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10060161 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 7491 KINGSBURY PL E2909 TRACTOR:CD ROOFING PERMIT NO: 10060161 OWNER'S NAME: YONG CHEN J✓ILBUR AVE DATE ISSUED:06/25/2010 jWNER'S PHONE: 4083639788 SAN LOSE,CA 95127 PHONE NO:(408)898-6605 JOB DESCRIPTION: RESIDENTIAL� COMMERCIAL 1A LICENSED CONTRACTOR'S DECLARATION OSB TEAR RE.ROOF OVERLAY 1X6 NO PLYWOOD OR License Class L.3� Lic.# � � 0 � � 9 OFF�. Contractor c3> Loo+_' Date J SHINGLE AND REPLACE WITH NEW CLASS A 20 SQUARES I hereby affirm that I am licensed under the provisions of Chapter 9 Q (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 S ;t Floor Area: Valuation:$4500 performance of the work for which this permit is issued. q 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 APP i Number:36229023.00 Occupancy Type: permit is issued. T APPLICANT CERTIFICATION PERMIT EXPIRES IF WORK IS NOT STARTED I certify that I have read this application and state that the above information is WITHIN 180 DAYS OF PERMIT ISSUANCE OR 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 spCupertino agatioose liabilities judgments, 180 DAYS FROM LAST CALLED INSPECTION indemnify and keep harmless the Clof City costs,and expenses which may accrue against said City in consequence of the Iss ied by: Date: 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. RE-ROOFS: Signature Date (� All roofs shall be inspected prior to any roofing material being installed.If a roof is ins alled without first obtaining an inspection,I agree to remove all new materials for ins)ection. OWNER-BUILDER DECLARATION �/J _Date: J9 44 ❑ ' Sil nature of Applicant: T ( ��^ I hereby affirm that I am exempt from the Contractor's License Law for one of ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER 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) HAZARDOUS MATERIALS DISCLOSURE I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). I Lave read the hazardous materials requirements under Chapter 6.95 of the C;difornia Health&Safety Code,Sections 25505,25533,and 25534. I will I hereby affirm under penalty of perjury one of the following three in rintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the declarations: H:alth&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 w Ilcontaminants comp)a ce with the Cupertino as defined by the Bay Area it Qu alipal, Code,Chapter Management District I performance of the work for which this permit is issued. tt a Health&Safety Code,Sections 25505,25533,and 25534. I have and will maintain Worker's Compensation Insurance,as provided for by 2 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 CONSTRUCTION LE NG 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 v herebork'y awhich thithat s permit isoss ere is a truction(Sec 130917,C venc for the performance of forthwith comply with such provisions or this permit shall be deemed revoked. bender's Name APPLICANT CERTIFICATION bender'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 non the above mentioned property for inspection purposes.(We)agree to save ARCHITECT'S DECLARATION emnify and keep harmless the City of Cupertino against liabilities,judgments, �,osts,and expenses which may accrue against said City in consequence of the 1 understand my plans shall be used as public records. granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section .icensed Professional 9.18. Signature Date Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 C U P E RT I N O Fax: 408-777-3333 CONTRACTOR / SUBCONTRACTOR LIST JOB ADDRESS: 9 1 i w S V cZy �' �- PERMIT# WOO OWNER'S NAME: PHONE # -4- c'y 8'` y ` 2- GENERAL CONTRACTOR: -H v tv G- o o +_ j ti BUSINESS LICENSE# ADDRESS: ( C F T v c S CITY/ZIPCODE: *Our municipal code requires all businesses working in the cit,, to have a City of Cupertino business license. NO BUILDING FINAL OR FINAL OCCUPANCY INSPECTION(S) WILLBE AHEDU ED UNTILCUPERTINTHE GENERAL CONTRACTOR AND ALL SUBCONTRACTO ZS HAVE OBTAINED BUSINESS LICENSE. Z U 1 / o I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: SUBCONTRACTOR BUSINESS 