03030003 CITY OF CUPERTINOs;~ ' '�'r, �s•' °_`'` �' • n
BUILDING DIVISION PERMIT CJN 'RA� UR INi•'Q�MATIO,
L:IUILDING ADDRESS: PERMIT NO.
10012 BYRNE AV 03030003
OWNER'S NAME: 42035 OSGOOD RD PERMIT ESUS DATE
FERNANDO KONG 03/03/2003
NE: SANITARY NO, CONTROL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�00 LICENSED CONTRACTOR'S DECLARATION Job Description
0
I heathy Affirm that T em licensed under provisions m Chapter 9(commencing P
with Section
' 7IXhi aftivialon3of Ne Bual send rofcu
lnw Cwe.m
dmylicenwts REROOFin fail fee faC `' -7S 77y "T
� License T O SH
AK
1
G COMP .
Dam Catrector . O 4 tew
mARCHITECT'S AT
g nw shall W used as public meords
dsaLicensed Professional JJAr��_...���
OWNEan attempt
.GER DECLARATION I{
F I hmenu .Ruse that I I.S.accept from the Commences is :A License Lew for the IILI,I
ye o following uires a(Saito]031. t.after. eM Profeulens Code:Any city or County I
M12� which its Issuance.
•permit re cnnstracL alter.hnineve,demolish.t fl repair any. atroctare
v,�t^^ poor qual he incensed 0.sanmquims lrespplis offmsuchp =', Olese,Law mtstemcnt
qqq < titommIs ercialwdpuntion7 dmpmYivim.3.CCOnVCmrinianIDIJW(chapter DO)CIT Sq.Ft.Floor Area Valuation
$ 'hat he sc ampth Section 7 ad the
O all f r nrthe Business eaxend on.Any
vi Cmk)or $7825
len he 4 eumpt therefrom end the baa for the alleged exemption.Any violNon of
Salon 7031.5 by Any appllcant for a permit subjects the eppliant to a civil penalty of [{PjQ j��ID� O OFf Occupancy
not men Ow hundred dollen($300). 3j']16 �/ Type
art N
0 1,u owner of the property,or my employees with wagon u thea sok wmpenabon,
willdo de work,and the&net..btutkknded aaaened Waste(Sec.7011,Business Required Ins actions
And Profassam,Code:The Communes Llceue Law does not apply to an owner of 305 — FRAME q P
.. property who builds orimprowsthemon.andwhodaonsahwork himulforNroughhis -- - -3.07 - INSULATION
ownemployea,provided that such Improvements want intended entreated forale.Ir,
lamever,the building or Improvement issold within one yea ofeompledon,the owner. 601 - ROOF TEAR OFF
builder will hew the burden of proving Net M1e did Wt build or Improve far purpose of
aa•)• 602 - ROOF PLYWOOD NAIL
❑1,n twiner of tie property,same aclwively Contracting with licensed antrums to 603 — ROOF BATTENS
awvuct the project(Sea 7044.Business and Profession,Code:)The Convector's U.
cense Law does not apply to an mover or temporly who bunds at Improves themes,and, 604 - ROOF IN-PROGRESS
who Contracts for such projects with a contractor(s)licensed parbtsm to the CormactoM1
Loewe Law. - -
0lameacmplismansea ,Bk PCfoethism•son
ver
Data
WORKERS COMPENSATION DECLARATION
1 hereby afiimt under penalty or perjury on of les following declarations:
)nuns and will for by eCeW3nu of the sent to Labor
Colo.for for performance
of me /
uaftes Camper.
rian,u provided for by Section 3700 of the Jaber Code.for Ne perfarmaae or the IY`v/y/"A✓.///T
wait for which this permit Is Issued.
0 I leve And will maintain Worlmes Compensation Insurance,u required by Section
3700 of tho Labor Codc,for the performance of the work for which this permit Is issued.
My WorkerY nm mnitn lnsunnce Cartier and Pol num ram: X�
`C•vle7rSC
JCERTIP- ICA�EMPnONFROMWORKERS' � // )
COMP replete
(Thavednnnaampleted nolhetl lflhe permit informs:hundrctl dollars($100) J C/ r✓J,J
or kat)
1 ardfy that in the performance or the work for which this permit is issued.l OWI not
employ ny Parton in any manwrsoam;to become subject 0 the Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption.you should
become subject to the Warka's Compewadon provisiaru of the Iabm Code you most
.JO forthwith Comply with such provisions Car this permit sball be dcemW rewked.
CONSTRUCTION LENDING AGENCY I
[tern I hereby a Man that then a acoutructum lending agency for the performance of
W Q ft ers for Nemo kM1 lest permit a IssuedIssued(ger.3097,C11 C
LendJ
YZ Lender's Address
U Q 1 coolly that 1 haw rad this application and main that the above information Is
U.!'+ concis 1 agree to comply with all city and county ordinance,and suss laws mating to
0 rV^ building convection.and hereby authorim representatives of this city to color upon the
W ahow-mentioned property for Inspection purpose.
4 (We)same M saw,indemnify ad keep hmrmleu the City of Cupertino 111WIL
to )abilities,judgments,calls and expenses which may in my way sane against aid City
V in eonaequenee Crime jamming of this permit. -
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT ALL NON-POINTIssued by: Date
SOURCE R LA7ION/
� ( � '/3 Re-roofs
'gnuurc of PP HAZARDOUS MATERIALS DISCLOSURE D Type of Roof
Will de applicant m(no=building occupant store or hander hmudow mateoal
u defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
e,salon 25332(•j7 11//No All roofs shall be inspected prior to any roofing material being installed.
❑Yu y3
Will the applicant or future building occupant on equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
L Wardnus air contaminants at defined by the Bay.Area Air Quality Management all new materials for inspection.
District?
Dyes )(No
I have reauRl the h,Secdo,25505,2553 and lul255 u.1 and star 693 of the Ctlifng
r.
nim Halle&Smcly Cada,Sadons23N13.23337 and 35334.1 unticnumd thstlfthc building
Joos nal cumcn0y eve A tenser,)bel it h my rcepondhllhy m nodl'y the acupanl of the
require ISO uthe ma 'or uT".rRoc ' attar up Y.� Signature 1 I ate
sev
J All roof coverings to be Class"B"or better
Owner orsuNo red rel Date
Community Development Department
Building Division
a J ' City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
CUPEkTINO
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: �e��AhO � l�otnnq
Job Site Address: 1�>yrvi e-
Roofing Company Name:
Applicant's Signature: Date: -3 3 3
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper