03110035CITY OF CUPEW11NO �:r �a%'u n.'t roc ca w lw ^' ::�.t
BUILDING DIVISION PERMIT h,<,CONTRACTOR INFORMATION:
�UILDING ADDRESS: CROWN ROOFING INC PERMIr ,4003110035
OWNER'S NAME: 3535 RIFER RD PERMIT LSSUEDATE
HSIUYING TSENG 2003
ONE:
(408) 874-0784 SANITARY NO. CONTROL NO.
ARCIlliFF/ENGINEER:BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
100 LICENSED CONTRACTOR'S DECLARATION Job Description
G7 O O O
�U❑ 1 hereby affirm that 1 am lammed under provisions of Chapter 9 (commencing p
ZW with Section 7000) of Division 3 of the Baainutatmd Pr cssiou Code. and my license is
< mfull force and cif
;�i ueen elau�_Lie.N REROOF
e-t„❑ Datcr��3 Cuntnc
q � ARCIIITELTS OE
<3 Iundentnnd my plans shall Mused uhlic records
y6
eo Liccnacd Pmfcasional
<S - OWNER BUILDER Of: Co Cman ON
i 1 hemhy reason. (Sistfarm that 1 1 exempt from Ne Geatns Co e: Any c Law tattoo my
G O which
requiresaPermit
to co L5. Business and improve.
demolish.
e nu h. Or: Any city t county
5 $ rr which myuscs a permit is construct, alter. improve, dcmldi h, fi repair any nroctom 4
inn Oat tor oimissuanpursuantto the thof for Cohpermi',License Law (Chapter
�� that he is licensed pursuanttothe00) provisions of the Bummer nd Pro.law(Chapmr9 Sq. F[. Floor Area Valuation
` (commcneingwithsmtion7000) of Diasisfr Ror ameal Business andon, An iom GWe)or
� � $ that he is esempt therefrom and Use basis for dm alleged exempdom Any violation of 31631023.00
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number Occupancy Type
nm more than five hundred dollars (5500). P Y YP
❑ I, as owner of the property, or my employees with wages as their set, compenssti.n,
will do the work and Nestrunute is not intended or offered for sal, (Sec, 7044, Business
and Professions Cade: The Contractor's Limas, Law docs not apply to an owner of Required Inspections
property who builds or improves thereon, and who does swhwork himself., through his
own employees, provided that such improvements arc not intended oroRered for tale. If.
however, the building or improvement is a.ld within one year of completion, are owner.
builder will have the burden of proving Nat he did not build or improve for purpose of t�
/sem
❑ 1, as Owner of she property, am exclusively contracting with licensed contractors to
construct the proact (Ser. 7044, Business and Professions Code:) The Contracmri Li.
muse law coca not apply owner of property who Wildspre
or improves thereon, and
who contracts for such projec ctsu with aconmctor(U licensed pursuant oato the Comnftora
License Law.
❑ 1 am exempt under Sec. , B A P C for this moan %
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury oro of the following declarations:
1 have and will maintain a Cemificam of Consent to selbiusu a for Workers Corti
.alio., as provided for by Section 37M of the Labor Code, for the porfmmattce of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Iusunnce, u requited by Section
37W of the Labor Code, for the performance of are work (or which this rental is Issued.
My Worker,. Coampennssa�ti�o�n�lr1mmaraca Cartier and Paic num ort: MtI�
Cartier. Omit T^+w� Policy NoY1 I � � V `7 V
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This action need not bra complcred if the (.omit is fmonc hundred dollars ($100)
len.)
1 certify Nat in the performance of the work for which this permit is issued. I shall not
employ any person in any manner in as w bcmme subject o the Workers' Comremation
Laws of Caliromia. Dam
Applicant
NOTICE TO APPLICANT: If, after making this Ccrari ase of Exemption, you should
become subject to the Worker's Compensation provisions of the labor Code, you must
.,O forthwith comply with such provisions or this permit shall he deemed revoked.
r CONSTRUCTION LENDING AGENCY
1 hereby aMrm Out there Is a coustmctinn lending agency I'., the Fc,formmcc of
D:.�i the wok fur which this permit is issued (See. 3197, Civ. C.)
Uj Q Lender's Name
z Lcndc,. Add..
[) 0 1 certify that I have mad this application and state that the above inrormation is
Fcorrect. I agree to comply with all city and county ordinances and stare Ie%a relating to
0O building construction. and hereby authorin mpresenladves of this city to curer upon the
U above-mentioned prorcny for inspection purposes.
y (we) agree to save, indemnify and keep harmless the City of Cupmart, against
vj liabilities, judgments, costs and expenses which may in any way arcane against mid City
V 7 in consequence of the granting Of this permit.
�i APPLICANT UNDERSTANDS IL PLY WITH ALL NON -POINT Issued by: Date
SO CEREG AT S.
Re -roofs
c HAZ RDOUS MATERIA CLOSURE Dare Type of Roof (-
—
WilltheeppliemitOrfumrebuilding upants mor hantllehaaartlousmarerial
u defined by the Cupeninn Municipal Cod . .12, and Ne Health and Safety
oda, Section 25532(a)?
❑Yes ❑N. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
It haunnus air ecoaxn rants as defined by the Bay Area Air Quality Management all new materials for inspection.
Wrist?
L
C] Yes No
1 have mol the WnN.m mamrialsnequimmcw under Chapter 6.95 of thc Califon
riaH or ASafety Cude, Secdurm 25505. 57t and 25534.1 understand Nuifdx: huilding
Jses a curmml tenant, Na s y rc ihility a notify the omupant of N,
0, trtmcnts c s ma rat' c faCcnificomaflkcuposay. Slg atUr ofA Date
wneru authori' cogent Date A roof coverings to be Class nBn Or better
4
r�
CITY OF
UPEkTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
Fax: (408)777-3333
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 coly with the above
�stated policy on re -roofing.
Homeowner's Name: 4 u U /
S l i 1 l" 1 C ✓ en I
Job Site Address:
Roofing Company Name:
'i
plicant's Signature:
Greg eel
Building Official
rol
Revised 1/30/03
Printed an Recycled Paper
Date:1 � 7103
n
LJ
•
,
CITY O
CUPERTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
v:31 t 03�
APN # --
�>
Date:
Building Address: /Ovv
neq ellue
Owner's N . h
, [
c en
J
Phone
ion to :
()CD
P e #:
License #:
BUILDING
Q
Plan Check Fee
Conta f Phone #: Q
61
Cupertino Business License #:
all 6L
—q
V
Type of Roof Covering.
Existing:
Proposed:
❑ Built -Up Roof
❑ . Asphalt Shingles
Wood Shak
❑ Built -Up roof
� Asphalt Shingles
❑ Wood Shakes
0o ingles
❑ Wood Shingles
Other pecify)`❑/Other
Number of existing coverings
(Specify)
, Provide I.C.B.O. Report # ,
Tobe Reed �I
land
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand Will Comply With Cu ertino's Tear Off Policy:
Job Description:
I a' SPL M W tip. &b Q Mil SIA` e
A.DU44 bo
o " w < f cs r«+ �JG
Residentia
CommercialfV ❑
Fire Zone: Yes ❑ No ❑
Confirmed with PI ng D_pt. if
[here are an re tctions: LJ
Cost of Prg�ject:n
T e of Const ti Occupancy g up:
O
,t3'
Abnlicabl
t /
Fee ID
MEN
Frr Tleccrintinn
PPP (rnnn
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
23 %
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