07010084 CITY OF CUPERTINO ZMIQN
BUILDING DIVISION PERMIT :
PERMIT NO.
BUILDING ADDRESS:
7521 DE FOE DR ABOVE ALL PERMrr t55uE DATE
OWNER'S NAME: 700 NOR'I HRUP ST 01/16/2007
EILEEN LIN
SANITARY NO. CONTROL NO.
'NE:i (f(�//l (408) 292-4188
y _s--- 15 5 T.m BUILDING PERMIT INFO
ARCHITECTIENGINEER: BLDG ELECT PLUMB MECH
O p LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that I am licensed under provisions oCChapter 9(commencing TEAR-OFF' LAYERS OF COMP/INSTALL 30#
=Z with Section 7000)of Division 3 of the Business and Professions Cod.,and my license is
=y in ful��A!=RCHrrECT`S
UNDERLAYMENT/INSTALL 40 YR. COMP
? Lie.. Lir.$
3nzDate COnIge6MDECLARATION
a< I understand my plans shall be used as public records
�yU
u.H Licensed Professional
ny<i OWNER-BUILDER DECLARATION
<2 1 hereby affirm that I am exempt from the Contractor's License Law for the
%O oy� following reason.(Section 703 1.5,Business and Professions Code:Any city or county
t*{ which requires a permit to construct,alter,improve,demolish,or repair any swcture Valuation
n Z} prior to its issuance,also requires the applicant for such permit to file a signed statement j Ft.Floor Area $6000
< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Ll'
xII--0 (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
y that he is exempt therefrom and the basis for the alleged exemption.Any violation of Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 5 9 2 4 0 2:. . Number P Y YP
not more than five hundred dollars(S500).
0 I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044.Business Required Inspections
and Professions Code:The Conuactoes License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If.
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)•nue Contrutor's U-
ccnse Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
0 I am exempt under Sec. B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 I have and will maintain a Certificate of Consent to self-insum for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
vc and will maintain Worker's Compensation Insurance,as required by Section
700 of the Labor Code,for the pt:rformance of the work for which this permit is issued.
My Worker's Compensation I crane carrier and Policy number are: �
Carrie Polity NO.:5:11—0009 0115
E IFICATE OF EXEMPnON FROM WORKERS'
COMPENSATION INSURANCE
(Chis section need not be completed if the permit is for one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued.1 shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z CONSTRUCTION LENDING AGENCY
F~•m mom. 1 hereby affirm that there is a construction lending agency for the performance uC
fY+> the work for which this permit is issued(Sec.3097,Civ.C.)
Lq Q Lender's Name
04 L.cndees Address
U 0 1 certify that 1 have read this application and state that the above information is
(t. correct.I agree to comply with all city and county ordinances and state laws relating to
O V building construction,and hereby authorize representatives of this city to enter upon thc
above-mentioned property for inspection purposes.
J'' W (We)agree to save,indemnify and keep harmless the City of Cupertino against
E.0. liabilities,judgments,costs and expenses which may in any way accrue against said City
in consequence of the granting of this it. Dat
C)Z APPLICANT UNDERSTANDS WILL COMPLY WITH ALL NON-POINT Issued b is
SOUR ULA
' Re-roofE
si "Apps' an T of Roof
MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? „,__// All roof;shall be inspected prior to any roofing material being installed.
I6d
❑Yes No
V_ If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District? y�r
0 Yes Q4Lro
I have mad the hazardous mate'als requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 5.25533 and 25534.1 understand that if the building
does not currently have a tenant, it is my responsibility to notify the occupant of the
requiremenuc w.h m. t be me or w issuance of a Certificate of Oce ancy. S ignatul e of Applicant
Date
� All roof coverings to be Class"B”or better
Ow or authon age Do '
Community Development Department
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 f irst 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 abovf stated policy on re-roofing.
Homeowner's Name: l ►� C �f-�'U1
Job Site Address:
Roofing Company Name:
APP /U b Applicant's Signature: -� _ Date: 7
Greg Casteel
Building Official
Revised 11/2/04
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
r:UPEkTINO
Building Department
JOB DD I SS• PERMIT#
074/ OD� /
OWNER'S NAME: PHONE # S
GENERAL CONTRACTOR- °,macIYAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and core. lete 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
Owner/Contractor Signature Date
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT.' RECEIPT OPERATOR: counter
COPY # 1
Sec: Twp: Rng: Sub: Bl}:: Lot :
APN . . . . . . . . : 35924021 . 00
DATE ISSUED. . . . . . . : 01,'16/2007
RECEIPT #. . . . . . . . . : BS()00000218
REFERENCE ID # 07010084
SITE ADDRESS . . . . . : 75:'.1 DE FOE DR
SUBDIVISION . . . . . . :
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : EILEEN LIN
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-4306
RECEIVED FROM . . . . : RECEIPT INTERFACE
CONTRACTOR . . . . . . . : KETT SULESKY LIC # 23092
COMPANY . . . . . . . . . . : ABOVE ALL ROOFING
ADDRESS . . . . . . . . . . : 700 NORTHRUP ST
CITY/STATE/ZIP . . . : SAI1 JOSE, CA 95126
TELEPHONE . . . . . . . . : (4()8) 292-4188
FEE ID UNIT QUANTITY I�MOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -- -------- ---------- ---------- ----------
BPERMFEE VALUATION 6, 000. 00 126 .36 0.00 126.36 0 .00
BSEISMICRE VALUATION 6, 000. 00 0 .60 0.00 0.60 0 .00
- -------- ---------- ---------- ----------
TOTAL PERMIT 126 . 96 0.00 126. 96 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 126. 96 13596
---------------
TOTAL RECEIPT 126. 96
0-::+C)
CITY OF C;UPERTINO
-^ REROOF
CUPEkTHNO PERMIT APPLICATION FORM
APN# Date: ,
3��►—a�- va� � t ce v
Building Address:
Ower's Name: Phone#:
n
� - �`
Contractor: License#:
v Cupertino Business License #:
Contact:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
pi,_Other(Specify) CG^."\nGF�`�`�n g Other(Specify) c e 1
Number of existing coverings ❑ Provide I.C.B.O.Rep4t#
To be Removed ❑ Provide Mfgr.Installation Specs.
EHave Read,Understand and Will Com ly With Cupertino's Tear Off Polic :
scription: v, �. \ v n �'C z
Residential 'r Commercial ❑
Fire Zone: Yes ❑ NoConfirmed with Planning De t. if
there are any restrictions:
Cost of Project: Type of Construction: Occupancy group:
Co
Qty. if Fee Group
97TZFee ID Fee Description p
EE Bldg Permit Fees BUILDING
Y Ener y BUILDING
CRE Seismic Fee Res BUILDING
ICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING