06040073 CITY OF CUPERTINO
BUILDING DIVISION PERMIT P CONTRACTOR INFORMATION
BUILDING ADDRESS: MICHAEL LUNNEBORG ROOFING 0ERMrrN0.06040073
809 SEPTEMBER
OWNER'S NAME: PERMIT ISSUE DATE
WU HWAI M AND BETTY M 1328 WHITE OAKS RD r)4 /13 /9oo6
NE:
SANITARY NO. CONTROL NO.
(831) 278-1837
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ipQ LICENSED CONTRACTOR'S DECLARATION Job Description
'.f ux C I nearby affirm Nat I saw licensed under provisions of Chapur 9(commercial,
<i withScctian 70f1U)of DivisianJof the Bmineuand Profeawns Codc.sed mylittnxu
mm11fotceaaeer(am 3S L1Cg /.I It'7'L-T— TEAR OFF WOOD SHAKE AND INSTALL LIGHTWEIGHT MET
a i3Z ucenx Class L
pa-c Dole o—+g Contracwr TILE
lwJ ARshallW SDEC N
1 undcrsunJ my plan shall he lied as par lie records
1 s t, Eu—mxd Professional ,N
0
7 S OWNER-BUILDER DECLARATION
ContrON
2
COC
I Wmso affirm that I an uempt from the Cortins Cu :My c law for the
p O following maven.permit
t ]IDIS,Buiness and Profession h.a My oily or county
3_ which tdo,ut its amu a permit m construct,albs,impro a,h drith.m repair any mnsevar
-i6 that he
eslicenad pursuant to
thovisios of fine,eacContractor's
tiltx Lrcdsuwmcm V 1�
thatheulieenuit puntion7 the provisions of the Comncass License law(ChapmCode) 9 Sq.F[,Floor Area A/ 7 Valu U% Q
y€� (commencing with Section7")and
bs3 rf@ca.d essand
on.Any Aclinde)of I T 100
— Nu he is...or therefrom std the buil for the Jleged evmptiat.My violation Of
Section 7031.5 by amy applicant for a permit aabjccu the applicant in a civil Penalty of APN Numberccupancy Type'
an
not mom NEva hundred dollars(M). 36212003 . 00
1,u owner of the property.or my employees with wages u their sole compewtion,
will do the weak and the soueure is not intended or offered for Ale(Sian.'I044,Business 98
and Prefict9an Codc:The CanlaaclMs License Law does M1 apply w an owlmr of Required Inspections
VU I—
property who builds or improves thereon,and who does such wort himxJror through his
own employees,pmvidcd Outman improvemenu are not intended oroffemd for sale.If,
bawevm,the building or impmvementla sold within one year of completion the owner-
buildcr will have the Which of proving dart he did stat Wild or improve for purpose of
Am.).
❑1,as Owner of the property,am exclusively corer ing with licensed contractors to
convect the pmjcct(Sec.7044,Business and Profession Code:)The Comracwri U.
cane law does not apply to an owner of property who builds or improves desmon.and
who comncu for such projeeu with a comaac ods)licensed pumwm w este ComAe es
Licence Law.
❑Iamexemptunder See .Bk PCforthismason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby of lno under penalty,of perjury one of the following dealanliwtr.
❑ I nave and will maintain a CeNOcata of Consent m xlf-inaurtfor Worker.Carolina.
sation,as provided for by Section 3700 Of be labor Code for the perfafm unce Of the
wont far which this pcdw,is issued.
❑1 nave and will mainmin Worse/,Compensation Insurance.as required by Section
3M of Nes labor Codc,for to perforrouee of the want for which Nb pcmtit is Issued.
My Wmke/e Campenauon Inxmntt cortin end Policy number am:
Gassier. JTI � Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(lnu xeiam recd not W cmnplcwtl if the permit is fmonc hundred dollen(5100)
or less) ,
1 cmufy duet in the perfmmaxc of the work for which this Prfmi,u issued.I shall not
employ anyperson in any manner x as in become subject to the Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT.IL after making diu Certificate of Eacmption,you should
lacerates subject to Nes Work s Compensation provisions of the Labor Code you mon
.J O fortwith comply with such provisions m Nu permit shall W deemed revoked.
Z CONSTRUCTION LENDING AGENCY
I-+ I hemby alnam Nat Yen is a convection lending agency for Nes perfafmance of
C' Ya work rte which this Permit u armed(Sec.3097,Civ,C.)
A Londa s Name
.D
z Undoes Address
U Q 1 certify Na I haws read Nis application W saw Nu the above information is
I, E^ COMCL 1 since in comply with all city and county ordinances'ad man laws arlaung in
p U building convection.and hereby authome mpieacmutives of Nis city to enter upno the
�-'W ahoya-mcmiuned properly for inspection purpows.
