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06100093Ica :r ZJU i -H 'in cerW< rntU U. U. , V1� :cc -Za :=e C CITE' OF CUPERTINO BUILDING DIVISION PERMITI)RATC) I�R1'TI�N* BUILDING ADDRESS: PRINCIPLE ROOFING & PERMIT NO. 06100093 10881 SANTA TERESA DR OWNER'S NAME: PERMIT L%UE DATE ANNY WU 1700 NORTH SNE: SANITARY No. CONTROL NO. (408)436-1681 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 LICENSED CONTRACTOR'S DECLARATION Job Description I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of Ute Business and Professions Code, and my license is in full force andefect - #T REROOF- TEAR OFF EXISTING, INSTALL SHEATHING & License Claz Lic• ri gl LJ Date Contractor LIGHTWEIGHT CONCRETE TILE. CLASS A ARCHITECTS DECLARATI N 1 understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I 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 a) its issuance, also requires the applicant for such permit to rile a signed statement Sq. Ft. Floor Area Valua$(Jr4 0 0 0 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 APN Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than fire hundred dollars (M). 35615005.00 ❑ I, as owner of the property, or my employees with wages az their sole compensation, ns Required Inspections p 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 q 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 sala.). ❑ 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 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. ❑ 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: ❑ I have and will maintain a Certificate of Consent to self -insure for Worker's Compcn- 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 Workers Compensation Insurance carrier and Policy number are-- re:Carrier. Carrier:`L., 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.) 1 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 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 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, indemnify and keep harmless the City of Cupertino against j liabilities, judgments, costs and expenses which may in any way accrue against said City r in consequence of the granting of this permit. + APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT T Issued by: Date SOURCE REGULATIONS. 32M --_ (dW 06 Re -roofs Type of Roof Signature of ApplicantlContractor 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 Cole, Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑Yes ErNu If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which az d ned by the Bay Area Air Quality Management emit hazardous air contamina;No all new materials for inspection. District? ❑ Yes 1 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 does not currently have a tenant, that it is my responsibility to notify the occupant or the requirements which must be met prior to issuance of a certificate of Occupancy. Signature of Applicant Date to! (1-1 All roof coverings to be Class 'B" or better Owner or auk tharircd agent e�— CITY OF �UPEI�TIN0 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS: PERMIT # OWNER'S NAME: PHONE # J9_ 77 2,q GENERAL CONTRACTOR: - • FAX # Gc,"4";0f7 I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: I (XIzZa6 Owner/ Contractor Signature Date SUBCONTRACTOR BUSINESS 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 I (XIzZa6 Owner/ Contractor Signature Date -!m 1 of 1 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 35615005.00 DATE ISSUED.......: 10/12/2006 RECEIPT #.........: 36419 REFERENCE ID # ...: 06100093 SITE ADDRESS .....: 10881 SANTA TERESA DR SUBDIVISION ....... CITY CUPERTINO IMPACT AREA ....... OWNER ANNY WU ADDRESS .. ........ CITY/STATE/ZIP ...: , OPERATOR: amyw COPY # : 2 RECEIVED FROM ....: PRINCIPLE ROOFING CONTRACTOR DERECK LOI LIC # 27564 COMPANY PRINCIPLE ROOFING & ADDRESS ..........: 1700 NORTH 1ST STREET, #154 CITY/STATE/ZIP ...: SAN JOSE, CA 95112 TELEPHONE ........: (408)436-1681 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC ---------- NEW BAL ---------- ----------------------- BPERMFEE VALUATION ---------- 14,000.00 -------------------- 212.76 0.00 212.76 0.00 BSEISMICRE VALUATION 14,000.00 1.40 0.00 1.40 ---------- 0.00 ---------- TOTAL PERMIT ---------- ---------- 214.16 0.00 214.16 0.00 METHOD OF PAYMENT AMOUNT NUMBER ------------------ ----------------- ------------ OTHER 214.16 MASTERCARD TOTAL RECEIPT 214.16 DLIORZ093 CITY OF CUPERTINO REROOF CITY CUPERTINO PERMIT APPLICATION FORM APN # Bldg Permit Fees Date: 0-4 Building Address: Energy a8$1 re -,",q - ,I. - Owner's Name: BUILDING Phone #: wt�- BUILDING C-i�ad Contractor: 01 BUILDING License #: it ,moi r!4f°. ori �c,- 46/ 63 9 Contact: Cupertino Business License #: D�-r1- Lely' Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑/Asphalt Shingles ❑ Asphalt Shingles l� Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Other (Specify) ❑ Wood Shingles ❑ Other (Specify) 1 ,t A COr�lir '� 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 ertino's Tear Off Policy: LV Job Description: ✓� �1 wow f G � G r� L; ray✓ C�iG�"�`E Residential Commercial ❑ Fire Zone: Yes ❑ No Confirmed with Planning Det. if there are any restrictions: LJ Cost of Project:�� Type of Construction: Occupancy OT 44,006, Cy (� -- Qty. if Annlirnhle Fee TTS Fee Description Fee Group i=ce 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