03120112 e CrrY OF CUPERTINO "R' •�' `` °k
BUILDING DIVISION PERMIT CONTRACTOR�INFORMATTION
k" BUILDING
ADDRESS: PERMIT NO,
03120112
OWNER'S NAME: PERMIT ISSUE DATE
FENG YE
ONE: - SANITARY NO. CONTROL NO.
ARCIRTLCT/ENGINCIAL BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
o o
vOO . LICENSED CONTRACT'OR'S DECLARATION
with Section Job DESCrI I1O❑
d C 1 hereby ffrm that l am licensed under p ''. ns of Chapter 9(commencing P
b witcnion](r�) fDivision3o(NCBusincasandP�5#ycAsinn.Codc,anJmylitenacis nn^n n
_I2Inraufnmq�adTdeffet. ,?�•y S__ ��� REROOF �yu��L E0
=2 Lice '��la�ss�� L�c^a
t;, Dalc �c limitation CONTRACTOR: WESTERN ROOFING
AR ITECP TION MAR
oxU 1 under my plans shall W used as li tc reecods M `R ' 1 2004
T o C; Licensed Professional • ^
a3 OWNER-BUILDER DECLARATION SUI �.V`IIIa
0 I With,reaso .,fere on 11th cxmnpt from the Cssions o :License Law for the ® L®
o O followhich re reason.Permit
t ]1131 3,Business and improve,
de Professions Cole:Any city or county
m tui which its
a pc also m construct,aalon,pplicant
ire for such
demolish,or a pair any tatement
d z i prior In its issmnca also r.to resthe the previsions
for Contractor's
iense Law stammcm
<
that
comme cingwiitpur,tion7(,ofDivio.nfthe CommnssandProflaonsCodma9 Sy. Ft. Floor Area Valua[i 6900
5f' (eommencingwithsectiournand the
basis for
of the
eged Business Professions
15§ that he u cacmpt IWmfrum and dde buts for the alleged cxcmption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to acivil penalty of APN Number ane Occu
not mote Nan five hundred dollar,($500). Occupancy Type
❑1,as owner of the property,or my employ,.with wag..theirsue compensation. 3 6924029 . 00
will do the work and the awemre is not intended or offered for sale(Sec.](Iced,Business
And Professions Cotler The Contractors License Law docs not apply to an Owner of Required Inspections
property who Wilds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within One year of completion,the owner-
builder will have the burden of proving Na he did not Wild or improve for purpose of
sale.).
❑I,as owner of she property,em eaClusivdy conuacting with licensed convectors to
construct Ne project(See.7044,Business and Professions Cotler)The Contractor's Lh
cense law docs not apply to in owner of property who Wilds or improves themon,and
who contracts for such projects with a coamostor(s)Blamed pursmnno the Contractor's
License law.
El am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
isI hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain v C.atificme or Consent o self insure for Worker's Compere
awian.as provided for by Sarson 3700 of the Labor Cade,for Ne perfmmame of the
work for which this permit is issuetl.
❑1 have antl will maintain Weeklies Compensation Insurance.as outlined by Section
3]00 of the labor Code,for the perform race of the work for which this permit is issued.
My W seer's Cnmpe.alion Insurance cooler num
and Polic Ise
CE TIFITE OF E) PTIONFROMW N S'
OMPENSATION INSURANCE
(Thu cation need not he Completed if the permit is forme hundred dollars(LBB)
or less) I
1 certify that in the performance of the work for which this permit is issued,1 shall ono
employ any person in any manner an u m Wco or subject to IW Workers Compensation
Laws of California.Date
Applicant I -
NOTICE TO'APPLICANT:If,after making this Ccnificam of Exemption,you should
become subject to the Worker a Compensation provisions of the labor CM..you most
z forthwith comply with such provisinm or this Permit shall W decmcd revoked. -
ZO CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a eonswetion lending agency for the performance of
z > the work for which this Fermi,is issued(Sol.309],Civ.C.)
CQ Lend.,',Nam.
