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07050264IO 0O fUV :Z H t�Z fa )W< U U.F— ' W y .00 <-.ff "? a exp ZF °RE BUILDING DIVISION PERMIT BUILgMgREA�UGUST LN OWNER'S NAME: LYNA PI NE: ARCHITECT/ENGINEER: LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and eftt ' License Clat Lic. # Date Cotractorn A Hf1ECTS DECLARATI g��, 1 understand y plans shall be used as public reco Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the 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 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 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 not more than five hundred dollars ($500). 0 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, Busiss and Professions Code: The Contractor's License Law does not apply to an ownerneof 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 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's U. 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. 0 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: U] 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 for which this permit is issued. have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performan a of the work for which this permit is issued. My Workers amp+ante tiler and Polley number r j� Cartier. 'd Policy No.: (J 9 C 7 CERTIFICA OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE or less.) (This section need not be completed if the permit is foronc hundred dollars ($100) 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 forthwith comply with such provisions or this permit shall be deemed revoked. 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.) Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. 1 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, indemnify and keep harmless the City of Cupertino against liabilities, jud menu, toss and expenses which may in any way accrue against said City in consequc o granting of'his permit. APPLICA U ERSTANDS AND WILL COMPLY WIT ALL N N -POINT SOURCE R ONS. 6 Signature of Applicant/Contractor Date HAZARDOUS MA ALS DISCLOSURE Will the applicant or future building occupant store or handle hazardous material as defined by the CupertinoMunicipal Code, Chapter 9.12, and the Health and Safety Code, Section 25532(x)? 0 Ya No Will the applicant or future building occupant use equipment or devices which emit hazardous air contYowL..'jils 'defined by the Bay Area Air Quality Management District? 0 Yes 1 have +cad the hadc' District? undcrChapter6.95 of the Califor- nia Health S Code, Sections 25505.25533 and 25534.1 understand that if the building does not rte t have a tenant, that it is my responsibility to notify occup of the re9u is h met ' r issuance of a Certificate of cupancy. Owner or authorized aecnt T D ROOFING 675 TULLY RD (408)892-3872 PERMIT NO, 07050264 PERMIT ISSUE DATE 05/29/2007 SANITARY NO. CONTROL NO. BUILDING PERMIT INFO Job Description REROOF-REPIOVE 2 LAYER WOOD SHAKE, INSTALL 40YR ,COMP 26 SQUARES -7/16x' OSB Sq. l7t. Floor Area $8600 Valuation 3 6 212 016 M'Fl Number Occupancy Type Required Inspections Issued by: Date ' '� Re -roofs Type of Roof All roofs shall be inspected prior to any roofing material being installed. If a roof is install A'without first obtaining an inspection, I agree to remove all new mat rials for inspection. Signature of Appl cant Date All roof coverings to be Class "B" or better 2 ITEMS OF 2 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: -'ot: APN 36212016.00 DATE ISSUED.......: 05/29,'2007 RECEIPT #.........: BS000001480 REFERENCE ID # 07050264 SITE ADDRESS 7924 1.UGUST LN SUBDIVISION ...... CITY CUPERTINO IMPACT AREA ...... OWNER LYNA FI ADDRESS ..........: CITY/STATE/ZIP CUPERTINO CA, RECEIVED FROM T D ROOFING CONTRACTOR LESLIE HOANG COMPANY T D RO3FING ADDRESS 675 TULLY RD CITY/STATE/ZIP SAN JOSE, CA TELEPHONE (408)8)2-8872 OPERATOR: suew COPY # : 1 95014-4113 LIC # 23155 95111 FEE ID UNIT- - QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL -------- ------------- --------------- ERMFEE VALUATION 8,600.00 158.76---- 0.00 158.76 0.00 BSEISMICRE VALUATION 8,600.00 0.90 0.00 0.90 0.00 TOTAL PERMIT :---------- ---------- ---------- 1_.9.66 0.00 159.66 0.00 METHOD OF PAYMENT ----------------- CREDIT CARD TOTAL RECEIPT : AMOUNT --------------- 159.66 --------------- 159.66 F.EFERENCE NUMBER ISA -- V CITY OF CUP'ERTINO REROOF CUPERTINO PERMIT APPLICATION FORM APN # 9/ �7 /W —7 Date: E /,zC1 O Building Address: fq 14 a �,k 51 �-� Energy Owner's Nae: ; BSEISMICRE Phone #: q 6 g 3 1 3 5 1 3 V) BSEISMICOM Seism c Commercial Contractor: R. oo -�► �1 BPLANCHK License #: $q 5 6-9 1 Contact: D! -t! o a to BUSLIC Cupertino Business License #: L-1: Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof LlAsphalt Shingles X 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 Cupertinc's Tear Off Policy: Job Description: r e roc c> V e yes U o o c� S [/l c� did e ; vi 0 C� t Residential Commercial ❑ ;1 e,0 1 `1 O S B Fire Zone: Yes ❑ No W1 Confirmed with Planning Deft. if there are any restrictions: U Cost of Project: Type of Construction: Occupancy group: Qty. if Annlicable Fee ID Fee Description Fee Group BPERMFEE Bldg Pi;rmit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seism: c Fee Res BUILDING BSEISMICOM Seism c Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING WY OF 7UPERTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 BuildinLy Department JOB ADDRESS: :T 9 aq- �� s �- r, PERMIT # _ j`-? d S -o 2 6' t j OWNER'S NAME: V% Pi PHONE # (q'OS 3 1 3 S i .3 GENERAL CONTRACTOR: 1 n a FAX # I am not using any subcontractors: A1 S1.1-9 0 Signature Date Please check applicable subcontractors and co m lete the fo in information Owner/ Contractor Signature Date SUBCONTRACTOR BUSINESr, 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