07100186 CIT�' O�� CUPERTINO : < � T ':
BUILDING DIVISION PERMIT �����VT�� ����:�L�T1QN� :
BUILDING ADDRESS: � PERMIT NO.
7478 FALLENLEAF LN D& D�;ONSTRUCTION 07100186 .
ER'S NAME: PERMIT LSSUE DATE
CHUA, ROY AND TAN, KNG KER 1447 H�IMPTON DR 10 26 2 07
PHONE: SANITARY NO. CONTROL NO.
(408) 6E�6-5298
ARCHI'fECT/ENGINEER: BUiLDING PERMITiNFO
BLDG ELECT PLUMB MECH
� � � �
� O p LICENSED CON7RACTOR'S DECLARAT[ON
� V� I heccby afficm �at I am licenscd unJcr provisions aC Chaptcr 9(commcncing IOIJ DCSCI7pC10I1
; Z� wiih Scction 7000) af Divicion 3 of thc Busincss and Profcssions Codc, and my licensc is �i
?� y in fuli Corce andeffect RE—ROOF' � PLAYWOOD 1/ 2 � 2� SQS � 1/ 3 0 LB � CLASS A
�� ? Licensc Class Lic. #
; E., O Da�c Conuactor
� � ARCHITECI'S DECLARATION
�� U 1 undcrstand my plans shall hc used as public rcrnrcfs
,a
� � y Liccnscd Pcufcssional
� y � OWNER-BUILDER DECLARATION
j a� I hcrcby alTirm that I am excmp� from thc Canvactor's Liccnsc Law Cor thc
: p O [ollowing rcason. (Sccdon 7(131.5, Business and Profcssions Codc: Any ciry ar rnun�y
e°� which requires a pertnit to cansuuc4 alter, impmve, demulish, or �epair any swcwre
? Z} prior to iLC issuancc, also rcquiccs �hc applicant Cor such permit ta filc a signcd siatemcn�
� x � �hat hc is liccnscd pursuant to thc provisions oC lhc Conlractor's Liccnsc Law (Chaptcr 9 iq. Ft. Floor Area Valuation
u F- �(commencing wi�h Scction 7000) of Division 3 of Ihc Busincst and Profcssions Codc) or � 9 O O O
,, �.. �hat he is exempt thercfrom and the bazis Cor the alleged exemption. Any violadon o(
Section 703 t.5 by any applicant Cor a pem�it subjects �he applicant to a civil penalty of A Number Oeeupaney Type
not morc than five hundred dollars (5500). 3 r j g 2 g � 2 �.$�
❑[, as owner of tlie proper[y, ar my cmploycrs with wages u their solc compensadon,
will do �hc work, and the suuaure is nae in�ended or offered far sale (Sec. 7044, Business
and Peofessions Code: The Conuactor's License Law docs not apply w an ownu of Required Inspections
praperty who builds or improves thereon, and who das such work himulf or �hrough his
own emplayccs, providcd that such improvemems are rwt in�ended or olieced for sak. IC,
however, the building or improvemrnt is wld within one year oC completion, the owner-
builder wilt have the burden of proving that he did nat build or improvc for pmpo,u of
salc.).
❑ I, as awner of the propetty, am exdusively conhacting with licensed rnnuutors to
construct the projett (Sec. 7044, Husiness and ProCessians Cade:) The Coolnctar's Li-
ccnse Law docs not appty to an awner of propeny who builds or improvas the2on, and ,
who convacts [or such projects with a conuactor(s) licensed pursuant to the Convactor's
License Law.
vn exempt under , B& P C for �his rcason
_..,,« :� oa� 07
ORKER'S G PENSATTON DECLARA710N - �
I hereby affitm under penalty of perjury one of U�e folbwing declarationz
❑ I hsve and will maintain a CeniGcatc of Consent to self-insure for Workcrs Campen-
sation, as provided for by Section 37a0 of the Labor Code, far �he performance a[ the
work far which Nis permi[ is issued.
