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07090071 CITY OF CUPERTINO BUILDING DIVISION PERMIT +CON`TrRA GTOR IFC?RMt1TION' PERMIT NO. BUILDING ADDRESS: P RM T DATE PIR OWNER'S NAME: D17, CS2 0 0 7 CONTROL NO. N ,1_ BUILDING PERMIT INFO ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH 0 j O LICENSED CONTRACTOR'S DECLARATION Job Description ?f= I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is y in full force and effect. Y�2 Z TEAR OFF TWO LAYERS OF WOODDSAHKE, INSTL PLYWD, z License Cl as Lic-A o Date Contracwr INSTL 3 �LB FELT, INSTL LANDMARK 30 YR. 26 SQ, Lu ARCHITECTS DECLA ATION ��I - ►!lC -� I understand my plans shall be used as public records CLASS A. ;f -U Licensed Professional a OWNER-BUILDER DECLARATION I hereby affirm that t am exempt from the Contractor's License Law for the jO 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 structure prior to its issuance,also requires the applicant for such permit to rile a signed statement r'q Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 �' -$ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or C— 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 penalty of APN Number Occupancy Type not more than five hundred dollars($500). 31623003 . 00 ❑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 Contractor's 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.). ❑1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li- cense 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. ❑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: J I have and will maintain a Certificate of Consent to self-insure 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. ❑I have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My WorkeesCoompensation Insurancecarrierand Policy number are: Cartier J sCfoLl� %V1,a Policy No.:Oo0tb!Q`ZOO 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.1 shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California.Dale 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 t z forthwith comply with such provisions or this permit shall be deemed revoked. 7 O CONSTRUCTION LENDING AGENCY r� I 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.) I a Lender's Name Lender's Address 1 Z 0 1 certify that I have read this application and slate that the above information is correct.1 agree to comply with all city and county ordinances and state laws relating to j V building construction,and hereby authorize representatives of this city to enter upon the + W above-mentioned property for inspection purposes. lei (We)agree to save,indemnify and keep harmless the City of Cupertino against liabilities,judgments,toss and expenses which may in any way accrue against said City )) ,Z in consequence of the granting of this permiL Date t" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: s4t�zw SOU,RCEREGULAnONS. ARe-roofs Signatuof App ican tntractor °e re Type Of Roof HAZARDOUS MATERIALS DISCLOSURE yP 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 roofs ;hall be inspected prior to any roofing material being installed. ❑Yes Will the applicant or future building occupant use equipment or devices which If a roof i;installed without first obtaining an inspection,I agree to remove emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. District? / ❑Yes I have read the hazardous materials requirements under Chapter 6.95 of the Califor- nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building q A Lo does not currently have a tenant.that it is my responsibility to notify dte occupant of the requirements which must be mel prior to iss Certifrcatc f Occupancy. Signature of Applicant Dat All roof coverings to be Class"B"or better O r azc uth nd agent are v c)-7/ CITY OF C'UPERTINO RE��OOF CUPfR,TINO PERMIT APPLICATION FORM APN# Date: � � 31 toZ300 as1/0-3- Buildin Address: 2 l 0v Fo�-e5t Av z , Owner's.Na� -F C4 � ��: Phone#6 � 365— l q� Contractor: JLicens #: Vv I? S tN o�r Q.,0� i✓1 �' Z Z 1 Contact: Cupertino Business License #: C-7cA-10C 21 \Zr)w. Y)a � ( Q`l —006 U T e of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles Asphalt Shingles Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings Z. ❑ Provide I.C.B.O.Report# To be Removed ❑ Provide Mfgr.Installation Specs. I Have Read,Understand and Will Comply With Cu ertino's Tear Off Policy: a ✓S a woo SMc� VI� �1 wuvj Job Description: -t�Cu �/ kwo y.r� � � y iO4o% I 30tb. t 'VA tCAl Cuhd d r • 2 Residential 0 Commercial ❑ Fire Zone: Yes ❑ No Confirmed with Planning Dept. if there are any restrictions: U Cost of Project: Type of Construction: Occupancy r1000 oup: 94 J s 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 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 apprcval. 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 vispection 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-he job site at the time on inspection. I understand and will comply with the above stated policy on re-roofing. Homeowner's Name: 0 'F U VI �j K cl job Site Address: Roofing Company Name: w eSAin 0�r-e T d�A kk v%L ' Applicant's Signature: 6Date: 0 Greg Casteel Building Official Revised 11/2/04 CITY OF CUPERTINO 2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 31623003 . 00 DATE ISSUED. . . . . . . : 09/11/2007 RECEIPT #. . . . . . . . . : BS000002618 REFERENCE ID # . . . : 07090071 SITE ADDRESS . . . . . : 20100 FOREST AV SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER XIP.OFANG PENG ADDRESS . . . . . . . . . . : 20100 FOREST AVE CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2009 RECEIVED FROM . . . . : BEID FOWLER CONTRACTOR . . . . . . . : PALL FOWLER LIC # 21417 COMPANY . . . . . . . . . . : WE:TSHORE ROOFING INC ADDRESS 2814 AIELLO DR C CITY/STATE/ZIP . . . : SAY JOSE, CA 95111 TELEPHONE . . . . . . . . : (4C8) 694-0060 FEE ID UNIT QUANTITY 1,MOUNT PD-TO-DT THIS REC NEW BAL ---------- ------------- ---------- -- -------- ---------- ---------- ---------- BPERMFEE VALUATION 10, 000. 00 169 .56 0. 00 169 .56 0. 00 BSEISMICRE VALUATION 10, 000. 00 1 .00 0. 00 1. 00 0. 00 ----------- ---------- ---------- ---------- TOTAL PERMIT 170.56 0. 00 170.56 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 170. 56 MC --------------- TOTAL RECEIPT 170.56 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CIV OF Fax(408)777-3333 #UPEkTINO Building Department JOB ADDRESS: PERMIT# Z o 110 Fov2s)l' fiV2 n`7 O '�FO,J' / OWNER'S NAME: PHONE # W? F6 5 -let 92 GENERAL CONTRACTOR: - CCk-cx-e P-C, FAX # v Y(o -- I am not using any subcontractors: 6t Signature D e Please check applicable subcontractors and co m Mete 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 A, Owner/Contractor Signature ate