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10050015I CITY OF CUPERTINO E'VILDING PERMIT I BUILDING ADDRESS: 21431 COLUMBUS AVE OWNER'S NAME: FENGQIU WU ,ER'S PHONE: 4084806740 ❑ LICENSED CONTRACTOR'S DECLARATION License Class Lic. # Contractor 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. 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. 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 unify and keep harmless the City of Cupertino against liabilities, judgments, , 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. 1-1) , Date 1A0 CONTRACTOR: BAKER ROOFING PERMIT NO: 10050015 2067 LA CON CT DATE ISSUED: 05/03/2010 CAMPBELL, CA 95008 PHONE NO: (408)559-5105 BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r MECH F RESIDENTIAL F COMMERCIAL JOB DESCRIPTION: RE -ROOF TEAR OFF WOOD SHAKES & REPLACE WITH B -HE kVY SHAKES W/304 FELT, CLASS A 15SQ Sq. Ft Floor Area: Valuation: $10000 APN Number: 36204009.00 Occupancy Type: PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSUANCE OR 1.80 DAYS FROM LAST CALLED INSPECTION. Issued byiLDate: tZlm t JLt& 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 inspe -.tion. Sigm.ture of Applicant: Date: ALL ROOF COVERINGS TO BE CLASS "A" OR BETTER HAZARDOUS MATERIALS DISCLOSURE I hai a 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 & Safeiy 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 mair tain compliance with the Cupertino Municipal Code, Chapter 9.12 and the Health & Safety Code, Sections 25505, 25533, and 25534. Own"r authorized #ge : �-- � Date: S` 3 2-•o to CONSTRUCTION LENDING AGENCY I herby affirm that there is a construction lending agency for the performance of work's for N hich this permit is issued (Sec. 3097, Civ C.) Lender's Name Lender's ARCHITECT'S DECLARATION I unc erstand my plans shall be used as public records. Lice ised Professional b 3 ITEMS OF 3 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 36204(09.00 DATE ISSUED.......: 05/03/2010 RECEIPT #......... BS000010310 REFERENCE ID # ...: 10050015 SITE ADDRESS .....: 21431 COLUMBUS AVE SUBDIVISION ...... CITY CUPERTINO IMPACT AREA OWNER FENGQ::U WU ADDRESS 21431 COLUMBUS AVE CITY/STATE/ZIP ...: CUPERTINO, CA 95014 OPERATOR: patg COPY # : 1 RECEIVED FROM ....: FENGQnU WU CONTRACTOR .......: JAMES BAKER LIC # 25385 COMPANY BAKER ROOFING ADDRESS ..........: 2067 LA CON CT CITY/STATE/ZIP ...: CAMPBELL, CA 95008 TELEPHONE ........: (408)559-5105 FEE ID UNIT QUANTITY AMOUNT PD -TO -DT THIS REC NEW BAL ---------- ----------------------- 1BCBSC VALUATION ---------- 10,000.00 ---------- 1.00 ---------- 0.00 ---------- 1.00 0.00 1BSEISMICR VALUATION 10,000.00 1.00 0.00 1.00 0.00 1REROOFRES SQ FEET 15.00 195.00 0.00 195.00 ---------- 0.00 ---------- TOTAL PERMIT ---------- 197.00 ---------- 0.00 197.00 0.00 METHOD OF PAYMENT ----------------- CASH TOTAL RECEIPT : AMOUNT --------------- 197.00 --------------- 197.00 VOICE ID DESCRIPTION -------- ---------------------------- 601 ROOF TEAR OFF REFERENCE NUMBER -------------------- VOICE ID DESCRIPTION -------- ---------------------------- 602 ROOF PLYWOOD NAIL 604 ROOF IN -PROGRESS 605 FINAL REROOF CITY OF CITY OF CUPERTINO RERO OF C u PO PERMIT APP=LICATION APN 30--0q-005. 