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07080236 CITY OF CUPERTINO BUILDING DIVISION PERMIT TC?R IQRM�iTION . PERMIT NO. "ILQI� ff'b�:(JA__jvj�S DR MICHAEL LUNNEBORG ROOFING 07080236 /7 PERMIT ISSUE DATE OWNER'S NAME: ALBERT LIU 1328 WH.CTE OAKS RD 08/27/2007 SANITARY NO. CONTROL NO. NE: (831) 273-1837 BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH C� 0 Z LICENSED CONTRACTOR'S DECLARATION o Job Description vI hereby affirm that I am licensed under provisions of Chapter 9(commencing Z�d with Section 7000)of Division 3 of the Business and Professions Code.and my license is TEAR OF.? ALL WOOD ROOF, FILL AS NEEDED 40 IBS y in full force and cff v�z License Classy Lic.f1 FELT ;t:w Date��0 ARCHITECTS0 N INSTALL METAL TITLE SYSTEM 23 # LESS THAN 61BS i a< I understand my plans shall be used public records t, ,aU wN Licensed Professional a OWNER-BUILDER DECLARATION _r I hereby affirm that I am exempt from the Contractors License Law for the 300 following reason.(Section 7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any strrtcture prior to its issuance,also requires the applicant for such permit to file a signed statement Valuation Z; P Ft. Floor Area that he is licensed pursuant to the provisions of the Contractor's license Law(Chapter 9 SLl• $14000 t=- (commencing with Section 7000)of Division 3 of the Business and Professions Cade)or 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 pemahy of Number Occupancy Type not more than five hundred dollars(5500). 3592 6 003 . ❑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,Businew Required Inspections and Professions Code:The Contractors License Law dors 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.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractors Li- ccnse Law does not apply to an owner of property who builds or improves tbereoo,and. who contracts for such projects with a conuactor(s)licensed pursuant to the Contractors License Law. ❑1 am exempt under Sec. B&P C for this reason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations ❑I have and will maintain a Certificate of Consent to self-insure for Workers Compen- sation,as provided for by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ave and will maintain Worker's Compensation Insurance,as required by Section of the Labor Code,for the performance of the work for which this permit is issued My Workers Compensation Insurance carrier and Policy number are: Carrier..,J t Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This 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.I 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 O CONSTRUCTION LENDING AGENCY F"14 1 hereby affirm that there is a construction lending agency for the performance of ((, > the work for which this permit is issued(Sec.3097,Civ.C.) W QLender's Name aLenders Address U O I certify that I have read this application and state that the above information is w►' correct.I agree to comply with all city and county ordinances and state laws relating to Ubuilding construction,and hereby authorise representatives of this city to enter upon the above-mentioned property for inspection purposes. �a (We)agree to save,indemnify and keep harmless the City of Cupertino against HV) liabilities,judgments,costs and expenses which may in any way accrue against said City U Z in consequence of the granting of this permit. Data APPLICANT UNDERSTANDS AND WILL CO LY WITH ALL NON-POINT Issued b): Z ? SOU CE REG An Re-roofs gnatu ofAp canvConuactor D81C Type of]hoof HAZARDOUS MA S DISCLOSURE Will the applicant or future buildi cupant 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 roofs shall be inspected prior to any roofing material being installed. ❑Yes 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 contaminantsas define by the Bay Area Air Quality Management all new r laterials for inspection. District? ❑Yes o I have read the hazardous materials requirements under Chapter 6.95 of the Califor- 7-�j nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building / r' does not currently have a tenant,that it is my responsibility to notify the occupant of the — 7wni cots which must be met pri ante o c cart o[oe up� � Sig aturl of Applicant Date �i All roof cover o be Class"B"or better agcn Date •,�l CITY OF CUPERTINO -_. : CUPERTINO PERMIT APPUCATION FORM APN# __t_Date: U� S 27-0 7 Building Address: blew Owner's Name: Phone#: YJk' -7?,r 0-32,2_- Contractor: 32ZContractor: -/ a€� ab0 License#: �✓pJ7�iN ao0�'�„ .f j�/�trs �� p' ` .�.n G 7�i 7 Z�' Contact: Cupertino B si ss�cense #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles Wood Shakes ❑ Wood Shakes -r Wood Shingles ❑ Wood Shingles ❑ Other(Specify) Other(Specify) 164-64WI T Number of existing coverings L Provide I.C.B.O. Report# c�U Z&e Ve--To be Removed �j Provide Mfgr.Installation Specs. I Have Read,Understand and Will Comply With Cupertino's Tear Off Policy: ❑ Job Description: Residential Commercial Ej Fire Zone: Yes ❑ No Confirmed with Planning Dept. if there are any restrictions: ❑ Cost of Project: Type of Construction: Occupancy group: 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 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 i. PI MY LO pE'1-)-Illi NsUiMCO, �)OU lY1Ust�glre ' Lo LC)ITlV With 19,)'-7 �� _ >l�itl��F�T�3 ; and manufacturers specifications on re-;oofing. 2. New roof coverings shall not be appliec 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 irspection 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 t-ie job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: /"W-/ fru Job Site Address: 7r-2- �tM�I •^ Roofing Company Name: 41el40/✓ / � U -� S'4°a Applicant's Signature: Date: Greg Casteel Building Official Revised 11/2/04 Community Development 10300 Torre Avenue i` Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 CUPEkTINO Buildi:n De artment JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # fkle 3(.Pfs/ f— GENERAL CONTRACTOR: �.. S' FAX # /7�f , I am not using any subcontractors: Si;;nature 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 a7 01�! ntractor Signature Date CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT' RECEIPT OPERATOR: CathyS COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35026003 .00 DATE ISSUED. . . . . . . : 08,'27/2007 RECEIPT #. . . . . . . . . : BS000002487 REFERENCE ID # 07080236 SITE ADDRESS . . . . . : 7552 DUMAS DR SUBDIVISION . . . . . . CITY CUERTINO IMPACT AREA OWNER AL:3ERT LIU ADDRESS 7552 DUMAS DR CITY/STATE/ZIP . . . : CUPERTINO, CA 95014-4311 RECEIVED FROM . . . . : MICHAEL LUNNEBORG CONTRACTOR MICHAEL LUNNEBORG LIC # 25896 COMPANY MICHAEL LUNNEBORG ROOFING ADDRESS 1328 WHITE OAKS RD CITY/STATE/ZIP . . . : CAMPBELL, CA 95008 TELEPHONE . . . . . . . . : (831)278-1837 FEE ID UNIT QUANTITY -%MOUNT 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 REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 214.16 VS --------------- TOTAL RECEIPT 214 .16