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10080199 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10398 NORMANDY CT CONTRACTOR:KEVIN SULLIVAN PERMIT NO: 10080199 ROOFING OWNER'S NAME: TERRY JIANG 1696`ALLEY OAKS DR DATE ISSUED:08/27/2010 NER'S PHONE: 4086077688 GILROY,CA 95020 PHONE NO:(408)842-1057 LICENSED CONTRACTOR'S DECLARATION : BLDG 7 f BUILDING PERMIT INFOELECT r PLUMB License Class C 3/ 1 Lic.# �� 7( � MECH r RESIDENTIAL r COMMERCIAL Contractor7 5�J L, Date =� �F JOB DESCRIPTION:RE-ROOF REMOVE EXISTING SHAKES,REPLACE I hereby affirm that I am licensed under the provisions of Chapter 9 Wf"DIANT (commencing with Section 7000)of Division 3 of the Business&Professions BAR]_IER OSB 7/16',#30 FELT,LIFETIME COMP CLASS A Code and that my license is in full force and effect. 30SQ 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 tkis Sq It Floor Area: Valuation:$12000 permit is issued. APPLICANT CERTIFICATION W anc Occu Type: I certify that I have read this application and state that the above information is APT Number:36929024.00 Occupancy YP correct.I agree to comply with all city and county ordinances and state laws relating to building constriction,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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point sou gula' ns per the Cupertino Municipal Code,Section 180 DAYS FROM LAST CALLED INSPECTION. 9.18. Date: Signature Date Z 7 0 Issi ed by: ❑ OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for one of RE-ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material being installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation, inst idled without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, insl ection. Business&Professions Code) Sig nature of Applicant: o��-__� a I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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 HAZARDOUS MATERIALS DISCLOSURE Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Section 3700 of the Labor Code,for the performance of the work for which this Sa ety Code,Section 25532(a)should I store or handle hazardous material. permit is issued. Ac ditionally,should I use equipment or devices which emit hazardous air I certify that in the performance of the work for which this permit is issued,I shall co itaminants 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 mu.intain compliance with the Cupertino Municipal Code,Chapter 9.12 and the Compensation laws of California. If,after making this certificate of exemption,I Hi alth&Safety Code,Sections 25505,25533,and 25534. become subject to the Worker's Compensation provisions of the Labor Code,I must O,vne o forthwith comply with such provisions or this permit shall be deemed revoked. a e: /U APPLICANT CERTIFICATION CONSTRUCTION LENDING AGENCY 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 I 1 ereby affirm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter fo r which this permit is issued(Sec.3097,Civ C.) -n the above mentioned property for inspection purposes.(We)agree to save Lender's Name unify and keep harmless the City of Cupertino against liabilities,judgments, L:nder's Address —sts,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 ARCHITECT'S DECLARATION 9.18. 1 inderstand my plans shall be used as public records. Signature Date Licensed Professional CITY OF 10 CITY OF CU.PERTINO REROOF CUPERTINO PERMIT APPLICATION APN# Date: Vii_2 7-- Building _Building Address: '; �- Owner's Name:�f Phone #: eZ HOA: Yes ❑ No If es ro a letter i'rom A , Contractor: Phone #: C�� r� -10S ;7 Poe(:�� /1,-/ 0 '✓'i n \/6 6 Fax#: Cupertino Business License #: Contractor Lice se #: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles Asphalt Shingles `Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. b Descri tion: � X � �za �nDJ� Z,�c Residential ti - Commercial Green Building: Please complete relevant portio a of the Confirmed with Planning Dept. if Green Building Checklist & attach it to the appl Lcation or if there are any restrictions: applicable, include in plan set & the sheet index. Valuation. i I Have Re , U erstand Will Comply with Cupertino's Tear-Off Policy: Sign re Revised 02/05/09 M.1ndDDr Air uality and Finishes 1.Use+Lawmio-YbCP, afi,4 1 M]Health pts Y-yes 0 2.Use Low VOC,Water--Based Wood Finishes 2 IAYHealth pts y--yes 0 3.:Use Lowes VOC Adhesives 3 lA wealth pts Ayes 1 0 4.Use Salvaged Materials for Interior Finishes 3 R wurce pts Y--yes 0 5.Use Engineered Sheet Goods with no added Urea 0 Formaldehyde 61PiGMealth pts Y--yes 6.Use Exterior Grade Plytr000d for Interior Uses 1 IP GMealth pts; y°Ye 0 7,Bea1 Ml�FF _ 41E GlHealth.- s - es B.Use FSC Certified Materials for Interior Finish 4 Fesource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 F esource pts y=yes 0 10.Install Whole House Vacuum System 314GlHsalth pts Y----Yes 0 1 1 1 N.Flooring 1.Select FSC Certified Wood Flooring B Ro.source pts Y--yes0 2.Use r#3eaekehle FIDDARg MatpnalS 4 R wures pts yeses 0 3.Use Recycled Content Ceramic Tiles 4 R:source pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 U&I-Isalth pts y�yes 0 5.Use Exposed Concrete as Finished Floor 4 R;source pts yeses 0 6.Install Recycled Content Carpet with Low VOCs 4 R:source pts Y--yes 0 Total Points Available: 140 130 57 Total Points Project Received: 0 0 0 r.:data/pMgslgreenbjIdingguidelines/remodeierslgreenpointsfina121P-Mp lecledAs Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Lai Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: PERMIT# OWNER'S NAME: ��r� h PHONE# rICEN% GENERALCONTRACTOR: o-v BUSINESS ADDRESS: CITY/ZIPCODE: < *Our municipal code requires all businesses working in the pity to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INS"ECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONT AC �AVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. 1 am not using any subcontractors: Date Signature Please check applicable subcontractors and complete the following information: T ONTRACTOR BUSINESS NAME BUSINESS LICENSE # ets & Millwork nt Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum/Wood Glass / Glazing Heating Insulation ELandscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date