02080004 OF
CITY
I BUILD NO DIIVIISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10294 ANN ARBOR CT SANFORD ELECT 02080004
OWNER'S NAME: APPLICATION,sUR DATE
PAO CHU CHEN 20888 PROSPECT RD 08/ 02/2002
PHONE: (408) 996-9797 SANITARY NO. CONTROL NO.
ARCHITECTIENGiNEER: BUILDING PERMIT INTO
w C BLDG ELECT PLUMB MECH
Z N= LICENSED CONTRACTOR'SDECLARATION JobDescri tion
0 Z-G I hereby affirm that I am licensed under provist sof Chapter 9(commencing P
p_I_w with Section 7")of Division3ofthehismasp.n h;'. naCode, omylicense REROOF
acted -t is in tall force an (_[. 6433oS
S:.rc< License Clens Lic,a
pdU Counter
RCHITECi'S DECLA07
ON
1 un erstand my plans shall be usW u public rtcoNs
�r
w S p O Licensed Professional
a. OWNER-BUILDER DECLARATION
u� a I hereby aRtrm that I am exempt from t Cmuch tar's License Law for the
g-z< following auon.(Sation 7031.5,Business and Professions Code:Any city or county $9000
at F o which rtquims a permit to conswct,elmq improve,demolish,or"'Pair anY swetum
.3:_ ri're, issuance.also requirta the aPplleam for such pemtltmBleasignW
thn'ti 1,licfnn puquanttolM1eP,nYssiats of the Co._, License law lChaptcr9
«bmmeticmgg,,wjth Saµan 5tlD6)of Division l of the Businrl-and iull Any viola
i Code) �;j't,;'t-'3*2' tOFI)4•°f b a]' a f_ ""a Rt Valuation
orthatnhlr ekem ftllerefkm ind the basis for Ne aIle dezein d.An -`-+•max t.•._ .. .1 a.1:1'.;�.t
p gb fLq Y violation
-."croon 4011:5 lb any ap"icam for a permit aidneen,the ePplicem to a civil penalty
oras mo"'th mI ve Wounad dollars(a5ool. 3 0 S AFN P*W jrl"t`."'r\';) Occupancy Type
01as owner ofthe property, my employees withwagess their sole compensation. - - Q _ __. .
_
--will tlo'th 'work:and to structure s norm[ended' offered far mle'(Sa Ot144'
Blii d Professions Coe Th Contract L Law does not apply m on 601 ROOF TEAS WR9 Inspections 1
or t maner ugh hscown employees.leeessonopd%vethat such ime who does not
ntnded or 602 - ROOF PLYWOOD NAIL
8 P Y P p_vemenu art not intended or
ro
'crumpled .lie nowebwsulder ill have --m-__. ingtha-ithid no -ild or "------"---'"- - '- "___ - ------...
Wilding�or i-Provcmcn w eyearo _ ..__._ _..._.- _..____.__.._
'cSmpledon,the ownervbuildcr will have the burden of proving Not he did not Wild or 603 - ROOF BATTENS �;A>:re;•:•. �" r'.,;�o�r.a
improve for purposenfole.). 604 - ROOF IN-PROGRESS
- ------
rt', Di;uowner o(We property,am exclusively contracting with liccuW convectors to
calone'the project(SecIYI.)044,Business and Professions Code:)The Contractor's � ' '`>•`I'1Ei::^l pL:..,9 >liil:
Lice
La d«. , pplY t ncr Ih P Pent h W Id or p th rton.
_.and ho canRuis,for such P.,n.. io a contmctot(s).Tae sW pars ant to.the _.__.. _ ___..._ _
Contramol L erre la _ s_(trs�
r ❑lam x to deirse -1S t< D U \4 1
P Bd PC
far
o th aeon P�g�D<, n !'
Own r •!D a Da - !''
[ WORKER SCOMPENSATION DECLARATION BUILDING
-1 hereby (firm undert
ya pcnaity�f pc0ury oneof1hcfollowingdeclamtions:--
❑ 1 huv'unL'will'maoisrn -imu"' for Wnrkcr's
Compensation, as provlded-fin by Section 3]W'of-the Labor-Code; fur he
Perfurmance of the work for which this Permits issued,,IO\
01 h d wdl'maitn t Worker's Compc torn lnsuriiice i,'A14torid ly Section
3700 of ibLhoi CWe fivi he perform of Ne work for which this permit is
isu d.'My Wort' C rope f
il o Inc.ra rLLand Pnnot cdy to a.: .: ,u
ti' - a Pol cY Nall/'F4/��lT
CV,
f;1 �,t
r; :
-i :.U•P.inn .w...... �..,.:..-.,,..
