05070098 (2) BUILDING DIVISION PERMITCONI'RAG�"TOR INFORMATION
Bu1LDINGADDRESS; MBROWN CONSTRUCTION, INC PERMIT No.05070098
W NER'S NAME: PERMIT ISSUE DATE
E; SANITARY iF'lONTROL N0,
ARCHITECT(ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 0 0
O Zp LICENSED CONTRACTOR'S DECLARATION Job Description
w 1 Wrcby affirm NM o
Load 1 am licensed under provisions Chapter 9(commencing
,ZW with Section 7IXIU)rf Division 3of NC Busies...and Prusg�n7Codc.ad m
nyliccnso is
^<^, in full forceeand�-Off
License ?� � — VY G.Z
;�= e i—L".g REMOVE 2 LAYERS, INSTALL APPROX . 29 SQUARE FEET
—o Daws conmaECT OF CLASS A 50 YEAR COMPOSITION
'J` sslt
ARCHITECT EC RATION
v�ree
1. '1.. hall Nupublic records (FLAT SECTION NOT INCLUDED)
JyV
T LLa Lxenxd P fdssionel
Oat I am exempt
from
DECLARATION
<E I hereby affirm than I am exempt from Ne Contractor's ra :Any c Law for the
o O which
moon.(Section 703L.3.Business and e.de Professions Cndr:Any city of county
K m which requires a permit to construct.th Pimp resume.h Perlia or repair any structure
semi priormits issuanre.alw requires the applicant for such Permit to flcasigned summcm
< that hcislicensed pursuant toNcpmvWomofOrContracmhLittnmLaw(Chapmr9 Sq. Ft. Floor Area Valuation
YFG (commencing with Section VOW)of Division 3 of the Business and Professions Code)or p,�^
i
that he is exempt therefrom and to bssu for the alleged exemption.Any violation of
Section 7031.3 by any applicant for a permit subjects the applicant o a civil penalty of APN Number t'-` Occupancy Type
not more than five hundred della.($SM), .,sfa
01.as owner of the popped,or my employes ewith wages as their wiz compensation, a' �'s n
will do the work,and the moderate is not immodcd or offered for sale(Sec.Ram,Business , 00
and Professions Code:The Com rxctnfs License law docs not apply w an owner of
Required Ins CC ns�V;{
property who builds or improves thereon,and who doessmh work himselfor through his p[b'�
Own employ=,provided that such improvements art not intended or offered for mile.If. �
however.the building or improvement is sold within one year of completion.the owner.
builder will have than Wrdcn of proving Out he did not build or improve(w Purpose Of zees
natal.
❑1.as owner of Ne pmpmny,am exclusively contracting with lieeomed crnmuears to C
construct the project(Sec.7064.Business and Professions Code:)The Conuacwls Li. �f
cense law does not apply to an owner of property who builds or improves Nemo.,and (� /}mow
ma .e
who comcts for such projects with aeontmr(s)licensed pursuant w Ove Comm ictofs If
License Law.
Fl I am exempt under Sec. .B h P C for this mason
Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following deellamliome
I lmm and will maintain a Certificate of Consent o self-insum for Worma's Compcm
nation,as provided for by Section 37M of the labor Code.for the performance of Ne
work for which this permit is issued.
❑1 have and will maintain Worker Compensation Insurance,as required by Section
37W of Ne labor Code.for the peffarnimme of Ne work for which this permit is issued.
My Wmkefs Cmm bu'on Insurance cam.e,and Policy number am: �7
Cartier: �. 'g-�ys gi/ Policy No.: II J' ja __7/
RTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
pTumdic n rued not W complOmd if Use permit is Inform hundred dollars(SIM)
or Irm.)
1 certify Nat in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as to become subject to the Workcri Compensation
Laws of Califrmla.Dare
Applicant
NOTICE TO APPLICANT:If,arm,making Nis COmEcam of Ezcmptirn,you should
become subject in the Workers Compensation p mvtsiom of Oe Iavar Code,you mum
.J O foMwith comply with such prnvism.or this permit shall be decmcd ranked.
