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12120059CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7960 SUNDERLAND DR I CONTRACTOR: BAY 101 ROOFING PERMIT NO: 12120059 OWNER'S NAME: ISHISAKA KURT Y AND TAN XIAODONG OWNER'S PHONE: 4083400488 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lie.# Contractor Date I hereby affirm that 1 am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business & Professions Code and that my license is in full force and effect. I 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. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. APPLICANT CERTIFICATION I certify that I 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 liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature. Date ❑ OWNER- BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of the following two reasons: 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 & Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.7044, Business & Professions Code). I hereby affirm under penalty of perjury one of the following three 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. I have and will maintain Worker's Compensation Insurance, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 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 Worker's Compensation laws of California. If, after making this certificate of exemption, I become subject to the Worker's Compensation provisions of the Labor Code, I must forthwith comply with such provisions or this permit shall be deemed revoked. APPLICANT CERTIFICATION I certify that I 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 liabilities, judgments, costs, and expenses which may accrue against said City in consequence of the granting of this permit. Additionally, the applicant understands and will comply with all non -point source regulations per the Cupertino Municipal Code, Section 9.18. Signature Date PO BOX 925 ALVISO, CA 95002 DATE ISSUED: 12/12/2012 PHONE NO: (408) 957 -0531 BUILDING PERMIT INFO: BLDG F ELECT r PLUMB r MECH f— RESIDENTIAL r- COMMERCIAL r JOB DESCRIPTION: REMOVE EXISTING ROOF, INSTALL 30SQ Sq. Ft Floor Area: 0 1 Valuation: $9000 APN Number: 36211038.00 1 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 180 DAYS FROM LAST CALLED INSPECTION. Issued by: Date: RE- ROOFS: All roofs shall 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 materials for inspection. Signature of Appl Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I have read the hazardous materials requirements under Chapter 6.95 of the California Health & Safety Code, Sections 25505, 25533, and 25534. I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Section 25532(a) should I store or handle hazardous material. Additionally, should I use equipment or devices which emit hazardous air contaminants as defined by the Bay Area Air Quality Management District I will maintain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Owner or authorized agent: Date: CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of work's for which this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I understand my plans shall be used as public records. Licensed Professiona t7960 TY OF CUPERTINO y/'v � "' BUILDING DIVISION PE kVoL\� �� '1ZN��:"y�� "'« Mf .rte !DING ADDRESS: PERMIT NCO 4 12 0 0 0 CJ SUNDERLAND DRER'S NAME: PERMIT ISSUE DATE JAE-PYO HONG 01 2004 NE: SANITARY N0. CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH �oo LICENSED CONTRACTOR'S DECLARATION Job Description M 1 thereby affirm Nes 1 em Ilmnsde cd under provisions m of Chapter 9(comanuing n� with Section7000)of Division 3 of the Business and Profataiurn Code,and my licence I.fun tome and affect. 7 ' FENCE SVi ts, Licensee Class Lie.0 . . n F Dau Contractor ARCHITECrS DECLARATION �i 1 understand my plans shall W used ss public records jct9 LiccnsctlPna(maional i O Io OWNER-BUILDER DECLARATION I hereby,fens n I am exemptItem he C License law for the following meson.