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12040077 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7575 KIRWIN LN CONTRACTOR:ALARCON ROOFING PERMIT NO: 12040077 OWNER'S NAIVE: YAU KWONG K AND LAU YUK H 59 WASHINGTON ST DATE ISSUED:04/13/2012 OWNER'S PHONE: 4082039981 SANTA CLARA,CA 95050 PHONE NO:(408)205-5533 ❑ LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL U COMMERCIAL License Class j Lic,q q7y RE-ROOF 25 SQ-TEAR OFF WOOD SHAKES, INSTALL Commdor 1lL/-Gds /[ Date yC �� C�Z- RADIANT BARRIER OSB 30# PAPER,GAF CLASS A 1 hereby affirm That 1 em licensed anal r the provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business&Professions Code and that my license is in full force and effect. I hereby affirm under penally of perjury one of the following two declarations: I have and will maintain a certificate of consent to self-insure for Worker's Compensation,as provided for by Section 3700 of the Labor Code,for the performance of the work for whichthis permit is issued. Sq.FI Floor Area: Valuation:$13410 1 have and will maintain Worker's Compensation Insurance,as provided for by Section 3700 of the Labor Code,for Ste performance of the work for which this APN Number:35921005.00 Occupancy Type: permit is issued APPLICANT CERTIFICATION - I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED correct.I agree to comply with all city and county ordinances and state laws relating WITHIN l80 DAYS OF PERMIT ISSUANCE OR to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save 180 CALLED INSPECTION. indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply Issued by: Date: with all nowpoint source regulations per the Cupertino Municipal Code,Section 9.18. RF.-ROOFS: Signature ,Date P, r AlLroofs shall be inspected prior to any roofing material being installed.If a roof is -/ installed without first obtaining an inspection,1 agree to remove all new materials for inspection. ❑ OWNER-BUILDER DECLARATION r / _ Signature of ApplicmL /YC �_ Date: 1 hereby affirm That I am exempt from the Contractor's License Law for one of the following two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 1,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&Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE construct the project(Sce.7044,Business&Professions Code). 1 have read the hazardous materials requirements under Chapter 6.95 of the California Health&Safety Code,Sections 25505,25533,and 25534. I will 1 hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: Health&Safety Code,Section 25532(a)should 1 store or handle hazardous I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should 1 use equipment or devices which emit hazardous Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District 1 performance of the work for whichthis permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent: T�, z57&-,_- Date: permit is issued. I cenify that in the performance of the work for which this permit is issued,I shall not employ any person inany manner so as to become subject to the Worker's Compensation laws of California If,after making this certificate of exemption.I CONSTRUCTION LENDING AGENCY become subject to the Workers Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.) Lender's Name APPLICANT CERTIFICATION Lender's Address I certify that 1 have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION and keep harmless the City of Cupertino against Iiabililics,judgments, costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional 9.18. Signature Date CITY OF CUPERTINO 4 ITEMS OF 4 PERMIT RECEIPT OPERATOR: SylviaM COPY # 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 35921005.00 DATE ISSUED. . . . . . . : 04/13/2012 RECEIPT #. . . . . . . . . BS000016542 REFERENCE ID #. 12040077 SITE ADDRESS 7575 KIRWIN LN SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . . OWNER . . . . . . . . . . . . : YAU KWONG K AND LAU YUK H ADDRESS . . . . . . . . . . : 7575 KIRWIN LN CITY/STATE/ZIP . . . :, CUPERTINO, CA 95014-4338 RECEIVED FROM ALARCON .I CONTRACTOR TIM ALARCON LIC # 29334 COMPANY ALARCON ROOFING ADDRESS 59. WASHINGTON ST CITY/STATE/ZIP . SANTA CLARA, CA 95050 TELEPHONE (408) 205-5533 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT- THIS REC- NEW BAL ---------- ------------- --------- ---- 0 1 . 00 1BCBSC VALUATION 13,410 .00 1 .00 0. 00 1 .00 0• 1BSEISMICR VALUATION 13 ,410 .00 1 .34 0 . 00 1.34 0. 00 1BUSLIC FLAT RATE 1.00 119.00 0 .00 119.00 0 . 00 1REROOFRES SQ FEET 25 . 00 350. 00 0. 00 350 .00 0_00 --- ------ ---- TOTAL PERMIT 471.34 0 . 00 471 . 34 0. 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- CHECK 471.34 CHK --------------- TOTAL RECEIPT 471.34 VOICE ID DESCRIPTION VOICE ID - DESCRIPTION - -- ---------------------------- 3 311 SCRATCH .COAT 09 EXTERIOR LATH 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE•CUPERTINO, CA 95014-3255 CUPERTINO (408)777-3228• FAX(408)777-3333 •buildingecuoertino.ora PROtECF ADORES ?S- lI'W /v LAI AFN" , 5�J I 1. 006—, OWNER NAME / V EMIL STREETADD L 7 VG CfT1f. SEAT:ZJP FAX APPucnxr NM¢ ap�il PH a��3 E-MAIL STREET ADDRESS CRY,SFA ZIP FAX S17 C& �= ❑OWNER ❑ OwNER-BUILDER ❑ OWNERAGENT ❑ CONTRACTOR ❑CON RACfORAGENr ❑ ARCHITECT ❑ENOWESR ❑ DEVELOPER ❑TENANT CONTRACTORNAI O LICENSE RNYjSTgAO7300 LInw BUS.LIC. C.4 CMNNME 4 � F -CO K LYIZ Les 12 '?6 STREET ADDRESS .C- / PHD a - 33 AROMCT/FNGII.EERN L10ENSENUMBER BIS.LIC" COMPANY NAME E-MAIL FAX STREET ADDRESS CITY.STATE ZIP PHONE USE OF SFD or Duplex ❑ Multi-Family ROOF _ VALUATION: STRUCTURE: ❑ Commercial a o Q 1113 EXISTING ROOF TYPE: El BUILT-UP ROOF ❑ASPHALT SHDrn Fe WOOD SHAKES ❑WOOD sHA1GLES 11 OTH&(SPFfh'1� REMOVE IREPLACE RYES IF NO. PLYWOOD NfK- ❑ LOB 13 N R WPR] ZROOF : A SS PROPOSED ROOF TYPE: ❑BURT-UP ROOF gRASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGIFS ❑OTHER ICC-FS REPORT" DFSC.UP ION OF WORK 30 Q is e, 4 5' lilalec haft/ lve By my signsmum below,I certify to each of the following: 1 am the property owner or authorized agent to act on the property owners behalf. I have read this application and the information I have provided is contaR i have read the Description of Work and verify it is accurate. I agree to comply with all applicable local ordinances and state laws relating to building construction I udmrirr,representadves of Cupertino tc enter the above-identified prop_,?,farm. pec uin purposes. Signanne ufApplicant/Agent Date: SUPPLEMENTAL INFORMATION REQUIRED If building is associated with a Home Owner's Association,provide letter of approval from HOA. Provide Planning approval to verify if there any restrictions. ss— Provide 5 �- # >`%; ,Y1.3r3'NIIiC:PLYFIEW-" - Provide copy ofManufBanIzer's Installation Specifications. _ — J _Provide signed copy of Cupertino's Tear-Off Policy. Reroof4pp_2011.doc revised 03/0711I