[-CERTIFlC TIONO EXEMPTI O(1aYFR�TORF.ERS 4 'a'� :
°f " +' ' `COh1PENSATION INSURANCE•-s4 .n 1. " I
-+F�sy�._�-...>:,.-nen-;...._••_•_.:-:.:..,.t........._..e-�}.m..:....-.:-..y 4�. ...�..-.,��...�...._.�.-_..__._.__.____._.._____••_-__•
..,.. 1,...�
..o-. 1.:_
.tiv P'':(Thii union need not be completed if the permit is for one hundred dollars
(5100)or
s. I c<rury thaeiti the perfomw-o(the woe k f A ch th perm t s issued.l -
Shall n t e ploy'any'persbn n a'Y riunnc to bxom s bled io the Workers' I ,? 1. .:1„}f f."�.•T.
C6mpensatian Lows of C Tfom a.Date"
CE TO APPLICANT If'hfta ink gthlsC of t fExempf nyou hold T''.` 'p klp'); `11
cam
z femoro b!cct io the WorkerC rope' t pm sons Df the Lobo Cade yo t - -
Q forth th reply itn u h pro or th s pe T shall bed ❑ ked.
CONSTRUCTION LENDING AGENCY
!Yi 1 hercb Prm th t there a'construction lending age cy for the perrorma c ,._f
W th work forwhichth perm r s rssued(S< 3099 C vg6.9Z Utuidel's Name .C)
UZ I f•lll 1 1 ❑.11!1`
r ,.y
Istraydoul
have read this applic tion and etata that the rWw information is
a't- c6 ct.I agree to comply.wish all city dnd county ordinanmad d state laws relating
_U to building connirvctiou.and nc4ci authonee rcPmiumMoves ardiiietym miter upon
the abohm-mentioned propcny for inspection purposes.-,
(We)ag t dera ify,and kap harmless the City 6f Cupentno agami
fn'
liabilities.judgmemor.coodur aril expenses which may in any way acerae against said
V Z Airy sT UNDe or th grant ng f Nis pc t ` '
APPLICANTUWERSTANbS AND WILL COMPLY WITH(���LI�N/�piV:POI.W
SOURCE REcuemos }❑,t , ;'; r ,r rCl/) Issued by: Date
r SAgtt wrc1AIn-Ippl cantMont n r t D�l 4 Re-roofs
HAZARDOUS MATERIALS DISCLOSU E N
Will th ppl com f t W Id' g a apo t tam o Handle hamrdo:mate nd T e Of Roof-....
u of W by theCupcn Mi0 p 1 Cod Chapter 9 12 d the Health and Safety ypt t '--ern* -•* - -
Cotl Section23�� ({)�q )I 14' ll, 'tS sl. f „ tri � 'S1 zc �.t +1 qYC� V"I iar!Vi?p. t+. - A?1 -
4All roofs shall be ms ected nor,to any roofing,material.being installed,
zauroe i,epplant i r[ ebuilding in « p t seequipmentili d<deviceswhich If a roof is installed without first obtaimn an ins echon+LI agree tolremove
mnh zallo s cn is ants tl fried b)'heSay Arc AuQuality Mineg [ P -....--
°i1 v - all new materials for inspection _Applicant understands and will core 1 with
P,Y
vi)kll aD Y'I Jy� , 0+1 r� 'r r; , n - '•,"` - all non-point source f0gn18hODS _1 -
have tend:the h
mmenai req trementa.under CT pier 695 bf Ne -
Cal'forn a Health Sk Saf ty Code Sc ltd s 25505 25533 cid 255341 u ike t nd then
if the building does not rren ly h a tenant,that s_y rc po bil ty t aiTY th” - .- - .. - .. - .. (� �7
ocivp m of the requ rem Its h h,m t W met p m sssumc<os d C nthcme of - // N ` -t(s L^ .
Get
Y '. yin ✓C/y-1
' '`_ - • - _ nature of_Applicant _ Date
r. ower th arm ag t - ; t o t�(, All roof coverings to be Class "B" orbetter
J ` t _ ` ._
1 ----.. . _.OFFICE-.. . ._. ...._. . . .. .. ._ .._. _. _ . . ...
Building Division,
,�. 10300 Torre Avenue
Cupertino,CA 95014-3255
` Telephone: (408)777-3228
= &CITYO Fait: (408)777-3333
CUPERTIN®
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 that the
proper City inspection can be performed.
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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: 'Pa-z Cktk o/"
Address:
. Reroofing Company Name: _ S'c�/l1 D C6 Al q
Applicants Signature: UU
Date: o
Joe Antonucci
(Chief Building Official)
6/25/01