04060099 CITY OF CUPERTINO
BUILDING DIVISION PERMITCONTRAGTORINT+ORMATIQN -(
BUILDING ADDRESS: JAMES LI PERMIT NOO4 O 6 O O 99
1
OWNER'S NAME: PERMIT MUE DATE
JAMES LI
ONE: SANITARY NO. CONTROL NO.
ARCHITECf/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+�+Op LICENSED CONTRACTOR'S DECLARATION Job Description
C 1 hereby affirm No
at 1 am licensed under provisions of Chapter 9(commencing
b olds Section]BBU)af Doiaion Sof Ne Businwand Profession,Code,md my license is
mma in fail furmcmdefrui REROOF
2 LKensc Cla{a Lic.Is
n F a DamContractor
ARCHITEcrs DECLARATION /
I understand my plans shall he used as public records Jy t
it OCD �I
Licensed Professional 1
g
OWNER-BUILDER DE CLARATION
0 I hereby mem mIfirmsec thm I e1.exempt Imo Ne Cosion;C a Liccmc Law for the
S oe O whichpollowre massa. emit t ](131.5,Business and ve,de tins Cade:Any city of county
1_ which qui e a p mit m mngnc4 al y,imp.c,d molksh.nr rep r a y sou sure
rZsprior to its issuance,also mquims the applicant for such permit to rile a signed statement
that W o licensed pursuant toshc pmvisiom of the Conuacturi Uaensc Law(Chapner9 Sq.Ft. Floor Area Valuation
(commencing with Smtion]BBB)of Division 3 ofdic Business and Professions Code)Or
y
but he is eaompt therefrom and the basis for Ne alleged exemption.Any violation of ernwnvn��
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of 3 GUTM Lfi a)elO 0 Occupancy Type
nt omore Nan five hundred dollars($500). P y YP
❑Lazowner of0rt pmpeny,or my employees with wages asNeirmle campenss0an,
will do she wort and Nesuucturt a mthma ded orofferW farole(Sec.7064,Business
and Pmresaia.Core:Tho Con=um'a License Law don trot appy m an Owner of Required Inspections
Property who bu ilds or impro ns thereon,and who denes such work h]msel f o r through his
own employees,provided Nat such improvements art not intended oroRered fosale.If.
however,the building or improvement is mid within one year of completion.the mi
Wilder will have the burden of proving that W did mot build or improve for ptopoe of
ssale�.).
ty I,as owner of Ne pmpeny,on exclusively committing with licensed contractors to
construct Ne project(Sec.7044,Business and Prof.sio en Code:)The Contractor's Li-
cense Law dors not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a eotraetoros)licensed pursuant w the ConuactaYs
License Law. ,
O lamexemptunder Sec. ,B&PC is
wner Dem v ( I t"
O
WOR�IOER'S COMPENSATION DECIl N -
Ik of by etrrsn under pemlty of perjury OW of be following declarations:
1 ban and will maintain a Cenificam of Conant to self-insure for WorkersCompcn-
.our,.provided for by Section 3700 of the labor Code,for the perfortnanre of the '
ooh for which Nis permit is issued.
❑I have and will maintain Workers Campemation Insurance,m required by Section
3]00 of the labor Code,for the performunce of the work for which Nu pemrit is issued.
My Worker's Compensation Insurance caller and Policy number are:
Carrier. Policy No.:
CERTIFICATE OF EKEMPTON FROM WORKERS'
COMPENSATION INSURANCE .
('Otic scetim need not beeompleed if the permit is form=hundreddollars($100)
or leas.)
I modify Nat in Nc perfnrmanec of the.,it for which this Permit is issued.I shall not
employ any person in my monerm as M become subject to the Workeri Compensation "
Lawa of California.Dam
Applic m
NOTICE TO APPLICANT:If.after making this Certificate of Escmption,you should
become subject to Yc Worker's Compensation provisions of Nc labor Code,you must
wJz fo"wids comply with such provisions or this Permit mail W deemed rented.
z O CONSTRUCTION LENDING AGENCY
[-+ I hereby affirm Nm there is a conmvctinn lending agency for NC Performance of
C' Om wish for which this permit is Wood(Sce.309T,Co.C.)
