The URL can be used to link to this page

04050160no,' 0oC <W rte= 7 nF� ;yU aa� foo +s—w —Z6 A, E`s$ 'CITY OF CUPERTINO 'A' ;,,."''` �^� BUILDING DIVISION PERMIT CONTRACTOR INFORMATION ' .•.d •d's_,. _.. Y. ...d9'..,.P t snkidic'�,w ills§ , BUILDING ADDRESS: MBROWN CONSTRUCTION, INC PERMITN0.04050160 OWNER'S NAME: - PERMITLSSUEDATE TERRY DUCEY 702 S. F)ANTRT. WAV NE: SANITARY NO. CONTROL NO. (408)260-1260 ARCHI' 01INGINEER' BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 LICENSED CONTRACTOR'S DECLARATION Chapur 9 Job Description p 1 hereby affirm that l am licensed under v..a- of (commencing withSomia-Tq% (Division 3af NCBusineajProfcsaumACodeand my license is ice rvllforce arid' Ln IO$ZZ. License CI O Lic. N REROOF W/ SHEATHING, COMP. �'� ,n orae— /L3g LES Dam Conv r PY r�J ON n ,. TcnNs 1 unders y plans hat] hosert d Ad public JUN 2 — 2004 Licensed Pmfessim al OWNER -BUILDER DECLARATION rra thatI w I Wmso .(Siem Nall exempt Ilam IPr Contractor's oh LiAnyc Law for thy he Contrac LS. Businessland Code: Any citycounty following mason. (Section1. which requires a pcnmit to construct, alter, improv, demolish, or repair any structure IBb prior m its issuance, also requires the applicant for such permit to file a signed statement that he is fimnscd puraenl to the privlsinns of the Contractors License Law (Chaper9 Sq. Ft. Floor Area Valuation (commencing wide Section 7000) of Division 3 of the Business and Professions Coda) or that he u exempt IWmfrom And the bats fa Ne alleged exemption. My violauon of Section 7031.5 by ao)• applicant for a permit subjects the applicant o a civil penalty of 3 ] �Il ��(] O Occupancy Type not mom than five hundred dollars (S500). PaDC y ❑ L as owner of Ne property, a my employes with wages. their ale compte am mi, ' will do the work, and Ne swcture is.untended or offered tonal, (Sec. 7094, Business or of and Professions Cade: The Contractor's License law, dors not apply H Art wm Required Inspections propeny who builds or improves thereon, and who doessuch work himself orthrough his own employers, provided thatnch improvements are nor intended oroRared forAsk. If. however, the building or Improvement is sold within ane year of mmplcu.n. the owner - builder will have the burden of proving Nal he did not Wild or improve for purpose of Asia.). ❑ h as owner of the, property, am exclusively contracting with licensed contractors to construed the pmjco (Sec. 70X4, Business and Professions Cade:) The CntracDr's Li. came law does not apply in an owner of property who Wilda or improves Hereon. and. who Contracts for such projecis with a contractor(s) licensed pursuant to He C'ontractor's License Lew. O lameaemptundv Sec. ,B&PCfm Nisreason Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury ane of the fallowing declaratiam: - J I have and will mninuin a CerliBcate of Coolant H salf-imam fm WorkcesCooper. ation, as Provided fm by Section 3700 of de LAWr Code, for Ne performance of the work for which this permit is issued. ❑ 1 haw and will maintain WOrkcrs Compensation Inanimate, As myuired by Section 3700.( the Inbar Code. for Ne Irrormanee of Ne work fmwhieh this permil is issued. . . MYW. rkd pe tion umurasla comer nd Polity numWr� r. � VIGI Polity Na, ERTIFICATE OF EXEMPTION FROM ORIK COMPENSATION INSURANCE (This Acclaim need notbccompli ed if the ycrnil is formic hundred dollus (SIM) or los.) I certify 0.1 1- the performance of He work for which this permit is issued. I shall not employ any Pera.n in Any mannan, .Asin become SY bicel to He Worians Compensation . Laws of California. Data Applicant NOTICE TO APPLICANT. If, after making this Ccr licate of Eaemption, you should become subject in the Worker's Compensation provisions of the labor Cods. you most forthwith comply with such provisions or Nu limit shall W deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby alfrro that thers is a moolroctinn voiding agency for IW perfomiarvx or ft wurle far which this permit is issued (Sec. 3097, Civ. C.) Lenders Name Lenders Address I certify, that 1 have read Be. application And sou that dic aWw information is COMCL I agree to comply with all city and county ordinances and sue laws relating H building construction. and hereby auNonre representatives of this city to color upon the above-menudgra pmpeny rayan impaction poryh (We) agora m an. Indemnify keep hualess And the City of Capenino aganmt may eftemuwhich may in any way eccrvc against aid City in of the in cOnseynnce of Ne granting of Nis permit. APPLTCrAW UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT SOUluraOk U}.A NS. Issued by: Date y ��/ Re -roofs / _ _ Signature o P' I Delo HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future Wilding oavpnt vane of handle hnardou material u defined by the Cupertino Municipal Code. Chapter 9.12. and the Health and Safety ate. sc❑y. 25532(a)? Ynd No All roofs shall be inspected prior to any roofing material being installed. Will the appliant o fuwm Wilding attupam vu cyuipmem m devices which If a roof is installed without first obtainingan inspection, I agree to remove P g mit harvdous air cnumi u ax dc0ocd by the Ray Area Air Quality Management all new materials for inspection. District?. C]Yes Ihowrcad smaurialsrcquiremcntsundcrChapur6.95 of Nc Califon /.