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10090252 CITY OF CUPERTIN O BUILDING PERMIT BUILDING ADDRESS: 22322 CUPERTINO RD CONTRACTOR: PERMIT NO: 10090252 OWNER'S NAME: PON LEE DATE ISSUED:09/27/2010 1ER'S PHONE: 4089738826 i�; w l `_4 PHONE NO: ❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r ELECT r PLUMB r License Class _ Li..#---:z q4/o`T MECH r r RESIDENTIAL COMMERCIAL r Contractor Date D I hereby affirm that 1 am licensed under the provisions of Chapter 9 JOB DESCRIPTION:RE-ROOF REMOVE EXISTING TILES TEMPORARILY& REINSTALL AFTER ROOF APPLICATION.APPLY ONE(1) (commencing with Section 7000)of Division 3 of the Business&Professions LAYER OF TITANIUM UDL#30 SYNTHETIC BASE FELT 20SQ Code and that my license is in full force and effect. I hereby affirm under penalty of 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 Sq.Ft Floor Area: Valuation:$22800 permit is issued. APPLICANT CERTIFICATION APN Number:32650061.00 Occupancy Type: 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 to building construction,and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 18O DAYS OF PERMIT ISSUANCE OR costs,and expenses which may accrue against said City in consequence of the granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION. with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. / Issued by.r��-----"'.? Date: Signature Date__ && /l a L, OWNER-BUILDER DECLARATION RE-ROOFS: I hereby affirm that I am exempt from the Contractor's License Law for one of All roofs shall be inspected prior to any roofing material being installed.If a roof is the following two reasons: installed without first o7* mspeection,' I agree to remove all new materials for I,as owner of the property,or my employees with wages as their sole compensation, inspection. will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professions Code) Signatur of Ap licant: Date: 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7044,Business&Professions Code). ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER I hereby affirm under penalty of perjury one of the following three declarations: HAZARDOUS MATERIALS DISCLOSURE 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 I have read the hazardous materials requirements under Chapter 6.95 of the performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. 1 will maintain I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health& Safety Code,Section 25532(a)should I store or handle hazardous material. Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534. Compensation laws of California. If,after making this certificate of exemption,I become subject to the Worker's Compensation provisions of the Labor Code,I must O ner or auth rize n: J p Date: Z forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY APPLICANT CERTIFICATION I certify that I have read this application and state that the above information is I hereby affirm that there is a construction lending agency for the performance of work's correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.) to building construction,and hereby authorize representatives of this city to enter Lender's Name upon the above mentioned property for inspection purposes.(We)agree to save unify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address and expenses which may accrue against said City in consequence of the granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION with all non-point source regulations per the Cupertino Municipal Code,Section 9.18. I understand my plan shall be used as public records. Signature Date Licensed Professional M.Indoor Air Quality and Finishes 1.Use LmMONOC Paw 1 IAQ/Health pts y=yes 0 2.Use Low VOC,Water-Based Wood Finishes 2 IAQ/Health pts y=yes 0 3.Use 1v�&VOGAdhe bas 31AQ/Health pts y=yes 0 4.Use Salvaged Materials for