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12100147 CITY OF CUPERTINO BUILDING PERMIT BUILDING ADDRESS: 10580 WRITE FIR CT CO\1'RACI'OR:FOUR SEASONS ROOFING PERMIT NO: 12100147 OWNER'SNAME: WU FANG AND MLAO YINGYU POTION 1668 DATE ISSUED: 10/192012 OWNER'S PHONE: 4082521032 SAN JOSE.CA 95109 PHONE.NO:(408)278-0330 ❑ LICENSED CON'1'RACI'OR'S DECLARATIONr [' BUILDING PERAf1T INFO: BLOC (- ELECT PLUMB License Class C 3� Lie.# It/ r r' I.J (�.� / _ 01EC11 RESIDENTIAL CO�NIERCL�L Contractor Date Date -_O / � /� hereby affirm lhal l am licensed under the provisions of Chapter 9 •JOB DESCRIPTION: RE-ROOF,RVMOVE SHAKE&INSTALL PLYWOOD AND (commencing with Section 7000)of Division 3 critic Business S Professions COMP Code and that my license is in full force and effect. SIIINGLES 13 SO CLASS A I hereby affirm under penallyof 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. Sq.FI Floor Area: Valualion:$4500 APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is APN Number:35905122.00 Occupancy Type: 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, PERMIT EXPIRES IF WORK IS NOT STARTED costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicantunderstands and will comply WITHIN 180 DAYS OF PERMIT ISSUANCE OR with all non-point source regulations per the Cupertino Municipal Code,Section 180 1 A F OM LAST CALLED INSPECTION. 9.18. �3��'g�ij tyrc��/w � Date r Iss a bv. r � Date: r6RZK ❑ O\VNER-BUILDER DECLARATION 1 hereby affirm that I am exempt front the Contractor's License Law for tine of RP:ROOFS: the following two reasons: All roofs shall be inspected prior to any roofing material beitg installed.If a roof is 1,as owner of the property,or my employees with wages as their sole compensation• installed without first obtaining an inspection,I agree to remove all new materials for will do the work,and the structure is not intended or offered for sale(Sec.7044, inspection. Business d Professions Code) I,as owner of the property,am exclusively contracting with licensed contractors to 8m ure of p it: Date: construct the project(Sec.7044,Business&Professions Code). I hereby affirm under penalty of perjury one of the following three ALL ROOT'COVERINGS TO BE CLASS"A"OR IID: 11"R declurations: I have and will maintain a Certificate ofConsenl to self-insure for Worker's HAZARDOUSMATERIALS DISCLOSURE 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 read the hazardous materials requirements under Chapter 6.95 of the I have and will maintain Worker's Compensation Insurance,m provided for by California Ilcalth S Safety Code.Sections 25505.25533•and 25534. 1 will maintain Section 3700 of the Labor Code•for the performance of the work for which this compliance with the Cuperlino Municipal Code,Chapter 9.12 and the Health S Safely Code.Section_553_(a)should [.store or handle havtrdou.c material. permit is issued. AddilTorudly,should I use equipment or devices which emit hazardous air I certify that in the performance of the work forwhich this permit is issued,I shall contaminants as defined by the Bay Area Air Quality Management District I will not employ any person in any manner so as to become subject to the Worker's maintain compliance with the Cuperlinu Municipal Code,Chapter 9.12 and the Compensation laws ofCalifomia. If,after making this certificate of exemption,I Ilcalth&Safety Code,Sections 25505,25533,and 25534. 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. v cru or mit orizatt a/7 . ger ll APPLICANTCERTIFICATION CONSTRUCHON LENDING AGENCY 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 I hereby a6-mm that there is a construction lending agency for the performance of work's to building construction,and hereby authorize representatives of this city to enter for which this permit is issued(Sec.3097,Civ C.) upon the above mentioned property for inspection purposes.