//� CcdceStdn nu HcalNhSafcty COdc.Secti 25505.2551] aW25534.1 undcrsuM thvif Nc Wilding ��/Dy Jou n Ctmoolly��111iiiaw a lonanL Net it v my respmmiM1ilily m nuly dm acupnl nr Nc C/ / �/ / rcyuircmcnLS uslWmetp'or uissuncc ofa Certificate of Occup ��d Signature of Applicant Date All roof coverings to be Class ••B" or better OwAci4rauthorindagent 61JD.tr WCITY OF UPEkTINO 0 Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRE 4` n r Vl P —/ O R'S N MFU o Cs:d PHONE _ 3 0 GENERAL CONTRACTOR: IHI1jffiAnFAX # &q(o v I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information - O /Contractor Signature 10/28/03 Date SUBCONTRACTOR BUSINESS 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 ,d Roofing G Septic Tank Sheet Metal F_ Sheet Rock Tile O /Contractor Signature 10/28/03 Date d' �CITY OF UPEI�TINO u Community Development Department Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 Fax: (408) 777-3333 Building Department Subject: Re -roofing policy for the City of. Cupertino 1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards and manufacturers specifications on re -roofing. 2. New roof coverings shall not be applied without first obtaining all inspection and written approval from the building inspector. A final inspection and approval shall be obtained from the building inspector when the re -roofing is completed. 3. All roofs shall be inspected prior to any roofing installation. 4. To receive a final sign off from the City, the following steps are required: 1) Pre -inspection and/or tear off approval. 2) In -progress inspection approval. 3) Final inspection approval. a) Spark arrester installation. 5. If plywood is installed, a plywood nail inspection is required. 6. Any roofing which is applied without first obtaining an inspection, will require the removal of all new material down to the sheathing, so a proper City inspection can be performed. IMPORTANT: 1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate that there is no ponding. 2. An I.C.B.O. report is required to be on the job site at the time on inspection. I understand and will comply with the above stated policy on re -roofing. Roofing Company Name: Greg Wteel Building Official Revised 1/30/03 Printed on Recycled Paper 653 S-o1Y 0m 1 of 1 CITY OF CUPERTINO PERMIT RECEIPT Sec: Twp: Rng: Sub: Blk: Lot: APN ........: 32628027.00 DATE ISSUED....Il..: CHRIS BROWN 05/26/2004 RECEIPT 4.........: 25637 REFERENCE ID # 1..: 04050160 SITE ADDRESS ..... SUBDIVISION ...... CITY .............: IMPACT AREA ...... OWNER ............: ADDRESS ..........: CITY/STATE/ZIP ... 10405 ANN ARBOR TERRY DUCEY 10405 ANN ARBOR OPERATOR: conniew COPY # : 2 METHOD OF PAYMENT ----------------- OTHER TOTAL RECEIPT : • AMOUNT ------------ 117.60 117.60 NUMBER ------------------ AMEX RECEIVED FROM ....: KM HAGAN CONTRACTOR .......: CHRIS BROWN LIC 4 25108 COMPANY ..........: MBROWN CONSTRUCTION, INC ADDRESS ..........: 702 S. DANIEL WAY CITY/STATE/ZIP ...: SAN JOSE, CA 95128 TELEPHONE ........: (408)260-1260 FEE ID ---------- UNIT QUANTITY ----------------------- AMOUNT PD -TO -DT THIS REC NEW BAL BPERMFEE VALUATION 6,000.00 -------------------- 117.00 ---------- 0.00 117.00 ---------- 0.00 BSEISMICRE VALUATION 6,000.00 0.60 0.00 0.60 0.00 TOTAL PERMIT ---------- ---------- 117.60 ---------- 0.00 117.60 ---------- 0.00 METHOD OF PAYMENT ----------------- OTHER TOTAL RECEIPT : • AMOUNT ------------ 117.60 117.60 NUMBER ------------------ AMEX 07) da : CITY OF CUPEkTINO CITY OF CUPERTINO REROOF PERMIT APPLICATION FORM q O� l6 APN # Date: 5 GC.e D Buildin res�S: Ener Owner' ame: CC� SEISMICRE hone #: 2 s`/ J �J Contra m cmd phone �O (L / to License � W b �2i Contact: Phone #: BPLANCHK Cupertino Business License #: BUILDING BUSLIC o2j 10 Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles Wood ShakesWood Shakes ❑ Wood Shingles ❑ Wood Shingles C3 Other (Specify) ❑ Other (Specify) Number of existing coverings ❑ Provide I.C.B.O. Report # ❑ To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: J b Descri tion: Residential%❑p Co ercial E]Fire (Yes Zone: ❑ No ❑ Confirmed with Planning D f there are anrestricti Typ of Construction Occupancy group: Costo Project:�� l5 / 'JzIQ� t`" if ncahle FPA m BPERMFEE Bld Permit Fees 100 VIv uuj BUILDING BENERGY Ener UILDN� G SEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING 01- zs'6 7 7,