Igd Q landcfs Name
z Lender's Address
U 0 1 certify Nat I hale read this application and sure wt Ne above information is
{I,f-r corms I agree to comply with all city and county ordinances and some laws relating to
DU building consuuaioa,and hereby authoriterep¢smedives Of Nis city to enter upon the
menOe-mentioned pmPeny for inspection purposes
y (We)agree to save,indemnify and keep harmless the City of Cupertino against
en labilities,judgmenu,costs and expenses which may in my waysccrue against said City
U z in comequmcc of to grouting of this Permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS
t Re-roofs
Signature ofd cant o -nor Y Date
V HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant at form Wilding oceupotsmre or handle bava dous material
az dcBned by Ne Cupertino Municipal Code,chapter 9.12,and the H.IN and Safety
ode, 25532(e)?
no. All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or(umre building oe:upam use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
/ mit hanrdnus air co muninmss ea defined by NC Bay Ares,Air Quality Management all new materials for inspection.
Diatrmrt P
❑Yeave �a
I haroad the hardmmam
anrials mquirtmentsunder Chapter 6.95 of the Califor-
is Health&SafetyCedd,Sector.25515,25533 and 25534.]Understand Nasifthc Wilding
does not curta N
endy haw a roma it u my reapomihility m nobly tad acupmt of the /
rcyuircmcnu which must met priarmissuarccafa Ccrtificam a( cury
p .
:�� 1 G
j/�� g/} Si _ [ureofApplicant Date
o m oraudofindagent / Dart r All roof coverings to be Class"B"or better
Community Development
� 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRESS:
D ESS : PERMIT #
S, 6 / AV6- a q"06009
OWNER'S NAME: PHONE # k— / - d =
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
60 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
Septic Tank
Sheet Metal
Sheet Rock
Tile
/Owner/Contractor Signature Date
OWNER-BUILDER VERIFICATION
1. (Check one) I or myintm
A. ediate family (parent,spouse or child) will perform:
_/ All the work authorized by this permit
B. A portion of the work
C. None of the work
If B or C is checked, complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
v� `:a v.uccu
3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
AM Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
_performed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information(reverse side))
Property Owner's Signature- Date:
JobAddress: O .S• Q�an el� Permit# 46 ° 9
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
City of Cupertino Building Department
CITY OF 10300 Torre Avenue '
C' I P E kT I N O Phone: (408)777-3
Dear Property Owner.
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible parry of record
on such a permit Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself,you
may protect vourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family,and the work
(including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as
contractors or subcontractors, then you may be an employer.
If you are an employer,you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding,federal social
security taxes,workers' compensation insurance,disability insurance costs,and unemployment compensation
contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are
especially serious with respect to workers compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your
obligations under state law,contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor,only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit,erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department,
City of Cupertino
Printed on Racyrded Paper
l Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
' CITY OF Fax: (408)777-3333
UPEQ INO
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 andwy]T'comply with the above stated policy on re-roofing.
Homeowner's Na1m: --Vv"
1 p U
Job Site Address: o tp o S /�C�r�� Gv c ot, Tw o,
Roofing Company e: �l
A plicant's Signature:, �i- Z Date:
\rt/�S1/I�D�XI 1
L
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEkTINO PERMIT APPLICATION FORM
APN# / Date: 6 j
-ip -Il- o tt o
Building Addr ss: � n
1'"�'y'0 S . � L,<!-moi' �d-tv .
Owner's Name: Phone#:
Contractor: Phone#: License#:
O G�rite.n 77 .,0 $3
Contact: Phone #: Cupertino Business License#:
__J/97Y1, 44-M- 0 8
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
EI/Asphalt Shingles ❑ Asphalt Shingles
Ef Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑/Wood Shingles / ^ 1
❑ Other(Specify) t8' Other(Specify) /_l 1vT W Qy Cca C o(e
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 Cu ertino's Tear Off Policy:
Job Description:
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed withy4grininnMot. if
there are an strictions:
Cost of Project: 000 Type of Constructt n Occupancy
QIY•
A c ble Fee ID Fee Description Fee Group
BPERMFEE BldgPermit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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