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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
...........,: :.:.:....::..
BUILDING ADDRESS:
ARCHITECT/ENGINEER:
LICENSED CONTRACTOR'S DECLARATION
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
in full force and effect.
License Class Lic. #
Date Contractor
ARCHITECTS DECLARATION
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors 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 arty applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
❑ 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
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.).
I, as Duro of the property, am exclusively contracting with licensed contractors to
tstruct 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.
❑ 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:
have and will maintain a Certificate of Consent to self -insure for Worker's Compen-
_aon, 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:
Cartier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he 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 mannet to the Workers' Compensation
Laws of California. Data
Applicant / e
NOTICE TO AppucATm If, after making this Ccttiffate 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 slate 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, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILLqOMPLY WITH ALL NON -POINT
SOURCE �CrREGULATI� 7 0--r, --sSignature of Applicant/Contractor a Date
HAZARDOUS MATERIALS DISCLOSURE
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)?
❑ Yes eqNo
Will the applicant or future building occupant use equipment or devices which
hazardous air contaminants as defined by the Bay Area Air Quality Management
—Strict?
[3 Yes No
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
docs not currently have a tenant, that i i my responsibility to notify the occupant of the
requirements whicli must be met Poot issuance of a CertiftcaT of Occupancy.
Owner or authorized aecmt Date
Issued by:
Re -roofs
Type of Roof
Sq. Ft. Floor Area
Number
Job Description
Required Inspections
uation
Occupancy
All roofs s-iall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new maerials for inspection.
Signature of Applicant Date
All roof coverings to be Class "B" or better
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILLlIrlo aTs6'AKVILLE AV
OWNER'S �(11 /N�AL�ME:
SHENG LIANG
)NE:
ARCHITECTIENGINEER:
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LICENSED CONTRACTOR'S DECLARATION
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
in full force and ffei
S.
License Class 9 Lic.#
Date — 2 `1 —c 1 Contractorr
ARCHITECTS DECLARATION
1 understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
I hereby affirm that I 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 rile 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 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
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.).
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 Li-
cense Law docs 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 Sea B & P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
] 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 Worker's Compensation Insurance carrier and Policy number are:
Cartier. l 2 6 Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100)
or less.)
I cenif-v 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
1 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 Nam
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 authorim 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, judgments, costs and expenses which may in any way accrue against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
S CE GUL TIONS.
Si nature of Applicut/contrador Dale
HAZARDOUS MATERIALS DISCLOSURE
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)?
0 Yes $No
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
District?
0 Yes 0 No
I have read the hazardous materials requircmcnu under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand thatif the building
not currently have a tenant, that it is my responsibility to notify the occupant of the
reyuMllkk_kn��
which m met prior w issuance of a Certificate of Occupancy.
Z�"
Owneror authorized agent Date
CUPERTINO ROOF, INC
1052 KE-jLY DR
(408)97:3-9427
PERMIT NO.
07050244
PERMIT ISSUE DATE
05/24/2007
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
Job Description
REROOF—T/O SHAKES,INSTALL 1/2 OBS FELT,50 YR—
CLASS
A, 28 SQUARES.
3q. Ft. Floor Area
3 6 913 0 0 3.4g; Number
Issued by:
Re -roofs
Type of R sof
$12000 Valuation
Occupancy Type
Required Inspections
All roofs ;;hall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
alj..i}eyv materials for inspection.
Signature of Applicant Date
All roof coverings to be Class "B" or better
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIT RECEIPT OPERATOR: suew
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ........: 36S13008.00
DATE ISSUED.......: 05/24/2007
RECEIPT #......... BSC00001452
REFERENCE ID # ...: 07C50244
SITE ADDRESS .....: 10440 OAKVILLE AV
SUBDIVISION ......
CITY CUPERTINO
IMPACT AREA ......
OWNER SHENG LIANG
ADDRESS ..........
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-4519
RECEIVED FROM ....: DAVE PRE
CONTRACTOR .......: DAVE SMITH LIC # 25701
COMPANY CUPERTINO ROOF, INC
ADDRESS 10E2 KELLY DR
CITY/STATE/ZIP ...: SAD' JOSE, CA 95129
TELEPHONE (4C8)973-9427
FEE ID UNIT
QUANTITY
;MOUNT PD -TO
-DT
THIS REC
----------
NEW BAL
----------
-----------------------
BPERMFEE VALUATION
----------
12,000.00
--------------------
191.16
0.00
191.16
0.00
BSEISMICRE VALUATION
12,000.00
1.20
----------
0.00
1.20
----------
0.00
----------
TOTAL PERMIT
----------
192.36
0.00
192.36
0.00
METHOD OF PAYMENT
AMOUNT
REFERENCE
NUMBER
----------------- ---------------
CREDIT CARD
192.36
--------------------
M/C
---------------
TOTAL RECEIPT
192.36
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
bl� ; � 9-5 e? --,,? �116
APN # 3 O� '
Bldg Permit Fees
Date: — –
2�
Building Address:
`
Owner's Name: `
BSEISMICRE
Phone #: /
BUILDING
BSEISMICOM
Seismic Commercial
Contractor:
(f u CQ e_4 vv c
BPLANCHK
License #:- ?
J
Contact.
1
BUSLIC
Cupertino Business Lice n e #:
a�2
a..� 2-�z-'
Type of Ri)of Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
� Asphalt Shingles
''-9 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 Cupertino's Tear Off Policy: ❑
Job Description: a� c 5 _h a
Residential] Commercial ❑
Fire Zone: Yes QT -M-5
Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
I P—e 0w— �
zvuv e es,
Qty. if
A licable
Fee ID
Fee Description
Fee Group
pp
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