07110007 CTTY OF CUPERTINO ' '
BUILVING DI':ISION PERMIT +Cfi��'�T��.���R �����T���
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BUILDING ADDRESS: PERMIT NO.
7588 ORANGE BLOSSOM DR MICHAEL LUNNEBORG ROOFING 07110007 .
NER'S NAME: PERMTT L5�'iUE DATE
TING LI-CHUNG AND TENG LI-TEH 1328 WHITE OAKS RD � 11/01/2007
PHONE: SANITARY NO. CONTROL NO.
(831)278-1837
ARCHI'IBCT/ENGINEER: BU(LDING PERMCC INFO
BLDG ELECi PLUMB MECH
� 0 0 0
u O p LICENSED CONTRACfOR'S DECLARAT[ON JOb D25CTlptlOil
v� I hcrcby �nn tlu� I am licenscd undcr provisions of Chapicr 9(commencing
� z� wi�h Secuon 7000) of Diviaon 3 of ihc Business and Profcssions Cadc, and my licensc is REROO F, TEAROFF WOOD S HAKE , F I LL SH EATNG A S
°� y in full forec and cff � 97 ?, r'
�,�z LicenacCl `�►a`1 �ic.� NEEDEI'.� 4OLBS FELT� INSTL METAL FILE� 2G SQ
= ^ � Datc �/ �1 �o^l Conu
� � -� ARCHTCECI'S D �
� Z e 1 undcrstand my plans shall be used ublic rnr /
a
� LL. y Liccnsed Prufcuional
� y � OWNER-BUILDER DECLARATION
1 hcreby nl7irm �at 1 am exemp� fn�m ihe Con�ractofs License law far thc
i O O following rcuon. (SccGon 7U31.5, Busincss and Profcssions Cak: Any city ar county
{$ Pi which rcquiccs a permit to cnnsuuc4 altcr, improvc, dcmulish, or �epair any swcwre
y Z y prior u� i�s issuancc, also requircs thc applicant for such permit to filc a signcd stucmcnt
�= Q ihai he is liccnscd pucsuant to thc pcovisions o[ ihc Comractor's Liccnsc [aw (Chaptcr 9 Sq. Ft. Floor Area Valuation
y t- $ (commcncing with Section 7000) nf Division 3 of Ihc Business and Profcssions Codc) or $15 5 0 0
y �.. ihat he ia uempt thercfrom and the besu Cor the sllcgcd eumption. Any violation oC
Section 7031.5 by airy applicant for a pumit subjecu ihe applicant w a civil penalty of e� Number Oeeupaney Type
not more �han fiw hund�ed dallars (5500). 3 6 6 1 1 � 5`� : t� �1
❑ I. u owner of the propertY. or my cmpioyces with wages as the'v solc compensadon.
will do the work, snd �he atcucWce is not intended or ofteced forsalc (Sec. 7044. Business Re uired Ins ections
and Prokssiona Code: The Conuactors License Lsw dacs �wt appiy �o an owner of 9 P
property who buitds a improves �hercon, and who does such work himself or tlwugh hia
own employccs, providcd �ha� such improvemenu are not imm�ded or oReced for sale. If.
however, �he building or impmvemen� is sold within one yesr oC complction, the ownu-
builder will have Uu burden of proving �hat he did noi build or improvc far purpose of
saleJ.
❑ I, ss owna of �he property, am eacclusivdy conuacting wilh licensed rnnuactors w
consuuct the pro�a (Sec. 7044. Busineu and Professions Code:) The Conuxtor's Li-
cenx Caw docs not apply to an ownu of propeny who builds or impmves ihereon, and ,
who contractt tor such pmjects with a conuutor(s) licensed pursuant to tAe Contrxtor's
L'uense Law.
I am aemp� undu Sec. , B dc P C for this rcason
wner ���
WORKER'S COMPENSATION DECLARATION
1 hercby affirm under penalty o[ perjury ane of �he following declaratians:
❑ I hsve and will mainuin a Cutificam of Consent to xlf-imure for Workcr's Compen-
sation, as providcd for by Section 3700 of the [abor Code, for the pedormancc of thc
work [or which Ihis pertnit is issucd.
❑ I havc and will maintain Worker's Compenution Insurana, as �cquired by Scction
3700 of the Labor Code, Cor the performance oC �he work for which �his pehni� is issued.
My Worker's �Ca�m�pe insurance carticr and Poliry number a�e:
Cartier.�7f/r/T�^�C PoliryNo.: �?�«
CERfIF1CATE OP EXEMPlTON FROM WORKERS'
COMPENSA710N INSURANCE '
(7'his section need not bc completed if the permit is for anc hundred dollars (S 100)
or Icss.) '
I cenify that in thc performancc af thc wark for which Ihis permit is issucd, l shall nat
employ any pccson in any manncr so u to bccomc subject w �he Workers' Compensauon
Laws of Califomia. Da�c
Applicant
NOTICE 7'O APPLICAM: If, aMr making ihis Ccrtificatc of Exemption, you should
bccome subjcct W thc Worker's Compcnsation provisions of Wc Labor Codc, you must
, O forthwi� comply with such proviaions w this pecmil shall be decmed n.woked.
z "" CONSTRUC170N LENDING AGENCY
F r � I he�edy alTirm that thero is a constnxtion lending agency far the pertormance of
a, .� ihe work for which this pemiit is issued (Scc. 3097, Civ. CJ
W Q Lendcr's Namc - '
� z L.cnde�s Address
V Q 1 certily Uut I have read Uda applicuion and s�a�c thu thc abovc info�madun is
w� cortccL I agree w comply wi�h alt ci�y and counry ordinances and sute laws relating w
Q U buildinb conswction, and hcieby authorim mprescmaGvcs of �his ci�y to cn�cr upon Uu
� W atwvc-mcntioned property for inspecdon purposes
a (Wc) agrce to save, indcmnify and kxp harmless ihe Ci�y of Cupenino agsinst
„H � Iiabilitia, judgmcn�s, costs and expensca which may in any way acccue againsl said City
V z in consequence oC the granling oC ihis permit. Date
�"� APPLICAM UNDERSTANDS AND WILL COMPLY WITH ALL NON-POIM Issued by: � �—�
SOURCE REGULA'I7 S.