= z Lender's AJdmas
U Q 1 certify that l have read this application and some that the above mr-muion is ^
ly F^ coned.1 agree m comply with all city and county otatiOca or and sure laws r upon
e V
pU abovengeonauadtion,and hereby auNonprposes. Olives of this city menter upon Ne
aMlvcmcnlion.d to ,tysaw,for coma fy an keep ha.
F y (W.)agree m uses indemnify and keep harmless the City or Cupcninu against
h Iivconsequ consequence
of the Staining
ind.apcnseswhich may in any way accrue againxl said City
Uz in consequenec of UNDERSTANDS
ur,his permit
'—' in URI,A UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:AA Date
SOURSE G ATIO S.
`* Re-roofs
Sig rerea AppliomuC ntracm Date
HA ARDO S MATERIALS DISCLOSURE Type of Roof
Willtheapplican or future building Occupant store or handle hararJous maedal
As
defined bj the Cuperinn M ipal Code.Chapter 9.12.and IW Health and Safety
cad..0YcAtion z553zlar. All roofs shall be inspected prior to any roofing material being installed.
Yoso
Willlthe Applicant or future building«.a and aa,. 'If a roof is installed without firs[obtainingan inspection,I agree to remove
pr, s o a Air rut of Marta which P g
it haramous air contaminants.dc0ncJ by the Bay Arca Air Qualify Management all new materials for inspection.
uuktT P
❑Ycx I�No
the mad the haaaNdmsma¢rials rtyuimroenu under Chap¢r695 oftW Caliror
ria Health&Safny Code.Sectors 25505,25533 and 25534.1 undersund that fifth.building
does nal a dy M1avC a Nnina that Il la my 2apgnallll fly b nllt'y the d<uPNI of th, xi
retuimm uihicA munWmnriormissuancc ofa Ccrufc��,,,,..,,,,,,..Ocapancy. �� Date
yi 22 O Ignature of Ap leant
owne ru eti,ed .n, v v Da,a Al roof coverings to be Class "B" or better -
OWNER—BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent,spouse or child) will perform:
A. — 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
be performed
v r: to'ST,IcZ 1. :. S F�lknl«i h'I Ts +Ms,11. S-4.t7t ?'q t - ,AS'1u//
4q , ZS ,UL.IB 624-70S lAt/d 9e fe k.e
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
�• 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: /2/!y/03
Job Address: 74S� Permit# U3iit000d
AU changes to the information provided on this form shall be submitted to the City of Cupertino Build
the information provided on this form shall be submitted to the City of Cupertino Build
• De_�artment.
_ City of Cupertino Building Department
CITY OF 10300 Torre Avenuer
C U P E IST 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 party 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 yourself 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 an Recycled Paper
a. Community Development Department
Building Division
City of Cupertino
V 10300 Torre Avenue
4CITY OF Telephone: (408) 777-3228
UPEkTINO 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 comply with the above stated policy on re-roofing.
c
Homeowner's Name: (� ry E k y E /�
Job Site Address: 7� 7� Z I,J * ' /� (Z— / (I C7
Roofing Company Name:
1
Apeellicant's Si�g�nature: �/L/ Date: —� —�
Greg t
Building Official
Revised 1/30/03 -
Printed on Recycled Paper
CITY OF CUPERTINO
GG REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Address:
� 2 — Z o
Owner's Name:_ \ C, �j) / ,y, , % one #: 2 gay
�liJ/� c�f`S /
Contractor:
A_ I I Phone#: L10 License#: 6 2SS_'
Contact: Phone#: J Cupertino Business License#:
L ++ )-Io - 6,6/-6697
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
Wood Shakes ❑ Wood Shakes
Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Nu er of existing coverings O Provide LC.B.O. Report#
❑ o be Removed ❑ Provide Mfgr. Installation Specs.
�. I Have Read, Understand and Will Cojnply With Cu ertino's Tear Off Policy: ❑
Job Description: s LAI) �J
Residential ❑ C ommer alb ('
Fire Zone: Yes ❑ No ❑ Confirmed with Planniniz Dept. if
there are an re inS. LIctio
Cost of Proje Type of ns c i Occupancy p:
r-
Qty. i
A ]' a Fee ID Fee Description Fee Group
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
r7 L
Z2