0 u #30-0q-005. Date: 30/�__v /0 Building Address: Z ( q-31 Co 1 tj j,,, /.tz s 14ve , C.-c.�:1z t -f i n o , ,CA 9 ro l�L Owner's Name: �� ����=� C 10 1.�� ��� Phone #: HOA: Yes ❑ No If yes, provide letter f rom HOA (w)6 % �4) Contractor: Phone #: (t O -y Fax #: Cupertino Business License #: � � � � Cont �r�Li`c�en3 #: Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles a—Wood Shakes -Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.C.E.S. Report # a To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: �-- ,.c) 5��Y,> a „� cry pAce__ AV 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: 10 OOQ) I Have Read, Understand and Will Comply with Cupertino's Tear -Off Policy: Signature Revised 02/05/09 CITY OF CITY OF CUPERTINO 12 REROOF CUPERTINO FEE SCHEDULE Number of Squares Fee ID Fee Description Fee Group Permit Type 1REROOFCOM Re -roof Commercial B 1COMMLROOF IBCBSC Cal Bldg Standa-ds Commission Fee B ALL PERMIT TYPES 1BSEISMICO Seismic Commercial B IREROOFRES Re -roof Residential B 1SFDWLR00F IBCBSC Cal Bldg Standards Commission Fec, B ALL PERMIT TYPES 1BSEISMICRE Seismic Residential B 1RER00FMRES Re -roof Multi -Family B 1MFDWLROOF IBCBSC Cal Bldg Standards Commission Fet; B ALL PERMIT TYPES 1BSEISMICRE Seismic Residential B 1BUSLIC Business License B 1. Use LDw No-V©C Paint 1 IAJHealth pts y=yes 2. Use Low VOC, Water -Based Wood Finishes 2 IAJHealth pts y=yes 3. Use Low/No VOC Adhesives 3 IAJHealth pts y=yes 4. Use Salvaged Matedals for lnterior Finishes 3 R:source pts y=yes 5. Use Engineered Sheet Goods with no added Urea 4 ReMrOe pts y=yes Formaldehyde 61AQ1HeaJth pts y=yes S. Use Exterior Grade Plywood for lnterior Uses 1 IAQIHealth pts y=yes 7. Seal ;ail Expasmill PaAbleb a d or idlDF 4 IAQ/HeaIth pts yEyes B. Use FSC Certified Materials for Interior Finish 4 R -,source pts y=yes 9. Use Finger -Jointed or Recycled -Content Trim 1 R:sou rce pts y=yes 10. Install Whole House Vacuum System 3 I, QlHsalth pts y=yes N. FioOring 1. Select FSC Certified Wood Flooring 6 Re3ourre pts y=yes 2. Use Raodly Renewable Flooring Materials 4 Re>ource pts y=yes 3. Use Recycled Content Ceramic Tiles 4 Re3Dume pts y=yes 4. Install Natural Linoleum in Place of Vinyl 5 IA Xl-lealth pts y=yes 5. Use Exposed Concrete as Finished Floor 4 ReMrOe pts y=yes 6. Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes M��� Total Points Available: Total Points Project Received: 140 130 57 01 0 Q Idatalprogs/greenbuilc ingguidelines/ramodelerslgreenpointsfina12.12.D4protarted.xls CUPERTINO CONTRACTOR / SUBCONTRACTOR LIST Building Department City Of Cupertino 10300 Torre Avenue Cupertino, CA 95014-3255 Telephone: 408-777-3228 Fax: 408-777-3333 JOB ADDRESS: vim- PERMIT # 04aa/ OWNER'S NAME: �t ✓ j,�c/ PHONE # �jb �-5 3 5_dye g GENERAL CONTRACTO q. ter- ROe BUSINESS LICENSE # 25 3 ADDRESS: 2-067 (.� ('e,,, C-} CITY/ZIPCODE: C`t.50'a• *Our municipal code requires all businesses working in 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:- ignat ire Please check applicable subcontractors and complete the following information: —1—( 0 Date Owner / Contractor Signature 5- l-1 v Date 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 5- l-1 v Date