�� � Re-roof, � �
Sig o canUC trac�or Datc
HAZARDOUS MA DISCLOSURE Type of Roof
Will thc applicant or futurc build' upant storc or handle har�rdaus malcrisl
efined by 1he Cupenino Municipal Code. C6apicr 9.12, and thc Health and SaCety
.� Scction 25532(a)? All roof s shall be inspected prior to any roofing material being installed.
❑ Ycs No
Will thc a�licant or future building accupant utc cyuipmcnt or dcvices which
If a rool is installed without first obtaining an inspection, I agree to remove
cmit harardous air comaminants as ncd by the Bay Area Air Qusliry Managcmcnt all new �►aterials for inspection.
Disuict?
Q Ycs No
t havc rcad �he hvarticws maicrials requiremcn�t undcr Chap�cr 6.95 of �he Cali(or-
nia Flcalih & Safe�y Codc, Scctians 25505, 25533 a�u17S534.1 undcrs�and tha� if ihe building � - /`��
docs not curtcn0y havc a icnant, ihat it is my rcsponsibiliry m noufy ilu occupant nf Uie �
rcyuitcmcnts which mus� bc met prio ficatc of Occu �,�. lgnatut e of Appl icant Date
�� All roof coverings to be Class "B" or better
Owncr o cm Datc
o
CITY OF I�UPERTINO
� � ; .�:,,,
�E�2Q4►F
CUPER`7tN(� PERMIT APPI,ICATION FORM
Date:
aPN # _ � �� � � C� d //-�- 0 7
Building Address: � �
�r'F�r D�q� �-6�vr� �� an'� �v
Owner's Name: Phone #:
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Contractor: License #:
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Contact: Cupertino Business License #:
/'+� lr,� �v.��✓ :� � � �
Type of F:oof Covering:
EZCisting: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
� Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
��ther (Specify)
Other (Specify) �ytw{'r►'� �'��'
uinber of existing coverings ❑ Provide I.C.B.O. Report # �"!� 2(i
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Ci� ertino's Tear Off Policy: ❑
Job Description:
� o�F U�da s�� ,�// s�r �,�✓ �e�er%� 3f�'•�-� , e��-/ ��/
Residential � Commer al ❑
Fire Zone: Yes ❑ No ❑ Confumed with Planning D�t. if
there are any restrictions: LJ
Cost of Project: Type of Constn�ction: Occupancy group:
/� ��°
Qty. if Fee Grou
Applicable Fee ID Fee Description P
BPERIVIFEE Bldg Permit Fees BUILDING
BENERGY Energ BiJILDING
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: patg
COPY # : 1
Sec: Twp: Rng: Sub: Bl{: Lot:
APN ......... 36511059.00
DATE ISSUED.......: 11/01/2007
RECEIPT #.......... BS�00003141
REFERENCE ID # ...: 07110007
SITE ADDRESS .....: 7588 ORANGE BLOSSOM DR
SUBDIVISION .......
CITY .............. CUPERTINO
IMPACT AREA .......
OWNER ............: TING LI-CHUNG AND TENG LI-TEH
ADDRESS . : 7588 ORANGE BLOSSOM DR
CITY/STATE/ZIP ...: CL;PERTINO CA 95014
RECEIVED FROM ....: MICHAEL D LUNNEBORG
CONTRACTOR .......: MICHAEL LUNNEBORG LIC # 25896
COMPANY ..........: MICHAEL LUNNEBORG ROOFING
ADDRESS ..........: 1�28 WHITE OAKS RD
CITY/STATE/ZIP ...: C�MPBELL, CA 95008
TELEPHONE ........: (E31)278
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
- ------------- ---------- --
-------- ----------
BPERMFEE VALUATION 0.00 83.16 0.00 83.16 0.00
BSEISMICRE VALUATION 0.00 0.50 0.00 _____0_50 ______0_00
TOTAL PERMIT :
83.66 0.00 83.66 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- --------------- ---------
CREDIT CARD 83.66 VISA
---------------
TOTAL RECEIPT : 83.66
Community Development
- , 10300 Torre Avenue
` `�, � Cupertino CA 95014
� ' Telephone (408) 777-3228
: �:_ � .
Fax (408) 777-3333
ClTY UF
CUPEf�TINO
Bli1lC�ll1 De artment
JOB ADDRESS: PERMIT #
7s'� ��. � G3 .� s�o� F- --� �(� O O
OWNER'S NAME: ti 7'iN PHONE # ��� f' �r �r
GENERAL CONTRACTOR: ,� � FAX #�'v� � / 7�
_ l/� � � l
I am not using any subcontractors: Date
i€;natur
Please check a licable subcontractors and com �lete e followin �BUSINESS LICENSE #
SUBCONTRACTOR BUSI1�iESS NAME
Cabinets & Millwork
Cement Fini.shing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum / Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
prnamental Sheet Metal
painting / Wallpaper
Paving
Plastering
Plumbing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile
�����
Owne /Co actor Signature
Date