11070046 CITl OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 10568 LONNA LN CONTRACTOR:ZV CONSTRUCTION INC PERMIT NO: 11070046
OWNER'S NAME: JINGHAI ZHOU 909 SAN RAFAEL AVE DATE ISSUED:07/08/2011
` NER'S PHONE: 4089529439 MOUNTAIN VIEW,CA 94043 PHONE NO:(650)213-6512
LICENSED CONTRACTOR'S DECLARATION JOB DESCRIPTION: RESIDENTIAL 11 COMMERCIALE]
rnse Class 7 Lic.# q5y72 RE-ROOF 23 SQUARES,TEAR OFF,ASPHALT SHINGLES
- ` OSB,CLASS A
r?�
tractoi ( 1D/ Date
I hereby affirm that I 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. Sq.Ft Floor Area: Valuation:$11000
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 f which this APN Number:35919016.00 Occupancy Type:
permit is issued.
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.I agree to comply with all city and county ordinances and state laws relating WITHIT! 7,11 OF PERMIT ISSUANCE OR
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DA ST CALLED INSPECTIO .
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 Issued by: Date:
with all n n-point source regulations per the Cupertino Municipal Code,Section
9.18.
RE-ROOFS:
All roofs shall be inspected prior to any roofing material being installed.If a roof is
Signature Date
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
NER-BUILDER DECLARATION 7'�al I
I hereby affirm that I am exempt from the Contractor's License Law for one of Signature of Applicant: Date:
the following two reasons: ALL ROOF CO INGS TO BE CLASS"A"OR BETTER
1,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)
1,as owner of the property,am exclusively contracting with licensed contractors to HAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&Safety Code,Sections 25505,25533,and 25534. I will
I hereby affirm under penalty of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Health&Safety Code,Section 25532(a)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Bay Area Air Quality Management District I
performance of the work for which this permit is issued. will maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health&Safety Code,Sections 25505,25533,and 25534. i
Section 3700 of the Labor Code,for the performance of the work for which this Owner or authorized agent Date: (/
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 CONSTRU ION LENDING AGENCY
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 I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this permit shall be deemed revoked. work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICANT CERTIFICATION Lender's Address
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 ARCHITECT'S DECLARATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
ting of this permit.Additionally,the applicant understands and will comply
with all non-point source regulations per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: SylviaM
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . . 35919016 . 00
DATE ISSUED. . . . . . . : 07/08/2011
RECEIPT #. . . . . . . . . : BS000013996
REFERENCE ID # . . . : 11070046
SITE ADDRESS . . . . . : 10568 LONNA LN
SUBDIVISION . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : JINGHAI ZHOU
ADDRESS . . . . . . . . . . : 10568 LONNA LN
CITY/STATE/ZIP . . . : CUPERTINO, CA 95014
RECEIVED FROM . . . . : ZV CONSTRUCTION
CONTRACTOR . . . . . . . : JIAYING HOU LIC # 32533
COMPANY . . . . . . . . . . : ZV CONSTRUCTION INC
ADDRESS . . . . . . . . . . : 909 SAN RAFAEL AVE
CITY/STATE/ZIP . . . : MOUNTAIN VIEW, CA 94043
TELEPHONE . . . . . . . . : (650) 213-6512
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 11, 000 . 00 1. 00 0 . 00 1 . 00 0. 00
1BSEISMICR VALUATION 11, 000 . 00 1. 10 0 . 00 1. 10 0 . 00
1REROOFRES SQ FEET 23 . 00 322 . 00 0 . 00 322 . 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 324 . 10 0 . 00 324 . 10 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 324 . 10 visa
---------------
TOTAL RECEIPT 324 . 10
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
309 EXTERIOR LATH 311 SCRATCH COAT
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF CUPERTINO
FEE ESTIMATOR-BUILDING DIVISION
ADDRESS: 10568 Lonna Lane DATE: 07/08/2011 REVIEWED BY: BG
APN: BP#: "VALUATION: $11,000
rPERMIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof
PRIMARY SFD or Duplex lex PENTAMATION 1 SFDWLROOF
USE: PERMIT TYPE:
WORK
SCOPE
FEE ID ROOF AREA
s.f.
