07090154 7777777
77777777 .7=
CITY OF CUPERTINO
BUILDING nr0SIOH PERMIT CT+C'1R IN +(}RMATIf3 ''
PERMIT NO.
BUILQII�G,/a"96-OTLAND DR AVALON CONSTRUCTION LLC. 07090154
l l l!� PERMIT ISSUE DATE
OWNER'S NAME:
MR. & MRS. TSAI 41882 CFADBOURNE DR 09/24/2007
SANITARY NO. CONTROL NO.
NE:
(510) 2E2-0980
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
p Z LICENSED CONTRACTOR'S DECLARATION Job Description
w r 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
z with Section 7000)of Division 3 of the Business and Professions Code,and my license is RMV & I1`S TL NEW ASPHALT SHINGLES ROOF, CLASS A
t=w in full force and effect-
r n Z License Class Lic.# 137
:—E Date Contractor
ARCHITECTS DECLARATION SQ FT 1/2 CD & 1 LAYER 3 0 LB FELT.
i d a I understand my plans shall be used as public records
)yU
U.yLicensed Professional
:O a OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
p O 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 file a signed statement r. Valuation
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 ,q.Ft.Floor Area $15000
e.t $ (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
L r 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 36228021
.�Number Occupancy Type
not more than five hundred dollars(5500).
❑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 offcmd for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law docs 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.).
XI,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 Contractors
License Law.
❑I am exe t under B&P C for this naso
Owne Date
WdRKEio COM EN ION 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 Workces 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 Worker's Compensation Insurance carrier and Policy number are:
Carrier: 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 perfomtance of the work for which this permit is issued,l shall not
employ any person in any manner sus�Q�f !! t to the Workers'Compensation
Laws of Cali(om Dar n C/! r'a"a
Applicant I —�
NOTICE TOA A a r making this Ccrtilgatc of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z, CONSTRUCTION LENDING AGENCY
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.)
W A Lender's Name
0 z L.cnders Address
U O I certify that I have read this application and state that the above information is
LL"
correct-I agree to comply with all city and county ordinances and state laws relating to
.J U building construction,and hereby authorize representatives of this city to enter upon the
Lfa above-mentioned property for inspection purposes.
Q. (We)agree to save,indemnify and keep harmless the City of Cupertino against
r�r liabilities,judgments,costs and expenses which may in any way accrue against said City
U,Z in consequence of the granting of this permit. Date
P4 APPLICAA4T UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by
SOURC EGULATI S.
Re-roofs
Signature of Applicant/Contebdor Date 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
Cade,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
13 Yes ❑No
If a roof i 3 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 rr aterials for inspection.
District?
❑Yes ❑No
I have read the hazardous materials requirements under Chapter 6.95 of the CAifor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1understand thatifthc building
docs not rrently have a tenant,that it is my responsibility to notify the occupant of the
requircm'n which LbemetpriortujlssuanceofaCcrtificatc ratmpancr. Signature ofApplica Dat
`/ -°7
All roof coverings to be Class "B"or better
Owncr or authorized agc Datc
0-70 I ®iso
CITY OF CXPERTINO
'' REROOF
CITY or
CUPER,TINO PERMIT APPLICATION FORM
APN# Date: c
v 7
2b OU 00
Building Address:
014,
Owner's Name: Phone#:
�i 1•nSG{n T,� - 51ti TSS
09 - )s - 37
Contractor: czS c r C_cvu V. License#: �4s¢g
aa-e1V f2
Contact: Cupertino Business License #:
(Sze-) C_Pqep5le
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
12 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#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu:)ertmo's Tear Off Policy:
Job Description: C D c b4a 4
e
Residential Commercial ❑ 0-7
Fire Zone: Yes ❑ No [�-' Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: Type of Constru;tion: iW Occupancy group:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
f 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 afire 2 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 f first obtaining an inspection,
will require the removal of all new mat?rial down to the sheathing,
so a proper City inspection can be performed.
7. NOTE: If you call for a plywood nail iuispection and the job is not ready,
you will be charged a re-inspection fee :)f$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: �� �' �1 -Sv1 n '�E'f' Ski yTS�c�
Job Site Address: 1114 SCU IaIIJ �erli n T so114
Roofing Company Name: t�-lddterZ G� -
P
Applicant's Signature: Date:
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: Bl}:: Lot:
APN 36228021 .00
DATE ISSUED. . . . . . . : 09,'24/2007
RECEIPT #. . . . . . . . . : BS000002729
REFERENCE ID # . . . : 07090154
SITE ADDRESS . . . . . : 11:.4 SCOTLAND DR
SUBDIVISION . . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . . .
OWNER MR & MRS. TSAI
ADDRESS 11:.4 SCOTLAND DR
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-5051
RECEIVED FROM . . . . : TIDE SHAN TSAI
CONTRACTOR . . . . . . . : ALLEN B SHAD LIC # 29256
COMPANY . . . . . . . . . . : AV2�LON CONSTRUCTION LLC.
ADDRESS . . . . . . . . . . : 41882 CHADBOURNE DR
CITY/STATE/ZIP . . . : FREMONT, CA 94539
TELEPHONE . . . . . . . . : (5"_0) 252-0980
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- -•--------- ---------- ---------- ----------
BPERMFEE VALUATION 15, 000. 00 223 .56 0. 00 223 .56 0. 00
BSEISMICRE VALUATION 15, 000. 00 1 .50 0. 00 1.50 0. 00
-•--------- ---------- ---------- ----------
TOTAL PERMIT 225 . 06 0. 00 225 . 06 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CHECK 225. 06 #1555
---------------
TOTAL RECEIPT 225 . 06
Community Development
10300 Torre Avenue
vLCupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
-UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
/ / 6-( S Co 4-) o.?o 5�a i S-
OWNER'S NAME: ;'�x PHONE # 2J77--37-7
GENERAL CONTRACTOR. , cJk,0,1 tc4AJ,-i- FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSIN!'ESS 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
Own r/Contfa for Signature Date