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10070196 . CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10420 PINEVILLE AVE CONTRACTOR:WOODS ROOFING PERMIT NO: 10070196 OWNER'S NAME: JING ZHANG 17700 SERENE DR DATE ISSUED:07/29/2010 � 1ER'S PHONE: 4084461985 MORGAN HILL,CA 95037 PHONE NO:(831)637-5576 LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG[_ ELECT I— PLUMB r License Class 643� 13 Lie.# 3� 5-f 3 1 MECH F RESIDENTIAL[_ COMMERCIAL Contractor+ylA9l�t-*t C, ho'- Date JOB DESCRIPTION:RE-ROOF REMOVE SHAKE ROOF&INSTALL 30#PAPER, I hereby affirm that I am licensed under the provisions of Chapter 9 40YR ASPHALT SHINGLES CLASS A 25 1/2SQ (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 Sq.Ft Floor Area: Valuation:$13256 Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. *r APN Number:36913040.00 Occupancy Type: APPLICANT CERTIFICATION /JJ 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 PERMIT EXPIRES IF WORK IS NOT STARTED upon the above mentioned property for inspection purposes. (We)agree to save indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the 180 DAYS FROM LAST CALLED INSPECTION. granting of this permit. Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section G� Go Issue Date: ?,2 ' 9.18. y: Signatu Date ❑ OWNER-BUILDER DECLARATION RE-ROOFS: All roofs shall be inspected prior to any roofing material being installed.If a roof is I hereby affirm that I am exempt from the Contractor's License Law for one of installed without first obtaining an inspection,I agree to remove all new materials for the following two reasons: inspection. I,as owner of the property,or my employees with wages as their sole compensatior,, will do the work,and the structure is not intended or offered for sale(Sec.7044, Signa A Ap licant: Date: ure Business&Professions Code) 1,as owner of the property,am exclusively contracting with licensed contractors to ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three HAZARDOUS MATERIALS DISCLOSURE declarations: I have and will maintain a Certificate of Consent to self-insure for Worker's I have read the hazardous materials requirements under Chapter 6.95 of the Compensation,as provided for by Section 3700 of the Labor Code,for 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& performance of the work for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as provided for by Safety Code,Section 25532(a)should I store or handle hazardous material. Additionally,should I use equipment or devices which emit hazardous air Section 3700 of the Labor Code,for the performance of the work for which this contaminants as defined by the Bay Area Air Quality Management District I will permit is issued. maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the I certify that in the performance of the work for which this permit is issued,I shall Health&Safety Code,Sections 25505,25533,and 25534. 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 ne r authorized a ent: Dater '9-/d become subject to the Worker's Compensation provisions of the Labor Code,I mu 3t �"`�' forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I hereby affirm that there is a construction lending agency for the performance of work's I certify that I have read this application and state that the above information is for which this permit is issued(Sec.3097,Civ C.) correct.I agree to comply with all city and county ordinances and state laws relating Lender's Name to building construction,and hereby authorize representatives of this city to enter unnn the above mentioned property for inspection purposes.(We)agree to save Lender's Address nnify and keep harmless the City of Cupertino against liabilities,judgments, ._s,and expenses which may accrue against said City in consequence of the ARCHITECT'S DECLARATION granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section I understand my plans shall be used as public records. 9.18. Licensed Professional Signature Date CITY OF CUPERTINO 2 ITEMS OF 4 PERMIT RECEIPT OPERATOR: patg COPY # 1 Sec: Twp: Rng: Sub: B]k: Lot: APN . . . . . . . . : 3E913040 . 00 DATE ISSUED. . . . . . . : 0"'/29/2010 RECEIPT #. . . . . . . . . BS000011019 REFERENCE ID # . . • 10070196 SITE ADDRESS . . . . . : 10420 PINEVILLE AVE SUBDIVISION . . . . . . . CITY CUPERTINO IMPACT AREA . . . . . . OWNER J=:NG ZHANG ADDRESS 10420 PINEVILLE AVE CITY/STATE/ZIP . . . : CUPERTINO, CA 95014 RECEIVED FROM . . . . : LjkWRENCE WOOD CONTRACTOR . . . . . . . : WOOD, LAWRENCE E LIC # 20810 COMPANY WOODS ROOFING ADDRESS . . . . . . . . . . : 1'7700 SERENE DR CITY/STATE/ZIP . . . : MORGAN HILL, CA 95037 TELEPHONE . . . . . . . . : (831) 637-5576 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL ----------- ------------- ---------- ---------- ---------- ---------- ---------- 1BCBSC VALUATION 13, 256. 