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05080150 " CI'T'Y OF CUPERTINO -- BUILDING DIVISION PERMIT " CONTRACTOR INFORMATION: BUILDING ADDRESS. PERMIT NO SCL CONSTRUCTION CO. 05080150 l 1`1'79 S AT.T)FRRR1`1r1K T.TJ iNER'S NAME. PERMITLSSUEDATE FLORAW CHOU 1664 SAMRDRA ST ,08/17/2005 ONE: SANITARY NO. CONTROL NO. (650) 678-8311 ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 E-71 :ao LICENSED CONTRACTOR'S DECLARATION Ise FC 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description -iW with section b")af Diviskm 3 ofthe Biomedical Profcssinna ode.and ylicense is m full fince and effect. \ Lieen amm Lie• b e�/�O REROOF--REMOVE WOODrFSHAKE INSTALL COM. E Dam Cumamum t//. SHINGLES 44� ARCIETEcTs DECLARATION f p o!< I understand my plans shall he used as public reards YJ 5]s ta Uwnud Pmfcssmnal ZQ�S OWNER-BUILDER DECLARATION CU <7 1 hereby alfimm that 1 am exempt Imam the Contractor's License Law for the ad.. 00 following round.(Seclrun IUD 1.5,Business and Prefessoom Code:Any city or county 1N�lI Q B n r' n <S�i which mquircs a permit In comwcl,alter,improve,demolish.or repar any stratum, Lxi prior at its issuance.also minutes the applicant for such permit to file a signed statement 0 a that he is licensed Pursuant o the pmvsions of the Contractor's License Law(Chapter 9 Sq.Ft.Floor Area °a"lAa ll Ey a fiIiII use VJ�Valuation (contmocia,with Seen..7")of Division 3 of the B usmevsnd PmFosmns Cade)or i that he I,eaempl therefrom and the buts fm die alleged exemption Any vml.mm or $6000 Section 7 031.5 by any applicant for a permit subjects the applicant to a Civil penalty of APN Number Occupancy T Oat.. 0.five hundred dollars one 00). P Y YP e Q 1,of owner of the property,or my employees with wages as their solo compensation, will do the work and the machine machine is not intended m.11ted far sale(Sec.7041,Business 3G 3,613 5..1 vv and Professions Code.Thc Conractors Liscmc Law aces not apply to m owner of Required Inspections property who holds or impatient thereon,and who does such work himself or through his Own employees.provided Nat such improvements are not Intended orollered Orion,If, however,the building or Improvement Is sold within one year of completion,the owner- budder will have the burden of proving Nat he did not build or improve for purpose of sale). ❑1,as owner of the property,am exclusively contracting with licensed eunduars in construct the Palen(Sec 7014.Business and Profeasrons Code:)The Contractors Lt- emse law does not apply to an owner of property who builds or improves flcomm,and who contracts for such projects with a contractor(s)licensed pursuant to the Conlnclors Licence Law. I am exempt under Sec. .B&P C far Nis mason Owner Date WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of pegury one of the following dedn adom: the ve and will maintain a Cenificate of Consent to stiff-msum for Workers Compcn- smon,in provided for by Section 37W of the Labor Code,for the perfom mince of the work for which this permit is rssupd. ❑1 have and will maintain Worker's Compensation Insurance.as required by Section 3700 of thc labor Code,for the performance of the work for which this permit Is issued My Worker's Compensation Insurance tamer and Policy number art Comer, fGT.1 ?DUr�Policy No.. 3r�- CE FICATE OF EMMON FROM WORKERS' COMPENSATION INSURANCE (This section need not heeomplcted if the permit is farm.hundred dollars(II W) or less) i eemfy Oar n On performance of die work for which this permit is issued.l shall not employ any person in any manner a as m become subject to the Workers'Compensation Laws of California Da- Applicant NOTICE TO APPLICANT:If,after making Nis Ccmfcalc of Exemption.you should become subject in the Worker Compensation previsions of the Labor