1REROOFFRES 2,300
Lj
NOTE. These fees are based on the preliminary information available and are only an estimate. Contact the De t or addn'1 info.
FEE ITEMS (Fee Resolution 11-0531 tf.' 1.-I1) FEE QTY/FEE MISC ITEMS
Permit Fee: $322.00
Work Without Permit? 0 Yes E) No $0.00
i
Strong]Motion Fee: IBSEISMICR $1.10 Select an Administrative Item
Bldg Stds Commission Fee: IBCBSC $1.00
SUBTOTALS: $324.10 $0.00 TOTAL FEE: $324.10
Revised: 07/01/2011
REROOF PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228• FAX(408)777-3333 • buildingacupertino.org
PROJECT ADDRESS �1/�'L e 1 f1 w'� LL L� �I APN# 2S q q
OWNER NAME -T'^,&-A
� /L-� a �R A PHONE 41q ?S-2 2 E MAIL
STREET ADDRESS 'v 7C GT(J(J� CITY, STATE,ZIP J FAX
APPLICANT NAME FA/'J ! PH NE �3 sr Z EMAIL
1� ly
�SrC :
STREET ADDRESS ,\ n CITY,STATE,ZIP' A) ,(� Z-1FAX
❑OWNER ❑ OWNER-BUILDER ❑ OWNER AGENT ''CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT ❑ENGINEER ❑ DEVELOPER ❑TENANT
CONTRACTOR NAME / t A L C s SE NUMBER y-� LICENSE TYPE BUS.LIC.# _
CTI
COMPANY NAME W` CSE-MAIL (� FAX 6,!�)%-7 2 1_7Z
STREET ADDRESS v'J r, GO- CITY,STATE,ZIP y�N �� L(�� ` (]�Q � PHONE/' � 19f
ARCHITECT/ENGINEEVRNAME LICENSE NUMBER I(/,( `J `�}+ ` BUS.LIC.
J
COMPANY NAME E-MAIL FAX
yes
STREET ADDRESSI:�,7 6 e�;6 CITY,STATE,ZIP b C ' PHONE
USE OF �SFD or Duplex�j�El Multi-Family ROOF AREA: VALUATION:
STRUCTURE: ❑
Commercial -2:7,,,o Silk ,
EXISTING ROOF TYPE: ❑BUILT-UP ROOF `ASPHALT sHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER(SPECIFY)
REMOVE/REPLACE)46S IF NO, PLYWOOD ❑ Y" ❑ PLYWD "ISB PITCH: ROOF
El NO #LAYERS. THICKNESS: TYPE: ❑ CDX •12 CLASS: A
ICC-ES REPORT#
PROPOSED ROOF TYPE: ❑BUILT-UP ROOF KASPHALT SHINGLES ❑WOOD SHAKES ❑WOOD SHINGLES ❑OTHER
DESCRIPTION OF WORK:
4?-K
By my signature below,I certify to each of the following: I am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information have provided is correct. I have read the Description of Work and verify it is accurate. I agree to comply with all applicable local
ordinances and state laws relating to ing construction. I authorize representatives of Cupertino tc enter the above-identified property for inspection purposes.
Signature of Applicant/Agent: Date:
SUPPLEMENTAL TION REQUIRED - �o�ICEIiSECsNr�Y
If building is associated with a Home Owner's Association,provide letter c> czc TYPE F ~_xouTnlc sL7P `
of approval from HOA. ❑ (}vER'THE CfIIIN 1 ZER' ❑ BUII DING PLALV REVIEW
_Provide Planning approval to verify if there any restrictions. ELANNWGPLAN RW
EVIE
_Provide copy of Manufacturer's Installation Specifications. j� sTAxDxtD - ❑TD1 PT
_Provide signed copy of Cupertino's Tear-Off Policy. ❑`rozHER•e
ReroofApp_2011.doc revised 03/02/11