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 CITY OF CITY OF CUPERTINO REROOF PERMIT APPLICATION CUPERTIIvo APN# Cl Building Address: f VQ �' L Phone #: Owner's Name: y,) ry C- C-f-I n/ �� - X03 - .57 HOA: Yes ❑ No +© If es, rovide letter from HOA Phone #: 4 2- Contractor: Contractor: L_ D _ Fax#: i tom-Kr'F ° '� N Contractor License #: Cupertino Business License #: 6' S �( Type of Roof Covering: Proposed: Existing: ❑ Built-Up roof ❑ Built-Up Roof gi, Asphalt Shingles Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) ❑ Provide I.C.C.E.S. Report# Number of existing coverings ❑ Provide Mfgr. InAallation Specs. ❑ To be Removed S Job Description: _ Commercial ❑ Residential [:J1 Conf rmed with Planning Dept. if Green Building: Please complete relevant he wl c of tat on or if there are any restrictions: El Green Building Checklist & attach it appl a licable, include in plan set & the sheet index. Valuation: I Have Read, Understand and Will Comply with Cu)ertino's Tear-Off Policy: Signature Revised 02/05/09 CITY OF CITY OF CUPERTINO REROC,F , , , FEE SCHEDULE CUPNumber of Fee ID Fee Deseriptio'a Permit Type p Squares 1REROOFCOM Re-roof CommercialJIB 1COMMLROOF 1BCBSC Cal Bldg Standards ALL PERMIT TYPES Commission Fe(; 1BSEISMICO Seismic Commcrcial B 1RER00FRES Re-roof Residential B 1SFDWLROOF 1BCBSC Cal Bldg Stand Ards B ALL PERMIT TYPES Commission FE:e 1BSEISMICRE Seismic Residential B 1REROOFNIRES Re-roof Multi-Family B 1MFDWLROOF 1BCBSC Cal Bldg Standards B ALL PERMIT TYPES Commission F-.e 1BSEISMICRE Seismic Resid�;ntial B 1BUSLIC Business License I B CITY OF CUPER"INO PERMIT RECECPT OPERATOR: SylviaM 3 ITEMS OF 3 COPY # : 1 Sec: Twp: Rng: Sub: Blk: Lot: APN 36229023 . 00 DATE ISSUED. . . . . . . : 06/25/1C109 RECEIPT # • . " ' 10060161 REFERENCE ID # SITE ADDRESS 7491 KINGSBURY PL SUBDIVISION • • • . . . : CUPERTIIdO CITY . . . . . . . . . . . . IMPACT AREA . . . . . . OWNER YONG CH 3N ADDRESS 7491 KISTGSBURY PL CITY/STATE/ZIP CUPERTI90, CA 95014-5046 RECEIVED FROM NANCY NGUYEN CONTRACTOR CHARLIE DUONG LIC # 28245 COMPANY . . . . . . . . . . CD ROOFING ADDRESS 2909 WILBUR AVE CITY/STATE/ZIP SAN JOSE, CA 95127 TELEPHONE (408) 858-6605 FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC - NEW-BAL- ---------- ----- ----- 0 . 00 __ - ---------- 1 . 00 -- ------------ 4, 500 . 00 1 . 00 0 . 00 0 . 00 1BCBSC VALUATION 0 . 50 0 . 00 0 . 50 1BSEISMICR VALUATION 4, 500 . 00 0 . 00 20 .00 20 . 00 0 . 00 260 . 00 1REROOFRES SQ FEET _____ _____ ------0 . ---------- ---------- 21 . 50 0 .00 261 . 50 0 . 00 TOTAL PERMIT : AMOUNT REFERENCE NUMBER METHOD OF PAYMENT -- --------- ------------ 261 . 50 7491 KINGSBURY PL CASH TOTAL RECEIPT 261. 50 VOICE ID DESCRIPTION VOICE ID DESCRIPTION ---------- ---------------------------- 602 ROOF PLYWOOD NAIL 601 ROOF TEAR OFF 604 ROOF IN-PROGRESS 605 FINAL REROOF MMnoor Air Quality and Finishes 0 1.Use Low'No-VOC Paint 1 IADJHeath pts y=yes I 2 IAQ/Hea th is es 0 2.Use Low VOC,1�later-Based Wood Finishes P Y=y 0 7 3.Use LowiNo VOC Adhesives 3 IAQ/Heeith pts y=yes 4.Use Salvaged Materials for Interior Finishes 3 Resourca pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea 6 IAQ/He�lthis - es 0 Formaldehyde P Y-y 0 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Hel:lth pts y=yes 0 7.Seal all Exposed Particleboard or MDF 4 IAQ/He;filth. pts y=yes 0 8.Use FSC Certified Materials for Interior Finish 4 ReSDur;e pts y=yeS 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resour;e pts y=yes 0 10.Install Whole House Vacuum System 3 IAQ/HE.alth pts y=yes N.Flooring 8 Resource pts y=yes 0 1.Select FSC Certified Wood Flooring 0 2.Use Rapidly Renewable Flooring Materials 4 ReSOurc e pts y=yeS 0 3.Use Recycled Content Ceramic Tiles 4 ReSOur(e pts y=yes 51AQ/Health is Y=Yes 0 4.Install Natural Linoleum in Place of Vinyl P Y-Y 0 5.Use Exposed Concrete as Finished Floor 4 Resour.e pts Y--Yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resour;e pts y=yes Total Points Available: 140T-1301 57 Total Points Project Received:1 1 01 0 0 G:datalprogslgreenbuildingltuidelines/remodelers/greenpointsfinal2.12.D4protected.xls - (4 � �