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04040058 CITY OF CUPERTIN0 BUILDING DIVISION PERMITCONTRACTOR INFORMATION ;i: . = z lir. 'sof u BDILDING ADDRESS: RELCO ROOFING PERMIT No 04040058 222 CARMEN OW NER'S NAME: PERMIT ISSUE DATE PATRICK KWOK 3450 KAYLENE D 9 2004 ONE: SANITARY NO. CONTROL NO. (408) 926-7334 ARCI IITECDENGINEER: BUILDING PERMIT INE70 BLDG [CELT PLUMB MECH 0 0 0 0 goo LICENSED CONTRACT'OR'S DECLARATION w p I hereby affirm that 1 am licensee under p -' acts of Chapter 9(commencing Job Des fl Fes-- ac wish Section 7(1(In)of Diviaio 30fHC Businc.`s adfL�'rufcssinm Cotic.a dmyliccnse is 't1+1a6�01 in full fn dClef� ✓ �-1 t4� REROOF jai License I Lica Date C. me, MAY 6 2004 If��11ARCI117ELT5 DECI.AR N y�'yr 1 understand my plana shat)W used asp a records =o1- LieenaedPrmfeaaianal BUILDING g OWNER-BUILDER DECLARATION i1 a S 1 hereby affirm that I am exempt from the Commelm's License Law for the 0 o following reason.(Section 7031.5,Business and Professions,Cole:Any city or county e m fLi which requires a Permit m construct,alter,imprnve.demolish,or repair any ummum °^tO poor to its omance.alsomquires the applicant for such permiuo rile a signed statement i< that he is hermcd pursuant to the ponvisions of the Contractor a Liuemm Law(Chapter 9 Sq. Ft. Floor Area Valuation at (come ncing with Section 70(0)of Division 3 of the Business and Professions Code)or i; that he is eachrm therefrom and the basis for the alleged exemption.Any violation of p Section 7031.5 by any app icam for a permit subjects the applicant to a civil Penalty or 3 5.PN$Qa]floane Cr 0 0 Occas Type nm more than five hundred dollar:(165M). P Y YP Lasownor .the the Struc.o withwagesasale(SelecompBusiness will da the work,and the structure is not intended Livens ora w do Tonal.(See 7044,a4,owner ss and eny who Code:The Contractor's nd who Law dos not apply to an owner of Required Inspections Own eny who builds ar improves Hereon,and who does such work himself oor ffered his Own eer,the building Heb such ret iss sold wit us not intendeor d n.rot owner. how utIder Rebuilding uimprovementisso10withinoneyear or completion.He owner builder will have He burden Of proving that he did not mild or improve for purpose of salt.). ❑ 1,as Owner Of He pmperty,am exclusively contracting with licensed contra ors to construct the project(Sec.7W4,Business and Professions Calc:)The Contractor's Li . cense law docs not apply to an owner of property who Wilds or improves themon,and who contracts for such projects with a contractors)licensed pursuant o He Corm actor s License law. Q 1 am exempt under Sec. .B&P C for this reason Owner Data WORKER S COMPENSATION DECLARATION 1 hereby afnon under Penalty of perjury one of the following declarations: 1 have and will maintain a Cenifcate of Caesanl to self-insua for Worker'sCampcn- 7371M on,as provided for by Section 37W of the Labor Cote,for He performance of the rk for which His permit is issued. 1 have and will maintain Worker's Compensation Insurance,as required by Section or the Labor Calc,for He performance of the work for which this permit is issued. Worker'sCnry retennttion Insu�re�`c carrier a'5Po'y numMr ajrrier: 1—uvl kh toliey No.: I < l�© � CERTIFICAI E OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This sectino need not hecompleted if the reed is for nnc hundred dallars(SI(N)) is,kse.) I eenify that in the performance of the work for which this Permit is issued.I shall net employ any person in any manner m as to become subject to the Workers'Compensation Laws of California.Dale Applieam NOTICE TO APPLICANT:If,after making this Ccniticate of Exemption,you should become subject to the Worker's Compensation provisions of the Labor Code,you must CD forthwith comply with such provisions or this Permit shall W deemed revoked. zCONSTRUCTION LENDING AGENCY I hereby alrmm that there is a werswction lending agency for the performance of x the work for which this permit is issued(Sec.3097,Civ.C.1 til Q Under's Name Lender's;Address agrees J 0 1 certify that l have read this application and state that He above information is 0U comply and withallcity and county ordinances f and site laws nrelating the �U huildingconswnion.and hereby euthoria<rcpresenmtivcsaf this city manor upon the F yabove-mentioned p rty for impcnion purposes. (We)ag I indemnify and keep harmless IW City of Cupertino against rAy liabilities,juW(3UER and cxpcnso which may in any way accmc against Sam City V z in svnscqueting of this Permit. APP LICAhANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCER . `�� .9.Ci` Re-roofs "ZA DOGS MATERIALS DISCLOSURE Dac Type of Roof Will the applicant or future building occupant store or handle hmummius material as defined by the Cupenino Municipal Code.Chapter 9.13.and the Health and Safety wc.Section 25512(ap �/ All roofs shall be inspected prior to an roofing material beim Installed. ❑Yea 'l71Na P P Y g g Will thea applicant or future building occupant use equipment or devices which If a roof is install without first obtaining an inspection, I agree to remove nn s P aAirQn n o haeurdnus air contaminants as defined by the Bay Arca Air Quality Management all new mat eri $ SPCChOn. ❑'ve RP Nn I have rc He v ousmawrials requirements under Chapter 695 of the Califon Health&Sef tyC .ar'uma M%5.25533 and 25534.1 understand that if the Wilding es not cum ly h a antNatitismyrespmuihilitywnotifytW(cesspoolofHeuimme�tta ni nmctpdorwiasaaneenrac<threateop.� IgnatureofApplicant Date tr Gaathori..ed agent D„e All roof coverings to be Class "B” or better M6: Community Development Department I Building Division City of Cupertino 10300 Torre Avenue Telephone: (408) 777-3228 CITY OF Fax: (408) 777-3333 4UPEkTINO 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 �jstated policy on re-roofing. Homeowner's Name: Va+,r i'Cy- K Jo ) Job Site Address: (a )2 Ccv 4- y"` ee Roofing Company Name: �6 A plicant's/Signature: Date: \itJP61NOt� Greg tee] Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO �d REROOF o q CUPERTINO PERMIT APPLICATION FORM APN # v Date: 3PL1 , 9 . O cl Building Address: Owner's Name: Phone#: �'4fst'c1c iCt�t� f` Contractor: Phone#: License#: Pe 1co 4(gK % )33e- 3676ti 1 Contact:S�Cut' l S �-te ►ti� tiG�6Phone #: Cupertino Business License#: - + - s-`i�'Z�iS'3 Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑l Asphalt Shingles A Asphalt Shingles yA Wood Shakes ❑ Wood Shakes "t Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) 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: � r i p �TO Residentialw Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planni t. if there are anrestri ons:' ' Cost of Pro' ct: Type of Construction: O upancy grou !.0 OCYJ.00 se- v00 / Qty A is le 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 � p