07050260 777777
CITE'OF CUPERTINO
BUILDING DIVISION PERMIT +€'` +r� +�fR IERMTIf�N�,
PERMIT NO.
BUILDANQ�I�FljEssESTERN DR WING'S :GOOFING INC 07050260
l U PERMIT ISSUE DATE
OWNER'S NAME:
JOSEPH N BABANEZHAD 3243 SYDNEY WAY 05/25/2007
SANITARY NO. CONTROL NO.
VE:
(510) 88)-9068
BUILDING PERMIT INFO
ARCHITECT/ENGINEER:
BLDG ELECT PLUMB MECH
0 0
p p LICENSED CONTRACTOR'S DECLARATION Job Description
v)= I hereby affirm that I am licensed under provisions of Chapter 9(commencing
z wwith Section 7000)of Division 3 of the Business and Professions Code,and my license is REROO F—'P/0, INSTALL 7/16" #15 30 YRS, CLASS A
a in full r a l force an,if,
j z License Lic.# 8�� ASPHALT SHINGLES. 23 SQUARES
F p Datc Contractor
ARCHITECTS DECLA ION
".4 I understand my plans shall be used as public rccor
�yV
U.I" Licensed Professional
y 2 OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the
pO following reason.(Section 7031.5,Business and Professions Code:Any city or county
rZ which requires a permit to construct,alter,improve,demolish,or repair any structure
z r prior to its issuance,also requires the applicant for such permit to file a signed statement t' .Ft.Floor Area Valuation
_ that he is licensed pursuant to the provisions of the Contractor's Liccnsc Law(Chapter 9 rq
e.F (commencing with Section 7000)of Division 3 of the Business and Professions Code)or $6950
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 penauy of AR Number Occupancy Type
not more than five hundred dollars(5500). 3 5 9 110 0 V
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure isnot intended oroffered for sale(Sec.7044.Business Required Inspections
and Professions Code:The Contractors 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 Cork:)The Contactors 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 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:
v I have and will maintain a Certificate of Consent to self-insure for WorkcrsCompen-
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 Workers Compensation Insurance,as required by Section
700 of the Labor Code,for the performance of the work for which this permit is issued
My Workers C mpensation I nonce rrier and Policy number am:
Cartier. Policy No.: /4 7XIS31
CERTIFICATE OF E MPrION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($I00)
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
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z, CONSTRUCTION LENDING AGENCY
(�C/3 I hereby affirm that there is a construction lending agency for the performance of
r7 the work for which this permit is issued(See.3097,Civ.C.)
Wn A
Lender's Name
]z Lenders Address
U C) I certify that I have read this application and sate that the above information is
�-^ correct.I agree to comply with all city and county ordinances and state laws relating to
Q U building construction,and hereby authorize representatives of this city to enter upon the
a above-mentioned property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
Hto liabilities,judgmcns,costs and expenses which may in any way accrue against said City
V Z in consequence of the granting of this permit.
APPLICANT UN ERSTANDS D WILL COMPLY WIT"LL NPN-POINT-POINT Issued by: Date
SOURCE RGUL TIONS. `7 !/ - 0 - 6
'
Re-roofs
Signature o A icant/Co o Darc Type
Of R JOf
H DOUS MATERIALS DISCLOSURE
Will the applicant r future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Cock,
Section 25532(a)? All roofs:ihall be inspected prior to any roofing material being installed.
El Yes ( No
Will the applicant or fast re building occupant use equipment or devices which
If a roof i.i installed without first obtaining an inspection,I agree to remove
,mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District? r
El Yes NO
I have read the hazardous materials requirements under Chapter 6.95 of the Califon-
nia Health&Safety Code,Sections 25505.25533 and 25534.1 understand that if the building `
does not currently have a tenant.tha it is my responsibility to notify Ute occupant of the
requirem s whi h must be r W issuance of a�'frcprc of Oc Signature of Appli ant Date
(�l/�( All roof coverings to be Class"B"or better
Owner o�TujWizcdlgt bate
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: suew
COPY # 1
Sec: Twp: Rng: Sub: Blk : Lot:
APN . . . . . . . . : 35911009. 00
DATE ISSUED. . . . . . . : 05/25/2007
RECEIPT #. . . . . . . . . : BS000001472
REFERENCE ID # • . . 07050260
SITE ADDRESS . . . . . : 10251 WESTERN DR
SUBDIVISION . . . . . .
CITY CUPERTINO
IMPACT AREA . . . . . .
OWNER JOSEPH N BABANEZHAD
ADDRESS . . . . . . . . . .
CITY/STATE/ZIP . . . : CUPERTINO CA, 95014-2944
RECEIVED FROM . . . . : WINGS ROOFING
CONTRACTOR . . . . . . . : CHEA, WING LIC # 21239
COMPANY . . . . . . . . . . : WING'S ROOFING INC
ADDRESS . . . . . . . . . . : 3243 SYDNEY WAY
CITY/STATE/ZIP . . . : COP.STRO VALLEY, CA 94546
TELEPHONE . . . . . . . . : (510) 889-9068
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 6, 950. 00 137.16 0 .00 137. 16 0. 00
BSEISMICRE VALUATION 6, 950 .00 0 .70 0 .00 0 . 70 0. 00
---------- ---------- ---------- ----------
TOTAL PERMIT 137.86 0 .00 137 . 86 0. 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 137.86 VISA
---------------
TOTAL RECEIPT 137.86
CITY OF C"UPERTINO
REROOF
CUP11 EY rINO PERMIT APPLICATION FORM
APN# �� �/) Date:
Building Address:
Owner's Name: t Q Phone#: /r 7167
Contractor: JL_V-01 License#: t3rG3 j 6191(
W r__4�A_f N CL
Contact: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 0 Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
)Q To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read,Understand and Will Comply With Cu)ertino's Tear Off Policy:
f Job Description: ( Tlt) 1,kt 7/ �, d
Residential Commercial E] 6L4_<,
e A
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: U
Cost of Project: Type of Con -tion: Occupa n grT
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