07100051 CIT�' OF CUPERTINO � ` ' ' `
BUILv1NG DIVI.�IOiV PE1�1v1IT ��1�� �T�� Z�'�������'
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BUILDING ADDRESS: PERMIT NO.
6724 JOHN DR KNIGHT FOOFING SERVICES 07100051 �
PERMIT LSSUE DATE
OWNER'S NAME:
MANQIU JI 42035 O:�GOOD RD 10 05 2007
SANITARY NO. CONTROL NO.
)NE:
(510) 43f;-9077
BUILDING PERMiTINFO
ARCHIIECT/ENGiNEER:
BLDG ELECT PLUMH MECH
� � � 0
i p Q LICENSED CONTRACfOR'S DECLARATION IOb DBSCflpUO❑
:�� I hcrcby affirm that I am licensed undcr provisians of Chaptcr 9(rnmmcncing
,z� withSccGon7000)o[Division3of�heBusinessandProkssionsCodc.andmylicenseu TEAR OFF' COMPOSTN ROOFING. INSTALL CLASS A
� a a in full Coece and effect '
��z LicenscClass L�.� � C�MPOSTTI SHITIGLE� 4� YR & 31 SQ.
. �, � Datc J %] ^ (Z„r� Conlractor
� ARCHITECTS DECLA A7'1
i a a I undcrswnJ my plans shall bc uud as public records
>yU
' a y Licenscd Pmfcssional
� y � OWNER-BUILDER DECLARATION
1 hcrchy alTirm �h�l 1 am cxcmpt trom �hc Contrxtars Licensc Law Car thc
� p o Collowing reason. (Sccuon 7031.5. Busincss and Profcssiv� Caic: My city ar county
<,°, � which rcquires a permit to constnut, altrs. improve. dcmoiish. or re�wir any stn�eture
° Z y prior to iLt issuancc, alw tcquires Ure applicant for such pertnit to filc a signcd stalcmcnt
- < tha� hc is liccnscd pursuant to thc provisions af ihc Conuactor s Liccnsc Law (Chaptcr 9 ;>q. Ft. Floor Area Valuation
r t �(commencing wi�h Scction 7000) of Division 3 of Ihc Busincss and Prafcssions Code) or $ 6 6 6 5
��� that he is exempt Neicfrom and Itx basu Cor U�e allcgcd eumption. Any violauon o(
Section 703 t.5 Ay airy applicant for a pecmit subjects �he applicant w a civil penalty of Number Oceupaney Type
not morc than fvc hundred dollars (SS00). 3 F) 9 2 3 O O�� ��
❑ I, as owner oC ttie propeny, or my employcu with wagu az their so� compensaGon,
wilt do thc work. and �he sttucture is not intended or oRercA for sale (Sa.7044, Buarcss Re u ired In s eetions
and Profctsions Cadc: The Conuactor's License Law does not apply in an owner of Q p
property who builds or improves tNereon, and wha daes such work himsel[or LLuoug6 his
own employccs, provided that such improvemen�s are not intended or oRered Cor sala If,
hawever. U�e building or improvement is sotd wiUtin one year of rnmpletion, � owner-
buitder will have the burden of proving �hat he did no� build ar impmve [ar pucpox ot
sale.).
0 I, az awner of the propeny, am weclusively convacting wi�h Gcensed con�s w
conswa the pcoject (Sec. 7044. Business and ProCessians Cade:)'Ibe Comractors Li-
cense Law docs no� apply to an owner of PropenY who builds or impmves theROn. and .
who canvacls for such projecLS with a comractor(s) liansed pursuant w �he Convxtor's
License Law.
� I am uempt undu Sec. , B� P C for this rcason
Ownu Date _ .. _
WORKFR'S COMPENSATION DECLARAT[ON
I hercby affirm under penalty af perjury one af the folbwing dxlantions:
❑ i hsve and will maintain a CeniCcate of Consent to self-insure (� Wmlcers Compen-
sation. as provided far by Section 3700 of che L.abor Cade. far the performaxe of ihe
work for which this permit is issucd.
❑ I havc and will maintain Workers Compensation Insunna, az�oquired by Section , �
3700 oC the Labor Code, Car the pedormance of the worlc (w which t6is pecmit is issued.
My Worke�s CompensaGon Insuronce cartier and Policy number aze: � 7
Cartier: Policy Na.: ��-� ��O 7 O f
CERTIFICATE OF EXEMP'I'(ON FROM WORKERS'
COMPENSATIONINSURANCE
('Iliis scction necd not bc completed i( the permit is for anc hundred dollars (SI00)
nr Icss.) �
1 cenify �hat in thc per(om�ance af ihc work (w which U�is permit is issued. 1 shall not
nmploy any person in any manncr so as to bccomc subject w ihc Workecs' Compensa6on
Laws of Califomia. Datc
Applicant
NOTICE TO APPLICANT: If, aftcr making Ihis Ccrtificatc of Eumption, you should
bccome subjcct m the Workcr's Compcnsadan provisions of thc l.s6ar Codc, you must
, O foMwith comply with such provisions or this pecmit shall6e decmed revoked.
z '"' CONS7RUCTION LENDING AGENCY
F r .�-� 1 herehy affirm U�at there is a construction Icnding agcncy for �he performancc uf _
(Y, � thc work Cor which Ihis permit is issucd (Sec:. 3097, Civ. CJ
W Q Lendcr's Narnc '
� z C.cnder s Address
U � 1 certify �hal I havc read this application and stale ihat the above informatiun is
��"" cortec� 1 agree to comply with all city and counry onlinances and sute laws rcladng to
0 U building conswction. and hemby authome representatives oC this city to enter u�n ihe
� W abovc-mcntioncd property for inspcc�on purposes.