(Section 7031.5.Business and profeesion,Code: Any tiny or county $ which requires a issuance,also re mnswa,altar,improsm,demolish,t nr repair any ttrumum $4500 w pnormiulensedPaluantto the the ovisio applicant forsuch the Connermilmfileasigned Law(Chmmenl �Z< Natheeccensed Pursue.to the provisions;of the eBass hLimnsclaw(C Coda) Sq.Ft.Floor Area Valuation (co��$ Bud he Indng withtherefrom asud afn basis for o. .tag i andexempt on.Any Code)or Nat he a exempt therefrom a n or base for be alleged to Any vlolauon of S.Iona 1031.5 w airy red dons Ito a permit abbjeeu Ne applicanto a null penalty of s Occupancy Type not mom Nan fisc hundred dollen($50(r). [T L as owner of the property,or my employees with wages u their able compensation, will do the work.and to structure is not intended oraRered foraeie(Sm.7054,Beat" Required Inspections and Profusslmu Cade:The Contractor's License Law don not apply to an owner of q P property who yces,pd bvided arcum Wa suth I m ro nd who doaaot th work or of e ed through rmle his awnem,the Wilding ip ing or j Nu such improvements art not ear oft car offered for sateen, Milder the buildinguimprovementis toldwithin one Xu of mmpkuon,Neovensof Milder will have the burden of proving Nu he did not Wild or improve for purpose of ... vu.l. 1,as owner of the properly,am exclusively contracting with licensed con secmra to ' eonsttmt dre pmjem(sec.7044,Business,and Professions Code)The Conuumr't U. e law dens not apply loan with a of property who Wilda m improv thereon,ad, 3 contracts such pmkcu wlNacontrwmKq licensed remains to Ne Conmctor's / nY JW. O 1 ase tondo sec .B&PCfor this r Dam WORKER' COMPENSATI RATION 1 hereby afflrm under penalty or perjury,one of tie following decimations: 2I hareend will maintains CeNfimmof Conce,to self-inswefoWmkm'sCompen- tion,u provided for by Secdon 3700 of the Labor Code,for the performance of tic work for which this permit is issued. ❑I have and will maintain Worker's Compensation In ursnce,as required by section 3700 of the Labor Code.for the performance of the wok for which Nu permit Is broad. My Worker's Compensation Insurance carrier and Policy number tie: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' _ COMPENSATION INSURANCE (the ammm card not Wcomplebd Bthe permit isfoone hundred dollars($100) or baa.) 1 cattily Not in the performance of to wart for which this Permit is issoad.l shell not -- employ any person In any manner an u m become subject o the Worker?Campensatian Laws of California Dau Applicant NOTICE TO APPLICANP.If.after making this Certificate of Exemption,you should hmme suhjmt in the Worker',Compounders provisions of dte Ichor Code,you must .,O forthwith comply with such Provisions or Ndeemed is pc,mit,h.li W rnm1had. q y CONSTRUCTION LENDING AGENCY E..t Ihereby affirm that there les construninn lending agency for the Performance of gSa' the work for which this permit is issued(Sec.3091 Civ.C.) a0 L bderl Name z Urbler's Address V Q I certify that 1 have read this application and state that the above Information is ta.E .neat.1 agree to comply with all city and county on inantts and sou laws relating in C) building construction,and hereby authorize representatives of this city to enter upon the III shovcmartumed Property for inspecuon purposes G (We)agree to an,indemnify and keep harmless the City of Cupertino against I,, liabilities judgments,costs and eapensea which may In any way ammo,against said City V 7 Inconsequent of the granting afthis permit. t1— AP? CA UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date. S RCE I ULATIONS. /3 /_ 1 (/ Re-roofs O 1 nature ren Contract �sD t HAZARDOUS MATERIALS DISCLOSURE Type of Roof " Will the applicant or rustic building mcupantstoe or hartdNhmnlous mnend as dcMed by the Cupertino Municipal Code.Chapter 9.13,and the Health and safety Code.Section 25532(+)? All roofs shall be inspected prior to any roofing material being installed. ❑Yea 0 N Will the applicant or future building occupant use equipment or deWcas which If a roof is installed without first obtaining an inspection,I agree to remove croft havudnus air contaminants as defined by the Day Area Air Quality Management all new materials for inspection. District? ,y, ❑Yost ttw. I have mad the hazudms materials requirements under Chapter6.95 of the Califor" rte Health,4S rely Code.Scmau 25X15.25533 and 75334.1 understand that if the Wilding docs trot c tly haw a unapt Net it"m my reaponsihility m notify Nc accupabt of dw requitcmc ichbmuWmdpdortoiswumedfaCmificasel Ge . Signature of Applicant Date (2-77o na ora 'area,sent Dam All roof coverings to be Class"B"or better CD nr p 2004 BY: l Alp Ila nd It is n ' onplansachall.nt+nca°r aRa� 'job (awfulte�Z oU� Wcl'� , ern®� cap h�Rtht!t Dar ehC?