersoninanymanncrsnastobec3ompaub'cc tMW pc inti Laws of California.Date [f Applicant � ) �P NOTICE TO APPLICANT:IL after making this Cenificam of Exemption,you should become abject to the Worker's Compensation provision of the labor Code,you must .JZ forthwith comply with such provision or this permit shall M deemed mvoked. z CONSTRUCTION LENDING AGENCY (-+ I hereby affirm thatthemisaeonsuuclem hodingagency fordm Performance of 0:> the work for which this permit is issued(Sec.7097,Civ.C.) �a Undoes Name .`7. z Lender's Address , U0 I comfy Nes I have read this application and state that tM above information is - 91 Fconte.I agmc or comply with all city and county oNinaues red sum Iaws relating m O V building eonstreciten,and hereby authonm mpmsenutives of Nis city to emr upon the above-mentioned property for iuPcction whichMpurposes. H y (We)agree m save,indemnify and keep harmless the City of Cupcnud against CO) liabilities,judgmcnts.costs and expertus which may in MY way atcrvc against said City in consequence of the 6rantin _ anis. U z SOURICA UNDER WI ,COMPLY WITH ALL NON-P Issued by: Date signvurc plida on Re-roofs HAZARDOUS MATERIALS DISCLOSU m Type of Roof Will tM apPliunt or future Wilding arcupant mom or handle Name ous material as defrrcd by the Cupertino Medici I Code.Chapter 9.12.mol the Health and Safety .Section 155J2(a)? ❑res No All roofs shall be inspected prior to any roofing material being installed. Will dre affilicans or future Wilding odeupant use equipment or devices when If a roof is installed without first obtaining an inspection,I agree to remove it harardnn air contsminanm u d by the Bay Area Air Quality Management all new materials for ins ection. isuict? ❑Yes Ihave mail the hvvdousm 505,25533mments4.I. lcoprc1Q95ofheWilding /O ria Healthomedy Cude.h..Mons. 25505.25577 and 2553a.l undermaM tlnif Bros Wilding _ don rwt cunentlY Wsc s tenant Nat it' dernmebitity of notify the occyyPanI the mquircmcnts which ssuanco La acidftcate 0gypadcy. Yd Si ureofA licant Date Owner ar,ytham. „e All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue i -•'-'� Cupertino CA 95014 '^ Telephone(408) 777-3228 � CITY OF Fax(408)777-3333 PEI�TINO Building Department JOB ADDRESS: PERMIT j a OO� �v8/D b OWNER'S NAME: /�/C ESE L /✓/ PHONE # GENERAL CONTRACTOR FAX # I am not using any subcontractors: 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 Ask Tile Owner/Contractor Signature Date CITY OF CUPERTINO �m 1 of 1 PERMIT RECEIPT OPERATOR: suem COPY # 3 Sec: Twp: Rng: Sub: Elk: Lot: APN . . . . . . . . : 35911041.00 DATE ISSUED. . . . . . . : 01/10/2006 RECEIPT #. . . . . . . . . : 32734 REFERENCE ID # . . . : 06010052 SITE ADDRESS . . . . . : 20810 PEPPER TREE LA SUBDIVISION . . . . . . . CITY . . . . . . . . . . . . . : CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : MICHELE LUM ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2917 RECEIVED FROM . . . . : ROLAND RICE CONTRACTOR . . . . . . . : LIC # COMPANY . . . . . . . . . . : ADDRESS . . . . . . . . . . : CITY/STATE/ZIP . . . . , TELEPHONE . EE ID UNIT QUANTITY. AMOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- ---------- ---------- ---------- ---------- BENERGY PERMIT FEE 83.16 39.92 0.00 39.92 0.00 BPERMFEE VALUATION 2, 000.00 83.16 0.00 83.16 0.00 BSEISMICRE VALUATION 1,500.00 0.50 0.00 0.50 0.00 ---------- ---------- ---------- ---------- TOTAL PERMIT 123.58 0.00 123.58 0.00 METHOD OF PAYMENT AMOUNT NUMBER ----------------- ------------ ----__--___---__-- CHECK 123.58 1459 TOTAL RECEIPT 123 .58 Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 C U P E�I N® 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: /V/c Jobs ite Address: «Agz-��O���7z it/. y . Roofing Company Name: ' Applicant's Signature: Date: O/ Greg Casteel Building Official Revised 11/2/04 Printed on Recycled Paper' 1 1\� -� CITY OF CUPERTINO REROOF CUPEFkTINO PERMIT APPLICATION FORM d�6/«sem APN # Date: �J�/ & Building Address: Owner's Name: Phone#: /%ici �c GSM o8 3/.7 ,Z 9,4,0 Contractor: Phone#: gp P?ipf`S' License#: 2 76 9 y 7 Contact: �- Phone#: Cupertino Business License #: 0/ Type of Roof Covering: ExiPro po d: Milt-Up Roof O' Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O. Report# JJ 0 To be Removed ❑ Provide Mfgr. Installation Specs. 1� I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: t9'f6k G c Residential [� Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are any restrictions: ❑ Cost of Project: Type of Construction: Occupancy group: 5 Oa DO`/N' 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