a (Wc) agrce to save, indcmai(y and kecp harmless ihe City o( Cuperpno against
�� liabilidu, judgmcn�s, costs and expenses which may in any way accruc agains� said City /�
�,} ,'� in consequence oC the granting of this permi� /�' q� uj
� APPL[CANT UNDERSTANDS AND WILL COMPLY W(TH ALL NON-POIN7 Issued by: Date
50 RC EGULA ONS.
f0'� � Re-roofs �"�
Signature of ApplxanU onuaci �'� T of R �of
HAZ US MATERIALS D[SCLOSURE YPe
Wi11 the applicant or futurc building occupant store or handlc harardous matcrial
u dcfi�d by thc Cupenino Municipal Codc. Chap�cr 9.12, and thc Health md SaCcty
Cafc, Scction 25532(a)? All roofs ;�hall be inspected prior to any roofing material being installed.
�y� �No
Will thc applicant or futurc building occupam usc eyuipment or dcviccs which IF 3 COOf 1 � installed without first obtaining an inspection, I agree to remove •
cmii harardaus air con�aminan�s u cicfincd by the Bay Arca Air QualitY M�6���� all new m 3terials for inspection.
District?
❑ Ycs Q'fNo
( havc rcad the ha�ard<ws ma�crials rcyuircmcn�s unckr Chap�cr 6.95 of ihc CaliCor
nia Hcalth & Safcry Codc. Secuons 25505, 25533 and 25534.1 un�cw�nd thaz iCU�c 6uilding
docs not currcnlly havc a tc ant, ihat it is my rtsponsibility to norify �hc occupant nf thc
rcyuircmc whichmust melp' r �u��uerec«�r��ora�. Signature ofApplicant Date
�� "'� All roof coverings to be Class "B" or better
Owncr r au�horized agcn� Datc —
�—I/ u o o� i
CITY OF C+UPERTINO
; �E�:C�(�F
CUPE� 1N0 PERMIT APPL [CATION FORM
APN # Date:
9-28-07
Building Address:
6724 John Dr.
Owner's Name: Phone #:
Manqiu �i 408 253 1800
Contractor: Phone #: License #:
Knight Roofing Services 510 438 9077 � 844108
Contact: Phone #: Cupertino Business License #:
Greg Knight 510 438 9077 27646
Type of R�of 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 I ❑ Provide I.C.B.O. Report #
�( To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Com ly With Cuaertino's Tear Off Policy: ❑
JobDescription: Tear off composition roofing. Insgall C�ass A
Composition shingle . �ft> /L. �I
Residential � Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning D�t. if
there are any restrictions: L�
Cost of Project: Type of Constru�tion: Occupancy group:
$6,665 Re roof —3
Qty. if Fee Grou
A licable Fee ID Fee Descri tion
BPERMFEE Bld Permit Fees BUILDING
BENERGY Energ BUILDING
/' BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
CITY OF CUPERTINO
2 ITEMS OF 2 PERMI�' RECEIPT OPERATOR: patq
COPY # : 1
Sec: Twp: Rng: Sub: BlJ;: Lot:
APN ......... 36��23005.00
DATE ISSUED.......: 10,'05/2007
RECEIPT #.......... BS(%00002903
REFERENCE ID # ...: 07:.00051
SITE ADDRESS .....: 67�;4 JOHN DR
SUBDIVISION .......
CITY .............. CUI'ERTINO
IMPACT AREA .......
OWNER ............. MAPTQIU JI
ADDRESS ........... 67�;4 JOHN DR
CITY/STATE/ZIP ...: CU�'ERTINO CA, 95014-4563
RECEIVED FROM ....: MAl`�IJEL MEZA VAZQUEZ
CONTR.ACTOR .......: DA�'ID RICE LIC # 27646
COMPANY ..........: KN7:GHT ROOFING SERVICES
ADDRESS ..........: 42(�35 OSGOOD RD
CITY/STATE/ZIP ...: FRE;MONT, CA 94539
TELEPHONE ........: (5]0)438-9077
FEE ID UNIT QUANTITY �.MOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 6,665.00 137.16 0.00 137.16 0.00
BSEISMICRE VALUATION 6,665.00 0.70 0.00 0.70 0.00
TOTAL PERMIT : 137.86 0.00 137.86 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER �
----------------- --------------- --------------------
CREDIT CARD 137.86 VISA
---------------
TOTAL RECEIPT : 137.86
, Community Development
10300 Torre Avenue
'`� ' ' ' ' Cupertino CA 95014
Telephone (408) 777-3228
ClTY OF Fax (408) 777-3333
�UPEI�TIN4 _
Buildin De artment
JOB ADDRESS: PERNIIT #
6724 John llr . �7� p p O�' I
OWNER'S NAME: Manq i u,�� i PHONE #� 0 8 2 5 3 18 0 0
GENERAL CONTRACTOR: xn i ght Roo f i n� � S e rv i c e F� # 510 4 3 8 0 6 0 4
I am not using any subcontractors:
Si;;nature Date
Please check a licable subcontractors and com �lete the followin information
SUBCONTRACT�R BUSIrTESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
Electrical
Excavation
Fencing �
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
_ �v-Q,��o�
Owner ontractor Signature Date