❑ I have and will mainwin Worker's Compensuion lnsurance, as required by Section
3700 0[ Uic Labor Co�, for thc performancc of the work for which Nis permit is issiud. '
My Worker's Compensation Insunnce carricr and Policy numbcr are:
Cartier: Policy No.:
CERTIFICATE OF EXEMP!'[ON FROM WORKERS'
COMPENSATIONINSURANCE
(1'his scctian nced not bc comple�ed it the permit is for onc hundred dollars (E I00)
or Icss.)
I ani(y Ihat in thc performancc of c w fw which �his permit is issucd, 1 shall not
employ any person in any �qyy� o c ortw ect w die Workcrs' Campensauon
Laws oC Califomia Datc L(� V
Applicant
NOTICE TO APPLICAM: If, a(tcr making this Ccrtificaic of EzcmpGon, you shauld
become subjcct a thc WorkcPs Compcnwtion provisioas of thc Lshor Codc, you muu
. O forthwi�h comply wi�h such provisions or this permit shall bc dccmcd revokcd. "
z � CONSTRUCI70N LENDMG AGENCY
[-� � I hcrcby atlirm Ihat there is a consuuctinn Icnding agcnry Cor the performance uf
4�i � �hc wurk Cor which �his permit is iuued (Scc. 3097, Civ. C.)
a Q Lendcrs Namc
� z L.ender's Address
U Q 1 certify �ha� I havc rcad �his applieuion and statc �haz Ure abovc infortnauon is
w� correct. 1 agrce to comply with a11 city and county ordinances and sute laws relaang w
p U building conswction, and hcrcby au�hori�e rcprescnutivcs of �his city to cntcr upon thc
abovc-mcntioncd propccty for inspcction purposes.
E ,'�"„� a (Wc) agrce to save, indcmnify and kecp harmless ihe Ci�y of Cupertino agains� y
H � liabilidu, judgmen�s, cos�s and expenses which may in any way accruc against said City
(� ,'� i� conxqucncc oC �he granting of this permi�
""' APPLICANT UNDERSTANp AN I L MPLY WITH ALL NON OIM' Issued by: Date Z�! ; ,L
SOURCE REGULATI � � O
Re-roofs �
Signawrc af Applicant/Conuactor �
Hnzaxnous ATERIALSD[SCLOSURE Type of Ro��f
Witl the applicant w future building accupant store or handle haiardous mau:rial
:fincd by Ihc Cupenino Municipal Code, Chaplcr 9.12, and thc Hcalth and Safety
__.�. Scction25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑ Ycs Q No
w�n u,� a��r��� o� mw� m,,;ias� «�Pa�� „� � o� �ri� .,nkn If a roof is i nstalled without first obtaining an inspection, I agree to remove •
emil harardous air con�aminants az defincd by the Bay prca Air Quality Managcmcnt all new mat �rials for inspec�ion.
District? �'�
❑ Ycs � Nu / / �
C L- �
1 havc rcad the iwardrnu maicrials requircmcnu undcr CNaptcr 6.95 of ihc Califor- �� � q�
nia Flcalih & Safcry Codc, Scctions 25505 25533 and 25534.1 undcrsiand �hat iCihe building ---"' � (J �
does not curten�ly have a ih t't my responsibility to no�fy U�e occ t of ihe �
reyuirc mus � o wissu o(aCcnit'ica�co� ' Signature o} Applicant � Date
;� rD �
Owncrorauthori�.cdagcm D ,� All roof coverings to be Class ��B" or better
. -r- .D� �o�� �C�
- .� :-.
CITY OF CUPERTINO '�` `� -- •
� �,,,
REIZOOF
CU�'ER PERMIT APPLICATION FORM
APN # Date:
�,��-2� --�=2 �;,�� ���2� 1 �
Building Address: ,
'�4".�� F���� .�r c�:rc�?i� , �� 9 �vl �
Owner's Name: Phone #:
� 0 Y C� /a l t�F a 2 s ����1
Contractor: r License #: ^ $ � � , /
� � Cl'ivi Sfi�'k c fr� �`�
Contact: Cupertino Business License #:
�� �
a , ��:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ ,Built-Up roof
❑ Asphalt Shingles �� Asphalt Shingles
�W ood Shakes 0 W ood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other (Specify) O Other (Specify)
Num,ber of existing coverings i ❑ Provide I.C.B.O. Report #
�To be Reinoved ❑ Provide Mfgr. Installation Specs.