Z CONSTRUCTION LENDING AGENCY
(–sem IWmby affirm Wt there is a construction lending agency or the performance of
C the work for which Nis pennot is issued(Sec.3097.Civ.C.1
fig] 0 lender's Namc
_,� Lcndera Add=
U C) I certify that 1 have read this application and sum Nat use above information is
r correct I agree w comply wish all city and county ordinances and some laws relating to
C U building construction.and hereby airborne,mpresenatives of this city to enter upon the
W above mentioned property for inspection purposes
,r C (We)agree to more,indemnify and keep harmless the City of Cupertino against
N liabilities,judgmenserims and,apenxes which may in any way scenic sgmus,said City
U Z APPOof me training I
L CANTUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE ULATIO . – ' ? C'(
O J Re-roofs
Signature f pplinnUConuacwr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
W th applicant or forum Wilding occupant mom or handle hazardous material
as defincil by the Cupertino Municipal Cndc,Chapter 9,1 2.and the Hc.lO and Safmy
oda.Securnz55320)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yrs
Will the alrylicam or inure building occupam um cyuipmcm or Jcvitts which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants as defined by than Bay Arca Air Quality Management all new materials for inspection.
micR
71 Yes �
Ihavc read the Wrsrd,m aurialsrequinents undcrCMper6.95 ofthe Califon-
ria Heal"Safety Code,Secti 25YJ5,3553 mand 2553x.lundc.und thatifNe Wilding
does not currently have a bu am,Onto i* responsibility to notify the occupant of the
.quimmcnts n hmpmbcmetpri maurm,of.CcmfimamofOcm Signature icant. Date
I d JS All roof coverings to be Class "B" or better
Owner or l dived agent Doc
CITY OF CUPERTINO
1 of 1 PERMIT RECEIPT OPERATOR: kiersaw
COPY # 3
Sec: Twp: Rng: Sub: Elk: Lot:
APN . . . . . . . . : 36917052.00
DATE ISSUED. . . . . . . : 07/18/2005
RECEIPT #. . . . . . . . . : 30405
REFERENCE ID # . . . : 05070098
SITE ADDRESS . . . . . : 6354 BLACKWOOD DR
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . : CUPERTINO
IMPACT AREA . . . . . . .
OWNER . . . . . . . . . . . . : IAN AND MYOUNG KANG
ADDRESS . . . . . . . . . . :
CITY/STATE/ZIP . . . : CUPERTINO CA, CA 95014-4617
RECEIVED FROM . . . . : MBROWN CONSTRUCTION
CONTRACTOR . . . . . . . : CHRIS BROWN LIC # 25108
COMPANY . . . . . . . . . . : MBROWN CONSTRUCTION, INC
ADDRESS . . . . . . . . . . : 702 S. DANIEL WAY
CITY/STATE/ZIP . . . : SAN JOSE, CA 95128
TELEPHONE . . . . . . . . : (408)260-1260
E ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 6, 000.00 126.36 0.00 126.36 0.00
BSEISMICRE VALUATION 6, 000.00 0.60 0.00 0.60 0.00
---------- ---------- ---------- ----------
TOTAL PERMIT 126.96 0.00 126.96 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
OTHER 126.96 AMEX
TOTAL RECEIPT 126.96
x Community Development
10300 Torre Avenue
' Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building De artment
JOB ADDRESS: ufer1-wO� PERMIT #
&3csdLjnd 12. cf-�, OSo-?vo q- cf�
OWNER'S NAME: fM PHONE # SS-
GENERAL CONTRACTOR: . c 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
Tile
ner/Contractor Signature Date
Community Development Department
- A� Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E IST I N O 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: Myr• q, firs, Lgpl�
2Wd - Q •
J 1Job Site Address:
Roofing Company Name: M & 2n CoASA-'Uclicl , JMC -
Applicant's Signature: Date: of
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
tig CITY OF CUPERTINO
�� REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
3cdl� ��-osa� -�_ � �•d�
Building Address-
63
ddress:G s� I� � ,�. J•w
Owner's Name: Phone#:
a�I c o�N ,�a✓L py• 293 i265�
Contra r: Phon License#:
A-K-61-04Cmpsl✓o ,,d�. Jnr . 41 . Z 2-
Contact:,,
Contact: Ph ne#: Cupertino Business License#:
mus a - uv• 06 (0
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
K Asphalt Shingles K Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing covering ❑ 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:
Job" es
Description:
n 2 1-9 I-- 01 l0 I r�v'-
Residential Commercial ❑ ut
(1—VA+ S-eG{-kin 0o4" inJjQeC(
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Projecg Type of Con stjuction:r Occupancy group: S
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