Code.you man ^J O forthwith comply with such provuma or dons Permit M deemed revoked. z h CONSTRUCTION LENDING AGENCY [-+ I hereby affirm Nat there is a construction lending agency tar the performance of Z the work fur which this pemm is issued(Sec.3097.Civ C.) lg)Q Le n it Na z Lea cr's A m^ .7 ddM l V 0 1 amify Thal 1 have(cad thn application and sate Nat the shove oformmian is Is. F' cmacL 1 agree to comply with all city and county monotones and sonic laws miamg to p U buddingce).9mmn.and t hereby lsonly naercpmuntaacsof this otymenter open the Y �� [Il above-mentioned pmperty for inspection patpous. LL (WC)agree to save,mdemmfy and keep harmless the Gty of Cupcnino agelnsi 1`q incomn,anceo mecoma and of this esmil. mey In any wey eccruc againsueiO City 1`,J z m PLIC NT of the granting of thin permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON.POINT Issued b Date SOURCEREGUL�pON —Q /1�' r�/I/)---v Re-roofs Signature of ApplicanUCo Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or forum building Co occupant store or handle h Health and as defined by the Cupemno Municipal Code.Chapter 9 12,and the Health and Safny Cale.Section 25532La)'i N All roofs shall be inspected prior to any roofing material being installed. Will the applicant or future Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove II hazardous air contaminants as dcfincd by the Bay Area Air Quality Management all new materials for inspection. I tn0o ❑RS I have &S9,1 the One,Sctwsmatena25533 t 235 under Chapter6eaddre Calif., rata Healthur Safny have a wham, atiti. myrand255301 m nobly Ifthent building of dots not currently have a tenant Nm a Is my rcspnnsMboy m nosily the occupant of Nc rcquiah:n h met pnurw issuance ofd.Ccmficatc of cup "_ b` �'/'�Y Signature of Applicant Date �b Owner sir aulhonmJ agent Date All roof coverings to be Class"B"or better ,-+°t Community Development 10300 Torre Avenue 'k 1F✓ Cupertino CA 95014 Telephone(408) 777-3228 CITY 0, Fax(408)777-3333 �UPEkTINO Building Department JOB ADDRESS: PERMIT #D S'2)(f0 OWNER'S NAME: ,C/oH-,�-^ /L PHONE # GENERAL CONTRACTdR: s �, , FAX# I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information 6d I SUBCONTRACTOR I 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 I Tile Owner/Contractor Signature Date Community Development Department Building Division L 1 City of Cupertino �= 10300 Torre Avenue CITY OF Telephone: (408)777-3228 Fax: (408) 777-3333 CUPEI�TINO Building Department Subject: Re-roofing policy for the City of Cupertino 17 Prior to permit issuance;you must agree to comply with 1997 UBG 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 Citv, 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: �r/O�✓{A` e!/X go(-A-/ Job Site Address: / e ZS / !/'�/t7r7tL Z-�L� Roofing Company Name: l l ��1. tios t . C e• , Applicant's Signature: �� Date: S tee- Greg Casteel Building Official Revised 11/2/04 CITY OF CUPERTINO $ aAF REROOF CUPEkTINO PERMIT APPLICATION FORM APN# 3 Date: n / ov Building Address: Owner's Name: Phone#: Contractor:-- Phone#: License#: Contact: , Phone#: Cupertino Business License #: l Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof O Asphalt Shingles M,,`A�sphalt Shingles Q/ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# ❑ To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cupertino's Tear Off Policy: ❑ Job Description: / el Residential Commercial ❑ ig(RC- IrC(L— Fire Zone: Yes ❑ No 12/ Confirmed with Planning Dept. if II there are any restrictions: LJ Cost of Project: Type of Construction: Occupancy group: Qty. if Applicable Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING 1 BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING / BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING p ? - 32---- r