I Ha�e Read, Understand and Will Com ly With Cu �ertino's Tear Off Policy:
Job Description: � u w ' ° � 3° ""
� - � � ���; �,, �- �
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning De�t. if
there are any restrictions: LJ
Cost of Project: ��� Type of Construction: Occupanc gr
��:
Qty. if
Applicable Fee ID Fee Description Fee Group
BPER1Vg'EE ]31dg Permit Fees BUILDING
BENERGY Energ BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
' � Community Development Department
� Building Division
� � City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
Fax: (408) 777-3333
Building I)epartment
Subject: Re-roofing policy for the C'ity of Cupertino
1. Prior to permit issuance, you must agre � to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
2. New roof coverings shall not be appliec. 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 :nspection is required.
6. Any roofing which is applied without f:rst obtaining an inspection,
will require the removal of all new mat��rial down to the sheathing,
so a proper City inspection can be perfc rmed.
7. NOTE: If you call for a plywood nail ir�spection and the job is not ready,
you will be charged a re-inspection fee ��f $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: R�� C H `� �
Job Site Address: ���� �� � L ��� L � A�` L r-►
Roofing Company Name:
� �-- t O r 2�� 2 t���-
Applicant's Signature: Date:
Greg Casteel
Building Official
Revise � 11 / 2/ 04
CITY OF CUPERTINO
2 ITEMS OF 2 PERMIZ RECEIPT OPERATOR: patg
COPY # : 1
Sec: Twp: Rng: Sub: Blk: Lot:
APN ......... 35928020.00
DATE ISSUED.......: 10/26/2007
RECEIPT #.......... BSG00003091
REFERENCE ID # ...: 07100186
SITE ADDRESS .....: 7478 FALLENLEAF LN
SUBDIVISION .......
CITY .............. CUFERTINO
IMPACT AREA .......
OWNER ............: CHi;A, ROY AND TAN, KNG KER
ADDRESS ..........: 74%8 FALLENLEAF LN
CITY/STATE/ZIP ...: CUFERTINO CA, 95014-5805
RECEIVED FROM ....: KNCKER TAN •
CONTRACTOR .......: ENLE WLT LIC # 23939
COMPANY ..........: D & D CONSTRUCTION
ADDRESS ..........: 1497 HAMPTON DR
CITY/STATE/ZIP ...: SUI�NYVALE, CA 94087
TELEPHONE ........: (4C8)666-5298
FEE ID UNIT QUANTITY FMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
BPERMFEE VALUATION 9,000.00 158.76 0.00 158.76 0.00
BSEISMICRE VALUATION 9,000.00 0:90 0.00 0.90 0.00
TOTAL PERMIT : 159.66 0.00 159.66 0.00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER '
----------------- --------------- --------------------
CREDIT CARD 159.66 MC
---------------
TOTAL RECEIPT : 159.66
Comxnunity Development
� 10300 Torre Avenue
` ' Cupertino CA 95014
Telephone (408) 777-3228
CITY OF Fax (408) 777-3333
CUPEt�TINO
Buildi�n De artment
JOB ADDRESS: PERMIT #
—� �( 2 � �- t,�.Q-� �S� Z �,, �� l �� c �' �
OWNER'S NAME: v �e PHONE # `7 Z.l -- �� � '
GENERAL CONTRACTOR: � , � FAX #
I am not using any subcontractors:
Si�nature Date
Please check a licable subcontractors and com lete the followin information:
SUBCONTRACTOR BUSI1� ESS NAME BUSINESS LICENSE #
Cabinets & Millwork
Cement Finishing
IIectrical
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
�' �?IS� /0 ��]
Owner/ ntractor Signature Date