06010052 CITY OF CUPERTINO 17777-1
xY+ x '_• •:�. .i
BUILDING DlvjsjoN ATION a'
PERMIT CON,TR "CTOR INFORM
T ,x FORMI
BUILDING ADDRESS: PERMIT N0,06010052
810 PEPPER TRT7.F T.A
EWS NAME: PERMIT ISSUE DATE
MICHELE LUM 01/10/2006
NE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG EISCT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION O O O
i H 1 hereby affirm Nat 1 am liceved under provisions of Chapin 9(commencing Job Description
n�1i nith Sation]atlll)af Divii of the and Prof mien Code.an myliccnm is -
orn follfMndcrfc / G r REROOF—DECK COATED W HOT MOP OR BITUTHENE
t z License, as T7� � / W/
HOT
Dam Contocmr 1/10/6 CREATIVE HOMES PD FOR BUS LIC
C ITECI'S DECLARATION
s< 1 un rwnd y plias shall M uxd u Puhlic records
D U
Is
o Liecroed Pm(essional
x g OWNER-BUILDER DECLARATION
I Wmhy affirm that I am cacmp,from the Crematories Lccnm law for be
O O following reason.(Section p01.5.Business and Profession Code:Any city of county
K m r which requires a Permit to cnnmuct,alter,improve,demolish,or mine any structure
pd.,to its issuance.also requires tMappluma far such permitta fleasigocdmentemt
ESG dm M uliconmd pursuant to Ban provision of the Consent's Liana Law(Chapter 9 Sq.Ft. Floor Area Valuati dL500
yF (commending withScetion7")of Division J of NC Business and Profession Codc)Or
y that he is eumpt tMmfrom and the,buts for the alleged exemption.Any violation of
section 7031.5 by airy applicant for if permit subjects the applicant toacivil penalty of APN Number Occupancy
rant more than five limed Balla s($!5(a)). 35911041 . 00
P Cy Type
❑I,uowner oftM property,or my employees with wgcaudreu role compcnuslan.
will do the work and the structure isnot intended in offered for sato(See.]OW,Businw
and Profession Cade:The Ci ntracmts License Law docs not apply in an owner of Required Inspections
propenywhn Wilds simper.dernif to d wWdonmich work himself or through his
own employees,provided that such imprownican an not intended aroffered for sale.If, p
however.me building or improvement is sold within ane year ofcompletion,the owner.
Wilder will have thc burden of proving that M did not Wild or improve for purpose of fid Cl/.y x ry
sale.). Illlllll �a �ejj f F .�
❑1,as owner of dm property,am eaclusively contracting with licemed contacted;to
coronet the pmjca(Sec.]Oad,Business and Profcssion Code:)The Commumm's U. r• ffjj�`
come Law don not pply m an owner of propeny.wW Wilds or improves demon.and ZOG6
who contracts for such projects with a eonc actm(s)licered pursuant to she Contractor
Lice.Law. MM
❑I am exempt under See ,B 6 P C for this moan [[grrggqAAAn����f ((l,((1 1rp��+a ffL@@g6((, (LL '%yq;
Date �' v � ✓ tl �``
WORKER'S COMPENSATION DECLARATION
1 Mrcby affirm under penalty of perjury ane of the following elimination:
I'll'y1m.
s¢and will maintain a Cenlficam of Consent m self-insum for Wurkeri Compen-
,u provided for by Section 3]00 of the Labor Code.for Ne performance of the
W
for which this permit is issued.
ove and will maintain Worker's Compensation Insurance,u rtyuircd by Section
of Ne labor code,for the performance of the work for which this permit is issued.
orker's Compensation Insurance career and Policy number art:
r: Polity No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not M completed if tM)omit Is franc hundred unit=($Iao
or less.)
1 certify Nm in the performance of the work for which Nis permit is issued,I shall nut
cmployanypersoninanymanncrsnastobec3ompaub'cc tMW pc inti
Laws of California.Date [f
Applicant � ) �P
NOTICE TO APPLICANT:IL after making this Cenificam of Exemption,you should
become abject to the Worker's Compensation provision of the labor Code,you must
.JZ forthwith comply with such provision or this permit shall M deemed mvoked.
z CONSTRUCTION LENDING AGENCY
(-+ I hereby affirm thatthemisaeonsuuclem hodingagency fordm Performance of
0:> the work for which this permit is issued(Sec.7097,Civ.C.)