` `�and spsc+�ba ac$ �11 — 11� �11` `!�t �S1 dOt1 � � O .1111.1; sit•`�`, (:1�� "..t.UH 1 �� 1a'�_. (�.� � t � ` o I Q FENCE APPROVAL 71HE EIUFD CITY OF CUP�I�T�NO 1 Wr� Community Development Department 10 ."a Ave Cupettino, CA 95)14 (408) 777-330 (DATE) I am an adjoining property owner of SAE PYC) 1106 J6 (NAME) • whose property is located at 7960 5b0[E LJOij) 912 CUPL Ohl(.) (ADDRESS) I approve (as per Ordinance No. 686, Section 16.28.040 of the Cupertino Municipal Code) the allowance of a foot high fence facing (8 FT. MAXIMUM) my property. SIGNED: NAME: KA Q KO K. F1J KJCI ADDRESS: 7868 5L)Q P&rL/ ) PiZ CiJPdqqr/k.�-j 0JrEf\T1QQ CI 5014- V FENCE APPROVAL CITY Of CUPEk INO Community Development Department 10300 Torre Avenue —ortinp�y�3�� (4118) 777-3301 DEC 2004 BY: � y I am an adjoining property owner of s0.e, (NAME) whose property is located at 1`� 0 5y r(io ar • (ADDRESS) I approve (as per Ordinance No. 686, Section 16.28.040 of the Cupertino Municipal Code) the allowance of a foot high fence .facing (8 FT. MAXIMUM) my property. Q/JLU A 1 iNl�C I-L �a SIGNED: NAME: NAME: VV ADDRESS: • OCITY OF CUPERTINO♦ cuPEi�F PERMIT APPLICATION FORM c4 ( 2cz' �'S' APN # Date: Building Address: Mailing Address (if different from building address): S rde,- c.h A-we Owner's Name: Phone#: Contractor: License#: T" Contact: Phone: Cupertino Business License#: Fax: Build' Permit Info: Bld ❑ lect Plumb ❑ Mech ❑ Job Description: Residential ❑ 0 Commercial ❑ Sq It. Floor Area: $/Sq.Ft.: ` Cost of Project: tz Occup cy Group- ype of Constructioni Pleaseb eck this bo a project is a second-sto ition: ❑ Project Size: Standard ❑ Laze ❑ Major ❑ Quantity Fee ID Fee Description Fee Group BAPPLOTHER Other Appliances MECHANICAL BBOILERI Boiler<= 100,000 Btu MECHANICAL BBOILER2 Boiler> 100K to 500K Btu MECHANICAL BBOILER3 Boiler> 500K to 1M Btu MECHANICAL BBOILER4 Boiler> IM to 1.75 M Btu MECHANICAL _ BBOILER5 Boiler> 1.75M Btu MECHANICAL BCONSTAX Construction Tax BUILDING BCONSTAX Ind/Off/Comm/Quasi BUILDING BCONSTAXBQ Con. Tax for BQ Zone BUILDING BCONSTAXH Hotel and Motel BUILDING .- BCONSTAXR Constax—Resi/Mobile BUILDING BELEC1000 Elec 600V<= 1000A ELECTRICAL BELEC1001 Elec 600V> 1000A ELECTRICAL n BELEC200 Elec Svcs 600V<= 200A ELECTRICAL BENERGY Energy BUILDING BENERGYADD Energy Add Multi BUILDING BINVESTIGA Investigation fee BUILDING o � 1 of 3 I ` �- WITY OF CUPERTIN00 CUPEI�TINO PERMIT APPLICATION FORM QuantityFee ID Fee Description Fee Group BMISCELL Miscellaneous Fee BUILDING BMITIGATC Comm. Housing Mit. Fee BUILDING BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BOVERTIME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Re i e Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinklerBackflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water Heater/Vent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 cfrn MECHANICAL BREMATRHAN A/C Units <= 10,000 cfin MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Fumace MECHANICAL _ BREMFURNOV Relo Fumace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Device/Apparatus ELECTRICAL BREMRECEPT Rc tl Switch & Outlets ELECTRICAL BREMRELOCA Relocation of Hood MECHANICAL BREMREPALT Repair/Alter Heating MECHANICAL BREMRESAPP Remodel Res Ap Hance ELECTRICAL 2 of 3 airall WITY OF CUPERTINO* CUP EI�TINO PERMIT APPLICATION FORM uantity Fee ID Fee Description Fee Group BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL BREMSIGNS Remodel Signs, Marquee ELECTRICAL BREMTHEATR Theatrical Lighting Fix ELECTRICAL BREMVENFAN Vent Fan Single Duct MECHANICAL BREMVENSYS Ventilation Systems MECHANICAL BSCBLVD Scb Specific Plan BUILDING BSEISMICOM Seismic Commercial BUILDING BSEISMICRE Seismic Fee Res BUILDING BSPECIAL Special Inection BUILDING BSWIN4 Swimming Pool BUILDING BTEMP Temporary Power ELECTRICAL BTEMPPERM Temporary Bldg Permit BUILDING BTEMPSVCS Temp Dist Svcs ELECTRICAL BUSLIC Business License BUILDING ELECTRIC Electrical sq foot ELECTRICAL EPERMITFEE Elec Permit Issuance ELECTRICAL _ MPERMFEE Mechanicals . foot _ MECHANICAL MPERMITFEE Mecb Permit Issuance MECHANICAL PPERMITFEE Plumbing Permit Issue PLUMBING PPLBG Plumbing Fee ig foot PLUMBING ZADDCHG _ Address Chane BUILDING i 3 of 3