12100143 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10572 WHITE FIR CT CONTRACI.OR:FOUR SEASONS ROOFING PERMIT NO: 12100143
OWNER'S NAME: WU WEI AND SUN Yl PO/SOX 1668 DA'Z'E ISSUED: 10/1912012
OWNER'S PHONE: 4088737618 SAN JOSE.CA 95109 PHONE NO:(408)275-0330
i
❑ LICENSED CONTRACTOR'S
DECLARATION BUILDING PERMIT INFO: BLDG C ELECT Cl .PLUMB r
License Class Lie.N M
/ '7 /a�U�
—11" ECFI r RESIDENTIAL 171 COMMERCIAL
Contractor Date
I hereby aRrm That I am licensed u d r the provisions of Chapter 9 JOB DESCRIPTION: RE-ROOF,REMOVE SHAKE&INSTALL PLYWOOD AND
(commencing with Section 7000)of Division 3 of the Business& Professions COMP
Code and that my license is in full force and effect. SHINGLES 13 SO CLASS A
hereby affirm under penalty 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 which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of die work.for which this
permit is issued. Sq.Ft Floor Area: Valualion:$4500
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is APN Numher:35905118.00 Occupancy Type:
correct.I agree to comply with all city and county ordinances and state Imus 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(he City ofCupertino against liabilities,judgments, PERMIT EXPIRES IF WORK IS NOT STARTED
costs,and expenses which may accrue against said City in consequence of die
granting of this permit. Additionally,the applicant understands and will comply WITHIN 0 DAYS OF PERMIT ISSUANCE OR
wit . Inon-point source regulations per the Cupertino Municipal Code,Section 180 DAY OM LAST CALLED INSPECTION.
9 8 /)
Date Issue by Date:
/d G
❑ OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for one of RF.-ROOFS:
the following two reasons: All roofs shall be inspected prior to any roofing material beiig installed If a roof is
1,as owner of the property,or my employees with wages as their sole compensation, installed without first obtaining an inspection,1 agree to remove all naw ma crisis for
will do the work,and the swcture is not intended or offered for sale(Sec.7044, inspection.
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors to S more f ppli m: Date.
construct the project(Sec.7044,Business&Professions Code),
hereby affirm under penallyof perjury one of the following three ALL ROOT'COVERINGSTO BE CI..\SS"A"OR RE'I-I'F,R
declarations:
I have and will maintain a Certificate of Consent to self-insure for Worker's HAZARDOUS MATERIALS DISCLOSURE
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued. I have read the hazardous materials requirements under Chapter 6.95 of the
I have and will maintain Worker's Compensation Insurance,as provided for by California llealth&Safety Code.Sections 25505.25533,and 25534. 1 will maintain
Section 3700 of the Labor Code,for the performance of the work for which this compliance with the Cupertino,Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section_553_(a)should I store or handle hazardous material.
permit is issued, Additionally,should 1 use equipment or devices which emit hazardous air
I certify that in the performance of the work forwhich this permit is issued,I shall ermtahnitunts as defined by the Bay Area Air Quality Management District I will
not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cupertino Municipal Code.Chapter 9.12 and the
Compensation laws of California. If,after making this certificate of exemption,I Hcalth&Safen'Code,Sections 15505, 433 d 25534.
become subject to the Worker's Compensation provisions ofthe Labor Code,I must / /n'
forthwith comply with such provisions or this permit shall be deemed revoked r or aully(rizeJ agent• ,�J //_/ 7
ate: V Y /
APPLIC,\\1'CliaPn'1CcfION CONSTRUCTION LENDING AGENCY
I certify that 1 have read[his application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating I hereby,affirm[hat there is a construction lending agency for the perfo mance of work's
to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.)
upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may acerae against said City in consequence of[he Lender's Address
granting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section ARCII ITECI"S DECLARATION
9.18.
1 understand my plans shall be used as public records.
Signature Date
Licensed Professional
( zI () 0 ) `( 3
CITY OF CUPERTINO
FEE ESTIMATOR — BUILDING DIVISION
ADDRESS: rr '� ��!!"�
( O� 2 V� v��L DATE: 10/18/2012 REVIEWED BY: jsg
APN: BP#: VALUATION: $4,500
*PERMIT TYPE: Minor Building Permit PLAN CIIECK TYPE: Re-roof
PRIMARY SFD or Duplex PENTAhIATION 1SFDWLROOF
USE: PERMIT TYPE:
NVORK Reroof, remove shake instal plywood and comp shingles
SCOPE
FEEID ROOFAREA
s.f.
1REROOFFRES 1,300
a
Meth. Plan Check Plumb. Plan Check Elec.Plan Check
Mech. Permit Fee: Plumb.Permit Fec: Elec. Permit Fee:
Other,tlech.Insp. Ll I Oiber Plumb Insp. Other Elco Insp.
