04090282 CITY OF CUPERTINO
BUILDING DIVISION PERMIT WONTRACTORANE RMATION "
Bu1LDlnc ADDRESS: ALLEGIANCE ROOFING PERMIT NO, 4090282
OWNER'S NAME: PERMIT ISSUE DATE -
CHI-WEN
NE:
SANITARY Pbr OL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
LE PLUMB MECH
I -A =
u0Z, LICENSED CONTRACTOR'S DECLARATION IobDescnpti _
mF 1 haffirm emby arm that I are licensed under provisions of Chapter 9(Commencing
U`uf with Sec 000)of Division3ofdm Busier d Profcsm,hocede.arWmylicomeis - - - --- ..
<a WmRme�derrefr.35 LK.g 7eQg REROOF W/SHINGLES OCT Llo ZOO4
j
LIZ Licenm Class
ZL—O DamConr
�: AR HGECTthammmRTION
jW e< 1 undersmnJ my Plans Mall he used as public meOrds
;p t; Licensed Professional
S OWNER-BUILDER DECLARATION
S± 1 hereby Affirm that 1 am exempt from the Contractors License law for the -
p O following mason(Seniun 7031.5,Business and Profeadom Code:Any city or county
m which myuims a permit to em undm.alter,improv,demolish,or repair any structure
z y prior to its issuance,also mquims the applicant for such Permit to tic a signed statement
t< that he is licensed purwantm We provision of the Conuacmr's license Law(Chapter 9 Sq.Ft.Floor Area - Valuaton
x~S (commencing with Section 70DO)of Division 3 of the Business and Professions Codc)or
�.. that he is exempt therefrom and the basis for We alleged eumption.Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant m a civil pemlry of 3'PEPD19:0**gr00 Occupancy Type
not mom Nan five hundred dollars(S500). _
0 1,As owner of the property,or my amplcym with wages as Weir sole compensation.
will do We work,and the structure is not intended oro@red for sale(Sea.70m,Business
And Prefessiona code The contractors Lt..taw dam nm apply m an owner of Required Inspections
pmpeny who Wilda Or improves thereon.and whodocssuchwerk himsselfortluough his --
Own employ=,provided Not such improwmenta am not intended or offered fmsale.If.
however,We building or improvement is said within one year of completion.We owner.
builder will have Wm Wrdcn of proving War he did but Wild or improve for purpose of
salt.).
0 I,As owner of the property,am exclusively contracting with licensed connections cors to
construct We project(Sec.7044,Business and Profession Code:)The Character's Li.
cense taw does not apply in an owner of propeny who Wilds or improve themon,ad.
I o conlmcuf` h cu with a cantmnm(¢)Ii sed pursuem to We Conuaanh - -
L'Wcme V
f7l am ez Copt undo B&PCin, n -
1307Mf} 7, e
wner \V.S� v Date --
W 'S MPENS ON DECLARATION
IherebY t under PcnaltY a( rjury one o(Jm following edantions:
thaw and will maintains Certifcam of Consentmself-imumfor Wof esCompm-
ien,m provided for by Section 3700 of We LaWr Code,for We perfmmanco of the
rk for which this permit is issued. -
1 have and will maintain Worker's Compensation Insumnco,as required by Section
0(WC Labor Code,fur We performance of dm work for which this permit is issued.
y Worker's Compensation Insumntt amu an'ddPolity number am,6;1 PmtgyN .
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This nation need not W compicuAl Bribe Permit is forone hundred dollars($100)
or less.) -
I anify War in the crfssmanee of Jus work for which this Permit u issued.I still not
employany pcao yuy m..C=reWcomc subject mWC Wmkcrs Compen¢atimi
Laws of Cil' lam
Ap him
VCot
N TO APP CANT: ,xfmr maki g th' Ccoifcam of Esemption,you should
become subject to We Wortrr's Compc Jo revisions of We LaWr Code,you must
0 ,Z forthwith comply with such provi¢iom o Permit shall be dcemmd mvokod.
z'O CONSTRUCTION LENDING AGENCY
(-+ I hereby affirm Out Were is a construction lending agermy tar the performance of
We work for which WO permit is issued(Sec.3097,Ci,C.)