00 1 .00 0 . 00 1. 00 0 . 00 1REROOFRES SQ FEET 26 . 00 338 .00 0. 00 338 . 00 0 .00 ---------- ---------- ---------- ---------- TOTAL PERMIT 339 .00 0 .00 339. 00 0 . 00 METHOD OF PAYMENT AMOUNT REFERENCE NUMBER ----------------- --------------- -------------------- CREDIT CARD 535 .00 VISA --------------- TOTAL RECEIPT 535 . 00 VOICE ID DESCRIPTION VOICE ID DESCRIPTION -------- --------------------------- - -------- ---------------------------- 601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL 604 ROOF IN-PROGRESS 605 FINAL REROOF CITY OF CUPERTINO FEE ESTIMATOR - BUILDING DIVISION ADDRESS: I DATE: REVIEWED BY: APN: BP#: "VALUATION: $13,256 *PERMIT TYPE: Minor Building Permit PL i.N CHECK TYPE: Re-roof PRIMARY TOTAL APPLICATION OLREROOF USE: SFD or Duplex ROOF AREA: 2,600 S f TYPE: All xW OO 3 � F EE ID 1RERDOFFRES 7E± F-T-1 _j NOTE: These fees are based on the preliminatrTy in ormatior available and are only an estimate. Contact the Dept for addn'1 info. 7FEE ITEMS (Fee Resohttion 09-051 Eff' 77/1`09) FEE QTY/FEE MISC ITEMS Permit Fee: $3:38.00 ' z z Work Without Permit? Yes (F) No $0.00 Strong Motion Fee: 1BSEISMICR $1.33 1.0 hrs Standard Hourly Rate Bldg Stds Commission Fee: IBCBSC $1.00 $126.00 SUBTOTALS: $340.33 $126.00 TOTAL FEE: $466.33 Revised: 7/27/2010 CITY OF CITY OF 11UPERTINO RKROOF CUPERTINO PERMIT APPLICATION APN# Date: Building Address: Owner's Name: ,�'i,v6 z lg�� Phone #: HOA: Yes ❑ No [ If yes, provide letter from HOA Contractor: Phone #: 4/o yo -a 8'a 3 L11�96P FS I� ��IvG /�� Fax#: * V -,7?c - Cupertino Business License #: Contractor License #: 3;?-5-- 131 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles j4 Asphalt Shingles I Wood Shakes o Wood Shakes ❑ Wood Shingles o Wood Shingles o Other(Specify) o Other (Specify) Number of existing coverings o Provide I.C.C.E.S. Report# ,kr To be Removed ❑ Provide Mfgr. Installation Specs. Job Description. c ins v SAkr, ,Q��'' S 7-4 jL_ .�51►i�/.� !� �' ��J'r ov G �C,c:' ,� .�- �� c' Residential Commercial Green Building: Please complete relevant portion of the Confirmed with-Planning Dept. if Green Building Checklist & attach it to the application or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation: I Have Read, Understand and Will Comply with Cupertino's Tear-Off Policy: Signature Revised 02/05/09 M.Indoor Air Quality and Finishes W 7 1 IAQ/Health pts y--yes D �. 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y--yea. p 3 IAQ/Health pts yeses p 4.Use Salvaged Materials for Interior Finishes 3 Resource pts yeses D 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y--yes p 6.Use Exterior Grade Plywood.for Interior Uses 1 IAQ/Health pts y--yes p _. 41AQ/Health pts yeses p B.Use FSC Certified Materials for Iriterior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y--yes D 10.Install Whole House Vacuum System 3 IAQ/Health pts y--yes p ' 1 ! 1 N.Flooring 1.Select FSC Certified Wood Flooring_ B Resource pts y=yes 0 - - — 2 ilsa3 4 Resource pts y--yes 0 3.Use Recycled Content Ceramic Tiles 4 Resource pts y--yes 0 4.Install Natural Linoleum in Place of Vinyl .5 IAQ/Health pts y=yes p 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes D 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y--yes 0 Total Points Available: 1401 1301--- 57 Total Points Project Received: 1 01 or 0 t7 � G:date/prngefg eenbuild'ingguidelines/remodelerslgreenpointsfina1212D4protecfedxls Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: fO a p Ar, '0- 'tom' PERMIT# OWNER'S NAME:,-J-/ 6 -- 1 — PHONE# - —O o GENERAL CONTRACTOR: _A, BUSINESS LICENSE ADDRESS: / `> 7ocv S t> CITY/ZIPCODE: 4 P *Our municipal code requires all businesses working iii the city to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILL BE SCHEDULED UNTIL THE GENERAL CONTRACTOR AND ALL SUBCONTRACTORS HAVE OBTAINED A CITY OF CUPERTINO BUSINESS LICENSE. I am not using any subcontractors. d Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINE SS NAME BUSINESS LICENSE # Cabinets & Millwork Cement Finishing Electrical Excavation Fencing Flooring/ Carpeting Linoleum/Wood Glass/Glazing Heating Insulation Landscaping Lathing Masonry Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date