F W (We)agree 10 Ave,indemnify and keep harmless Ina City of Cupertino agaiosl
fA Iiabiliueajudgmcnu.cosi and Ispeneez which may in any way acerae a gain,said City
t 1'Z in ca rcc of tM[ranun6 of this pandit. (�
^ APPL ANT UNDERSfANOS WILL C Y WITH ALL NON-POINT Issued by: Date I '1�O G
SOK
RE LATI S.
Re-roofs ---�-
nu of ApplcanUCo ver Data
H RDOUS MATEJU 1 OSU0.E Type of Roof
Will Nes applicant orforum Wilding upon m mhandlc hanrtlous not..unnal
as defined by the Cupenina Municipal Ca pwr 9.12.end the Health and Safety
Cade.Ouon 25532(x)? O All roofs shall be inspected prior to any roofing material being installed.
• Yu Na
If a roof is installed without first obtainingan inspection,I agree to remove
an
Will the applicor future Wilding Occupant use equipment or devices which P g
emit hxrardnus air conlaminanu as dcftrcd by the Bay Area Air Quality Management all new materials for inspection.
District'
❑Y. it
hannealhehua twmamdalsm9uimmenuundr Chapmr6.95ufhCalifor-
niaHcaIthafey Cadc, cuW5,255J3 and 25534.l understand thatiftho Wilding
does not .dc?y nava a instant.Nat it a my mapra w nedfy the occupant of Inc
require nicnmunWmet winm era reoroccaparcy. Signature of Applicant Date
own car ammrariaed Ogen Date All roof coverings to be Class"B"or better
CITY OF CUPERTINO
gem 1 of 3 PERMIT RECEIPT OPERATOR: amyw
COPY # 2
Sec : Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 36212003 . 00
DATE ISSUED. . . . . . . : 04/13/2006
RECEIPT 4 . . . . . . . . . : 33979
REFERENCE ID # . . . : 06040073
SITE ADDRESS . . . . . : 809 SEPTEMBER DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : WU HWAI M AND BETTY M
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : ELK GROVE CA, 95758-
RECEIVED FROM . . . . : WESTERN ROOFING
CONTRACTOR . . . . . . . : MICHAEL LUNNEBORG LIC # 25896
COMPANY . . . . . . . . . . : MICHAEL LUNNEBORG ROOFING
ADDRESS . . . . . . . . . . : 1328 WHITE OAKS RD
CITY/STATE/ZIP . . . : CAMPBELL, CA 95008
TELEPHONE . . . . . . . . : (831) 278-1837
*FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---- ------ --- ------- ----------
BPERMFEE VALUATION 16, 000 . 00 234 . 36 0 . 00 234 . 36 0 . 00
BSEISMICRE VALUATION 16 , 000 . 00 1 . 60 0 . 00 1 . 60 0 . 00
---------- ---------- ---------- ----------
TOTAL PERMIT 235 . 96 0 . 00 235 . 96 0 . 00
•
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.
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 Y4 " 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
pp the above stated policy on re-roofing.
Homeowner's Name: �Rti W 1
Job Site Address: Sol Sorl eMbe Ur
Roofing Company Name: Inlo'fcra YwJ�ry t �� en
Applicant's Signature: Date: � z +Jy
• Greg Casteel
Building Official
Revised 11/2/04
l
Community Development
s 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
WUPERTINO
Building Department
JOB ADDRESS: I PERMIT #
O <SP , ef2 6 a(.K b 0-7 3
OWNER'S N (,, PHONE # of grtet, qr-tc—
GENERAL CONTRACTOF-- FAX # WrIl
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the awing 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
Tile
•
Owner/Contra or ignature Date
CITY OF CUPERTINO OQ0400T�>
• x!u, REROOF
CUPWINO PERMIT APPLICATION FORM
APN# Date:
3(02 - 12-OD ✓, �z-alp
Building Address:
SSO� S� er�C'
Owner' Name: Phone#:
/FUS 3L9 Z39 -3
Contractor: License#:
1,7 q f
Contact: Cupertino Business License #:
�nno�a
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
Wood Shakes ❑ Wood Shakes
Wood Shingles ❑ Wood Shingles `
13Q
Other(Specify) �B— Other(Specify) PA '\ rG —Me_
Number of existing coverings J❑ Provide I.C.B.O. Report# G lL p
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
—Te aa� 44tew+ I, I t i6q .lt C s
Residential ( Commercial ❑
Fire Zone: Yes ❑ No RT-, Confirmed with Planning Dot. if
there are any restrictions: Ll
Cost of Project: Type of Construction: Occupancy g p:
�—
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
•