Interior Finishes 3 Resource pts y=yes 0 5.Use Engineered Sheet Goods with no added Urea Formaldehyde 61AQ/Health pts y=yes D 6.Use Exterior Grade Plywood for Interior Uses 1 IAQ/Health pts y=yes D 7 S8da1 sed w l= 4 IAQ/Health-pts y--yes D B.Use FSC Certified Materials for Interior Finish 4 Resource pts y=yes 0 9.Use Finger-Jointed or Recycled-Content Trim 1 Resource pts y=yes 0 1 D.Install Whole House Vacuum System 3 IAQ/Health pts y=yes 0 N.Flooring 1.Select FSC Certified Wood Flooring 8 Resource pts y=yes 0 11se 33apidlyenenileoorif�g 1ateraa�s 4 Resource pts y=yes D 3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yes 0 4.Install Natural Linoleum in Place of Vinyl 5 IAQ/Health pts y=yes 0 5.Use Exposed Concrete as Finished Floor 4 Resource pts y=yes 0 6.Install Recycled Content Carpet with Low VOCs 4 Resource pts y=yes 0 1 1 1 r Total Points Available: 1 7401 1301 57 Total Points Project Received: 01 0 :::0] &datalprogslgn enbuDdngguidelines/remodelerstgreenpointsfina121204profeDled.ids Building Department City Of Cupertino 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: 408-777-3228 CUPERTINO Fax: 408-777-3333 CONTRACTOR/ SUBCONTRACTOR LIST JOB ADDRESS: Z 'Ott) - 4PERMIT# OWNER'S NAME: HONE#GENERAL CONTRACT R' GNESS LICENSE# ADDRESS: j q,I -Ji6-,KA- 4 ITY/ZIPCODE: •T C �� *Our municipal code requires all businesses working in the city to have a City of Cupertino business license. EULED UNTIL THE NO BUILDING FINAL OR FINAL OCCUPANCYION(S) WILL BE HAVE OBTAINED AHCITY OF CUPERTINO GENERAL CONTRACTOR AND ALL SUBCONTR CTORS BUSINESS LICENSE. a I am not using any subcontractors: '� Sig nature D e 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 Painting/Wallpaper Paving Plastering Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile Owner/Contractor Signature Date CITY OF CUPERTINO FEE ESTIMATOR-BUILDING DIVISION ADDRESS: DATE: REVIEWED BY: APN: BP#: "VALUATION: $22,800 I�PZERMIT TYPE: Minor Building Permit PLAP1 CHECK TYPE: Re-roof PRIMARYZ'(17;9L PENTAMATION 1SFDWLR00F USE: SFD or Duplex I()(�5 41"1 "I: PERMIT TYPE: WORK SCOPE FEE ID ROOF AREA s.r. 1 REROOFFRES 2,C OO I-P<<lt. ?'E,.rt Ch,c k Cta�-�- c' 1 ;,t( h�,ik t re'C.. P' mi Vc',: othui,Ah,cL Inst, Ol c. .Pi? rl;Inst, Li L OihcP 1 t`:c :r<V Li NOTE: These fees are based on the relimina in ormation available and are only an estimate. Contact the Dept for addn'1 info. FEE ITEMS(Fee Resolution 09-051 a. 7%1:10) FEE QTY/FEE MISC ITEMS Platt Chef"A Fere: Stt/)/1/. PC FCC Pltttrt/�:_11cch.'flee:f'/all C hcck: Permit Fee: $26C.00 C`ortst�-ltcti�lft 7�c�.�� Work Without Permit? 0 Yes E) No $0.00 71-ovel Ooulf;Mlwolion Fccs': Strong Motion Fee: IBSEISMICR $2.28 Select an Administrative Item Bldg_Stds Commission Fee: IBCBSC $1.00 SUBTOTALS: $26:3.28 $0.00 TOTAL FEE: $263.28 Revised: 9/22/2010 CITY OT CITY OF C UPERTINO Olt REROOF CUPtRTINO PERMIT APPLICATION APN# ,. � � ( Date: ® / Building A dress: Owner's Name: Phone #: Qn 4-o8 -73 -fig Z�, HOA: Yes ❑ No If yes, provide letter from HOA Contractor: Phone#: ewFax#: Cupertino Business License#: ContractorLicense #: K -V Type of Rc of Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) cZ4 ta Other (Specify) T(-e- t2ys4� Number of existing coverings ❑ Provide I.C.C.E.S. Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. Job Description: a, ,ex�sf' T�i�e f;� v ;l�.4 k,ejggk Q 0?w r4 Ill ca,(,0'L. C I) �' p 7'7' Fct/z r,-m #=:? U DZ_ #.fid , vtthef'` a oc, (.l) 57u"-k,"L&(. Residential Commercial ❑ Green Building: Please complete relevant portion of the Confirmed with Planning Dept. if Green Building Checklist &'attach it to the application or if there are any restrictions: ❑ applicable, include in plan set & the sheet index. Valuation: 22 ,x-00 I Have Re erstand and Will Comply with Cupertino's Tear-Off Policy: i Signature Revised 02/05/09