U,A Lender's Namc
=z tender's Address
U C) 1 Goofy dial 1 haw mad Wis application and sum War the eWm information is
Iy U toilet I agree m comply with all city and county ordinances of and sou laws relating e
D U building construction,And hereby au.onp rposes. utiws of Nia city mento upon We
r abovemcntionrd rty for impaction purposes.
(~ 0. %( ;on
m saw,indemnify and loop harmless We City of Cupertino against s
rp liabilities,ja nu.cmu antl cxpcnusw ich may in yway acrnmagainst said City
UZ in conseq_' of.
f We gmmingaf Wis me it.
" APPLICA UNDERSTANDS AND IL'CO LY WITH ALL N(*-YOINT 1$ ed by: Date
SO ER GULATIONS.
L
Re-roofs
narure of APPlican on"
Dam
NA2ARDO000S ding DISCLOSURE Type of Roof
Wilby the Cui,e or fumm al Cg upanumm2.handle Health Andaetrcaus Safety al
As defined n We Cupertino Municipal Cod Chapter 9.13,and We Health and Sa(cry
Code. 0 Vti 255J2(a)? Na - All roofs shall be inspected prior to any roofing material being installed.
wdl We applicant (uWm building aocupant esu equipment or devices which If a 100 S instal d without first obtaining an inspection,I agree to remove
mit a vardoes air conumina u//s u defined by We Bay Arca Air Quality Management all n material for inspection.
Dislricl7 //// <
❑Yrs NO
IhevcmWd chaaardnusmamriasmquimmenuu rChapmr6.95ofthe Califor- / _)I)
— '
Imquimmenut
ix HraIm&Sof Codc.Satiom25 .25533am125534.I rsmmlhari(We Willing r / J
manicure ly ham a Conant War' u my msponsibilay o undly the occupant of We S v
hickmustWMet pmissuance hfaCOM CAM fOocpynCy. Signaiureofplicant DaI
woermaut dzcdagcnt / Dam - All roof colin 4 be Class "B"or better
Ism,
Community Development
F' 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Departqtent
JOB ADDIS: PERMIT # -6 2 �•
/ / lzno, jC�
OWNER'S NAME: PHONU
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signa - Date
Please check applicable subcontractors and c0m le '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 [k( C6C7lq C� jz�cc
Septic Tank
Sheet Metal
Sheet Rock
Tile
/C tractor Signa6re Date
Community Development Department
Building Division
Fet I City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
OUPEkTINO
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.
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: ^ ,� /
Job Site Address: 9091 13A/ZA/W4.19e-
Roofing Company Name: 4A6*M N C — /11'r,7 C7
App licant's Signature: Date:\ q Zry U Y
` �il/r6WDCJc1 ,
�• Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
ZUlsa- REROOF IPJ z�P Z
CUPERTINO PERMIT APPLICATION FORM
APN# � �So9O�d Date: � 2�
Building Address:
Owner's Name: Phone#:
Contractor: Phone#: License#:
�s},�v TSN✓Po y� s3�-9�s� ��o�'P�
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ,UK Asphalt Shingles 3 d ✓�
❑ Wood Shakes- - - ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) 7AdZ d dli9q✓&— ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
jja�I Have Read, Understand and Will Com 1 With Cu ertino's Tear Off Polic ❑
Job Description: ��Mo✓/�l fr rd/z < z 6E4� 0Y�2
M
Residential Commercial ❑
Fire Zone: Yes ❑ No❑�� Confirmed with Plann' t. if
there are any res ions:
Cost of Project ( Type of Construct io Occupancy gro p
Qty.
Fee ID Fee Description Fee Grou
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