09110151 CITY OF CUPERTINO BUILDING PERMIT
BUILDING ADDRESS: 11606 CEDAR SPRING CT CONTRACTOR:THE HOME PERMIT NO:09110151
IMPROVEMENT SOURCE INC
(""NER'S NAME: LONG CHANG-SHONG AND HSIOU-CHI 1655 WHIPPLE RD STE 22 DATE ISSUED: 11/30/2009
U t*NER'S PHONE: 4088651370 HAYWARD,CA 94544 PHONE NO:(510)675-0009
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG F_ ELECT T_ PLUMB r
License Class Lic.# r
MECH RESIDENTIAL COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF TEAR OFF&ADD ASPHALT COMP SHINGLES
(commencing with Section 7000)of Division 3 of the Business&Professions CLASS
Code and that my license is in full force and effect. A 23SQ
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 Sq.Ft Floor Area: Valuation:$9300
permit is issued.
APPLICANT CERTIFICATION APN Number:36654064.00 Occupancy Type:
1 certify that I have read this application and state that the above information is
correct.1 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 PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the WITHIN 180 DAYS OF PERMIT ISSUANCE OR
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18.
Issued by: Date:
S: qture Date
❑ OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
1,as owner of the property,or my employees with wages as their sole compensation, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business&Professions Code) Signature of Applicant: Date:
1,as owner of the property,am exclusively contracting with licensed contractors to
constrict the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
1 hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
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 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 Safety Code,Section 25532(a)should I store or handle hazardous material.
Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
1 certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
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 Owner or authorized agent:
forthwith comply with such provisions or this permit shall be deemed revoked. Date:
CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
I he above mentioned property for inspection purposes.(We)agree to save
i,_ nify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
costs,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. 1 understand my plans shall be used as public records.
Signature Date Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 3 PERMIT RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN . . . . . . . . : 36654064 .00
DATE ISSUED. . . . . . . : 11/30/2009
RECEIPT #. . . . . . . . . : BS000009290
REFERENCE ID # . . . : 09110151
SITE ADDRESS . . . . . : 11606 CEDAR SPRING CT
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER . . . . . . . . . . . . : LONG CHANG-SHONG AND HSIOU-CHI
ADDRESS . . . . . . . . . . : 11606 CEDAR SPRING CT
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-5139
RECEIVED FROM . . . . : ROBERT CARDOZA
CONTRACTOR . . . . . . . : DONALD SPINGOLA LIC # 30509
COMPANY . . . . . . . . . . : THE HOME IMPROVEMENT SOURCE IN
ADDRESS . . . . . . . . . . : 1655 WHIPPLE RD STE 22
CITY/STATE/ZIP . . . : HAYWARD, CA 94544
TELEPHONE . . . . . . . . : (510) 675-0009
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
1BCBSC VALUATION 9, 300 . 00 1 .00 0 .00 1 . 00 0 . 00
1BSEISMICR VALUATION 9, 300 . 00 1 . 00 0 .00 1. 00 0 . 00
1REROOFRES SQ FEET 23 . 00 299. 00 0.00 299. 00 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 301 . 00 0 .00 301. 00 0 . 00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- --------------------
CREDIT CARD 301. 00 VISA
---------------
TOTAL RECEIPT 301 . 00
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
-------- ---------------------------- -------- ----------------------------
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
604 ROOF IN-PROGRESS 605 FINAL REROOF
CITY OF CUPETINO
REROOF
CUPS TING PERMIT APPLICATION
APN# , 646,
Date: ,
C
Building Addres :
C-)
Owner's Name: ' ( Phone#:
HOA: Yes No- if es provide letter from HSA
Contractor: Phone#:
Fax#:
Cupertino Business License M. Contractor License#:
Type of Roof.Covering:
Existing: Proposed:
o Built Up Roof ❑ Built-Up roof
❑ Asphalt Shingles a Asphalt Shingles _
❑ Wood Shakes o Wood Shakes
o Wood Shingles a WoodShingles
❑ 'Other(Specify) o :Other(Specify)
Number of existing coverings., ❑ Provide I.C.C.E.S. Report#
o 'T'o'be Rerriaved -u Provide Mfgr. Installation Specs.
Job Description: r
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: ❑
a licable include in plan set& the sheet index.
Valuation;
I Have Read;Understand and Will Comply with Cuperti no's Teaf-Off Policy:
Signature
Revised 02/05/09
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Xr1T .'O '
,.uPE1�T1N0 �FEE- CI EDUL
Number of Fee ID Fee Description Fee Permit Type
Squares:: Group
1REROOFCOM Re-roof Commercial B 11COMMLROOF
1BCBSC Cal Bldg Standards B . ALL PERMIT TYPES
CommissLon
IBSEISMICO Seismic Commercial B
1 REROOFRES Re-roof Residential B . SFDWLROOF
IBCBSC Cal Bldg Standards B ; ALL PERMIT TYPES
Commis Fee
1BSEISMICRE Seismic Residential B
1 REROOFMItES" Re=roof Multi-Family B. 1MFDWLROOF
1 BCBSC Cal Bldg Standards B ALL PERMIT TYPES
Commission Fee
IBSEISMICRE Seismic Residential B
IBUSLIC Business License B