.Ylech.Insp.Fee: Plumb. btap. Fee: Elce. bup.Fee.- .
A'OTE:.Tliis estimate does not include fees dee to odter Departments(i.e Planning, Public Works, Fire,Sanitary Server District,School
District,etc). These fees are based on the prelitninan information available and are only an estimate Contact the Dept for addn 7 info.
FEE ITEMS (Fee Resolution 11-053 Eff Z/U12 FEE QTY/FEE MISC ITEMS
Plan Gteck P'ee:
Suppl. PC Fee
PIumb.lkfech./F.lec
Permit Fee: $195.00
Suppl. Insp Fee
P/am h.l.Alec.h.lEl e r.
Plunih./Alech.lElec Permit Fee:
Construction Tax:
Administrative Fee:
Work Without Permit? O Yes (j) No $0.00
Advanced Planning Fees:
Travel Documentation Fees:
i
Strong Motion Fee: 1BSE1SMICR $0.50 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
'SUBT0 TALS:'j $196.50 $0.001 $196.50
Revised: 10/01/2012
I UNDERSTAND AND AGREE TO THE FOLLOWING: — J
riip. mi n Cnlifomia Codes.. - — -- I
RPROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT- BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO.CA 95014.3255
CUPEgTINo (408)777-3228-FAX(4D8)777-3333 • buildingQcrupertino.oLq
PROJECT A 2T APN''rt '/ 15q- 06 '
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CONTACT NAME. PHONEZ E-MAIL
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❑OWNER ❑ OW:\'ERAUILOBk ❑ OWNER AO_'NT J CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENO:NFIRn ❑ nn'.LO?Ek ❑ TENANT
CONTRACTORNAME L!CF.NSEVChIBER LICENSE 1' PE Bus.I.IC.a
e�r_Cgwsnnn 1��-1i _ HZI_P_ a
COMPANY SAME A�E R-NtAII. FAX
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STREET ADDRESS I ❑TY,SLATE 71 P PHONE
502 a o 2 C $'O
ARCHTIEC UENGINEER NAME NJ LICENSE NUMBER BUS.LIC.n
COMPANY NAME C-MAII. ^�- ._ FAR
STREET ADDRESS CITY,STATE,VIP PHONE
us_ OF ❑ SFD or Duplex JC Multi-Family AO0FAREA: VALUATION: AD
,STRUCTL'Rr: ❑ Commercial v _3 S6i__ y on -
EYISTINO ROOF TYPE: ❑BUILT-L'1ROo.1F ❑ASPIIALTSFIINCLES ;w%Vo00ShIAKF.S ❑WOOD SHINE ns ❑OTHFRISPCVCI:_YI
RCMOVEIREACC PLYWOOD J61- ❑ PLYWD ❑OSa PITCH.
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RUOP
F. S ❑ dl" TYP
PRQr059U ROOF TYPE: ❑6CILT-uP ROOF XA$PtLALT SHINGLES LIMOOD q)IA KF.S ❑W000 SHINGLE.$ ❑OTHER ICC-F$REPORT it
DESCRIPTION OF W''ORR:
9r 04exis-in� �ta0c, shn�f e rno� T nc�411 /Z�I G
�ys.�-ae�+ltisrt_3s��e_l-E und.e.cLay-r�►at�-��Ei�all�...�_i.�t.�al1
win
By my si,RiQture below.I certify to ucb nf:he following: I am the property owner or omhnnmd ogcn:to act on;he puppetry owner's bchnlf. I have read this
application and the inforta-Itloo I have provided Lc correct, I hRve and the Dseriptioa of work and verify it is nuumtc I agree to comply with nl1 tpplluble Joel
urdilmrcea and state laws,relining-to building cony+ .Ilon, I a^ orizt repress, tiv^ u:Cupertino to enter IIIc abovt•Idendfied pmpery for inspection purposes.
Sigllenlra of Applican✓Agrn;; �, Dnte:
SUPPLEMEWAI..INFORMATION IiEQUIRFD OFFICE USE ONLY
_ If building is associated with a Home Owncr's ARSOcitil provide leacr PLAN CHECK TYPE ROIAING SLIP
of Rpproval from HOA. ❑ OVER-TH17COUNTER ❑ tilllLaING PLAN A6VILlV
Providc Planning approval to vcrifv if rhLTc on),restrictions. ❑ FaPRT55 ❑ PLAnNIu rLnN'ftEV16W
_ Provide copy ol'Manufnclur_r'z lnslnllntion Spociricatione. CI sanrvn..nn ❑ nar.nrrr
_. Provide Signed copy of Cupertino's TearDrr Policy. ❑ OTIIER:
Nel•onJApp_Z0l l.docrevixed OJ/lG/)1