(We)agree to save Lender's Name indemnify and keep harmless the City of Cupertino against liabilities,judgments, costs,and expenses which may accrue against said City in consequence of the Lender's Address granting of this permit.Additionally,the applicant understands and will comply with all non-point source regulations per the Cupertino Municipal Code,Section ARCIIITECI"S DECLARATION 9.18. I understand my plans shall be used as public records. Signature Date Licensed Professional 121 out �f1 CITY OF CUPERTINO FEE ESTIMATOR — BUILDING DIVISION f f+ ADDRESS: �(�� 1J�� ✓ DATE: 10/18/2012 REVIEWED BY: jsg APN: BP#: 'VALUATION: 1$4,500 *PERDIIT TYPE: Minor Building Permit PLAN CHECK TYPE: Re-roof PRIMARY SFD or Duplex PENTAMATION 1SFDWLROOF USE: PERMIT TYPE: WORK Reroof, remove shake instal plywood and comp shingles SCOPE FEE ID ROOFAREA • (s.fJ 1REROOFFRES 1,300 c Mech.Plan Check Plumb.Plan Check Elea Plan Cheek Mech.Pennh Fee: Plumb.Permit Fec: Elec.Permit Fee: 'Other,tlech.Incp• Other Plumb Inap. Other Elce.Insp. El ,Rech.hrsp.Fee: Plumb. Insp.Fee: Elee.Insp. Fee: ' NOTE:.This estimate does not include jeer due to other Departments(i.e. Planning, Public Il orks, Fire,Sanitary Server District,School District,etc). These fees are based nn the prelinzinan information available and are only art estimate Contact the Dept for addn'l in o. FEE ITEMS (Fee Resolution 11-053 Eff 711111) FEE QTY/FEE MISC ITEMS Plan Check Fee: Sappl. PC Fee Phtmb./.Wech.lElec Permit Feer $195.00 Suppl. lnsp Fee Phtlnb. Ailech.lElec Plumh./A•Iech.lElee Permit Fee: Construction Tax: Administrative Fee: Work Without Permit? O Yes (j) No $0.00 Advanced Planning Fees: Tremel Documentation Fees: i Strong Motion Fee: IBSEISMICR $0.50 Select an Administrative Item Bldg Sids Commission Fee: 1BCBSC $1.00 r 'SUBT6TALSiF $196.50 $0.00 ,- s TOTALFEE4�� $196.50 Revised: 10/01/2012 COMMUNITY DEPARTMENT BUILDING G DIVISION ESAAORPEOLOFFICIAL _ _ iLT D . CUPERTNOCA 9 32 I bo REROOF PERMIT APPLICATION COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION 10300 TORRE AVENUE •CUPERTINO•CA 95014-3255 CUPERTINO (408)771-3228• FAX(408)177-3333• buildingPcupertlno.oM PPOIE APS G C t w _RNAM¢ l/ f , E-MAIL lav I � _1 I FAx sRMTCCY S-0 14 e G r CONTACT NdMB PHONE E-M.AIL fr�dl�Gaa 4 -71'18-o O sTnEer Apparss SO2 ^AQS . cm'.STA-Z.zlP� —�.oSer�. 4St Env -'ow"A El0-NER-nUILDER ❑ OWNRR AME, P/CONTRACTo0. ❑rONi0.AClOR AGEUT ❑ ARCHfTECT ❑SNOINEEN ❑ IIEVELOFFR ❑ TENANT CONTRA17QRNAME LICENSENUMBER LICENSE PE BUS.LIC.u.t__S�ws-cas_l�in '12 0 —e��.3- COMPANY NAME E-MAIL FAX SAr�E • STREET AODRFSS CITY.STATE.7,IP PHONE SO•Z _ I A O$ c 40a—Z710-699 ARCHITF.CT/ENGINEFR NAME 610ENSE NGNIBCR BUS.LIC.e COSiPANY NAME E NAIL PAX FBEET ADDRESS .I CITY.STATE_],IP PHONE U313. OF ❑ SFD or Duplex /y Muhl-FBmlly 0.00E ARU: vALCATION: STRUCTURE: D Commercial //.� /3% 1O(0)SHA-"-5 0 EXISTING ROOF TYPE: ORUILT-UPROOF ❑ASPIIALT5HINOLES PwOODSHASP5 ❑WOODSHINDLC.S 001 mv..RISPECIFY) REMOVE;REM.Arf YFS :F NO. PLYxvOOD 9- ❑ PLYwD 1�1/056 PITCH ROOF ❑ NO n<. If'N� L •A' TY'PF IYASP 12 I S f,' ?ROPOSEDROOFTVPE: ❑BUILT-UPROOTIMES RVORT0 �PHALT SYINOLES ❑TVOOA AURES ❑wO0A SHINGLES ❑OTHER DF-SCRIPT ION OF WORK: �E.ar c� exis�i_a9J.14sx�. S�u�Loo�.�eS�}all � Z" GD - ��-� [�tf•Ew:n�ma.{�_—[LC�tia=i.�--CDM�S�.IL�S • Gie�ef � C.�f��—� 8y my signature bra ow.I certify to each of the following: I am the propene owner or oulhonmd agent to act on the property owner's bcholf. I have mod this npplic,mon and the infonnndon I have provided is coned. I have rcid the Description of Work and verify It is accurate. I ogree m WI"PIV with All epplicablc Iocml ordinarccc and.,laic lows relating to l+Idlding con., .tion. 1 a•' .ori¢e mprcc ;iv- orc pertmo to crier die above-idcntilied prooe-r:for Inspection purposes. Signmucc of Applimol/Agcm: Date: 5UPPLEMENTAL INFORMATION REQUIRED OFFICE.USE ONLY •II'building is associated With'a Home Owner's Association.provide letter PLLNCHF.CCR firer- ROUTING BLIP ofopproval from HOA. ❑ OVER-THE•COUHTER ❑ OUILOINGPLANREvinve _Provide Planning epprovui to verify;f there any restrictions. �j 'EyrRFSS ❑ PLA,NNiNG ELAN REVtew _ Provide cony of Manufectulcr's Installntion Specificotions. ❑ srANonno `❑ naRnrvT Provide signed copy of Copertino's Tear-Off Policy. ❑ OnERo Heroojdpp_]011.doc ravised q}/lG/I I