�a Undoes Name
.`7. z Lender's Address ,
U0 I comfy Nes I have read this application and state that tM above information is -
91 Fconte.I agmc or comply with all city and county oNinaues red sum Iaws relating m
O V building eonstreciten,and hereby authonm mpmsenutives of Nis city to emr upon the
above-mentioned property for iuPcction whichMpurposes.
H y (We)agree m save,indemnify and keep harmless the City of Cupcnud against
CO) liabilities,judgmcnts.costs and expertus which may in MY way atcrvc against said City
in consequence of the 6rantin _ anis.
U z SOURICA UNDER WI ,COMPLY WITH ALL NON-P Issued by: Date
signvurc plida on Re-roofs
HAZARDOUS MATERIALS DISCLOSU m Type of Roof
Will tM apPliunt or future Wilding arcupant mom or handle Name ous material
as defrrcd by the Cupertino Medici I Code.Chapter 9.12.mol the Health and Safety
.Section 155J2(a)?
❑res No All roofs shall be inspected prior to any roofing material being installed.
Will dre affilicans or future Wilding odeupant use equipment or devices when If a roof is installed without first obtaining an inspection,I agree to remove
it harardnn air contsminanm u d by the Bay Area Air Quality Management all new materials for ins ection.
isuict?
❑Yes
Ihave mail the hvvdousm 505,25533mments4.I. lcoprc1Q95ofheWilding /O
ria Healthomedy Cude.h..Mons. 25505.25577 and 2553a.l undermaM tlnif Bros Wilding _
don rwt cunentlY Wsc s tenant Nat it' dernmebitity of notify the occyyPanI the
mquircmcnts which ssuanco La acidftcate 0gypadcy.
Yd Si ureofA licant Date
Owner ar,ytham. „e All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
i -•'-'� Cupertino CA 95014
'^ Telephone(408) 777-3228
� CITY OF Fax(408)777-3333
PEI�TINO
Building Department
JOB ADDRESS: PERMIT j a OO�
�v8/D b
OWNER'S NAME: /�/C ESE L /✓/ PHONE #
GENERAL CONTRACTOR FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Ask Tile
Owner/Contractor Signature Date
CITY OF CUPERTINO
�m 1 of 1 PERMIT RECEIPT OPERATOR: suem
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 35911041.00
DATE ISSUED. . . . . . . : 01/10/2006
RECEIPT #. . . . . . . . . : 32734
REFERENCE ID # . . . : 06010052
SITE ADDRESS . . . . . : 20810 PEPPER TREE LA
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : MICHELE LUM
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-2917
RECEIVED FROM . . . . : ROLAND RICE
CONTRACTOR . . . . . . . : LIC #
COMPANY . . . . . . . . . . :
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . . ,
TELEPHONE .
EE ID UNIT QUANTITY. AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BENERGY PERMIT FEE 83.16 39.92 0.00 39.92 0.00
BPERMFEE VALUATION 2, 000.00 83.16 0.00 83.16 0.00
BSEISMICRE VALUATION 1,500.00 0.50 0.00 0.50 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 123.58 0.00 123.58 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ----__--___---__--
CHECK 123.58 1459
TOTAL RECEIPT 123 .58
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
C U P E�I N® 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.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
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.
Homeowner's Name: /V/c
Jobs ite Address: «Agz-��O���7z it/.
y .
Roofing Company Name: '
Applicant's Signature: Date: O/
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper'
1 1\�
-� CITY OF CUPERTINO
REROOF
CUPEFkTINO PERMIT APPLICATION FORM d�6/«sem
APN # Date:
�J�/ &
Building Address:
Owner's Name: Phone#:
/%ici �c GSM o8 3/.7 ,Z 9,4,0
Contractor: Phone#: gp P?ipf`S' License#: 2
76 9 y 7
Contact: �- Phone#: Cupertino Business License #:
0/
Type of Roof Covering:
ExiPro po d:
Milt-Up Roof O' Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
JJ 0 To be Removed ❑ Provide Mfgr. Installation Specs.
1� I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description:
t9'f6k G c
Residential [� Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: ❑
Cost of Project: Type of Construction: Occupancy group:
5 Oa DO`/N'
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING