04050169CITY OF CUPERTINO'
PERMIT
'iCONTRACTORINF+FORMATIONt
BUILDING DIVISION
BUILDING ADDRESS:
EWOOD CONSTRUCTIONS
PERMIT NO 04050169
121020 CLASSTC (T
0 W NER'S NAME:
PERMIT ISSUE DATE
PO CHOO & WEN- HE
NE:
SANITARY NO. CONTROL NO.
(408)828-5118
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby affirm that I am licemed u do to mo of Cluprer 9 (commencing
iN Section 7tl'IU)of Doisum3JZB�a ape Profcsiorm Cods.endmy1mosis
m full fm.eldderrect. 81.246
REROOF W/ SHINGLE
om
Dow— e(� n L Li .M
Date Contractor TION >(0 irot$ if K
AR NITECTS DsGCt ryfyrcoO�
{{�k
JUN ly 2004
n d my 1 ns shall be a �x�rllBEf
F��eayptptB Vpax� A}�
IF UOLDYg�apar
' hied ssional
OWNER-BUI RDECLA0.ATION
I h by affirm Nat 1 am tempt from Ne Convectors License Law for the
111100 �J YY VV'CltIHNJ
fallowing moon. (Semon 7(D L5, Business and Pmfessiom Cade: Any city or county
which requires a permit to construct. alter, improve, demolish, or repair any svucture
prior to its issumcc. also ret niecfhe applicant forsuch Permit o lilt a signed staremem
Ft. Floor Area
Valuation
thin he is licensed Intention, to the previsions of the Contacmri License Law (Chapter 9
Sq.
(commencing with Section 7") of Division 3 of the Business and Professions Code) or
Nat he is mempt thsmtrom and the basis for the alleged csampdm. Any violation of
���sx
3 N8411518er0 O
Vy�
Occupancy Type
9071.5 by ry applicantfor apertnit subjects the applicant m e eivil penalty of
Sectionai
not mom Nan rive hundred dollars (5500).
❑ I. an owner ofthe property, or my employees with wages as Noir =to mmpenauon,
Required Inspections
will do Ne work. and the swaum is not inumdcd or,Bemd period. (Sec. 70aa, Business
and Pmfemions Code: The Ciummeo is License Law does not apply to an owner of
property who builds or improves Hereon, and who doesswit work himselfor through his
own employees. provided that such imprwemenu are not intended oroffered forsake. If.
h,wcrcq the building or improvement is sold within ore ysar of mmnindim. Ne owmr-
builder will lure the burden of proving Nat le did not build or impmse for purpose of
sake,).
❑ T. as owner of dm property, am exclusively contracting with licensed mnmunum to
construct the pmject (Sec. 71W4, Business and Professions Code:) The Contractors LF
mom Law does not apply W an owner of property, who builds or improves thereon, and.
who contracts for such projects with a contrmicau) licensed pursuant, the Commences
License La-
0 I am tempt under Sm. . B 6 P C for Nis raven
Owner Dat
WOR 1(ER'S COMPENSATION DECLARATION
I hemby affirm under penalty of perjory one of the following decimations:
I bars and will maintain a Certificate of Consent to self-Insua for WorkelsCompen-
I vidcd for by Section 37M of Ne tabor Code, for the performana of the
ation, u m
work for which this permit is issued.
❑ 1 have and will maintain Worker's Comperuadon movants, o myuimd by Section
371M of the labor Code, for the performance of the work forwhich Nis Permit is contend.
My Worker's Compensation Insurance cancer and Policy number aa:
C"17�IJaC' NII+gill( Polity No.: �-37D7.Y2�
CERTIF1 ATE OFF EM MON FRGZW;2RrERS'
COMPENSATION INS URA C
(This section need not bec.,Ic.d if tine Permit is for one hundred dollars (SIM)
or loss.)
1 certify Nat in me performance of the work for which this permit is issued, 1 shall not
employ any person in any manners as to become subject in the Workers Compensation
Laws of California. Dat.
Applicant
NOTICE TO APPLICANT: If. after making this Certificate of Exemption, you should
become subject in the worker's CompermoOm Pavilions of the labor CMB you must
foMwith comply with such provisions or this permit shall M deemed revolted.
j CONSTRU.CTION
maimaENDINGAGENCY
I Mr Nat there is lending agency for the performance of
which Or s ed (See
' to work for which Nis permit is issued (Sec. 7097, Civ. C.)
Lender's Namc
Lender's Address
1 certify that 1 have mad this application and sum chat the above information is
' cmmct. I agree to comply with all city and county ordinances and state Iowa relating to
Wilding construction. and hereby authome represenlaures of Nis city to enter upon the
I above-mendoned pmpony for inspection Purposes
(We) agree in arc, indemnify and keep harmless the City of Caperton, against
j liabilities judgment, costs and cxPerucs which may in any way acetic against said City
in consequence of the gaming of this permit.
UN S AND WILL COMPLY WITH ALL NON-POINT
Issued by:6� Date
Re-roofs
Type of Roof
HAZARDOUS MATERIALS DISC ate
e applicant or future building othe
rSccuon
Cupertino Municipal Code. Cbmmr 9.13, and the Health and Safety
25532(e)?
NaP
All roofs shall be ins ected roar to an roofin material beim Installed.
P Y g $e
a roof is installed without firs[ obtaining an inspection, I agree to remove
applicant or fumrt builJing occupant use fyuipmem art devices whichIf
s air contaminant as defined by the Bay Area Air Quality Management
all new materials for inspection.
Dimm? ` �
Cl Yes IWN.
d have read the Womfous materials requirements under Chapter 6.95 of the Caliber
niaHcalth$Saf.tyCMe,Sadom 25605, 25533 and25534.1undcrsund thetifthc building
V'
does nctLampm4.W a he ant. that It Is my mapenslmllry or molly the,ectpam of the
mvsamceoracenirea¢afoce.pmcy.
'S -ig namre0 rAppl IC Date
S o
All roof coverings to be Class "B" or better
M authoriicd am
WCITY OF
UPEkTINO
0
•
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
Building Dqp'a-rbqaent
JOB ADDR S .� Sic
T # 04(()5-01 6
OWNER'S N : Pp GJ ra jVe, - (
PRPNE # (4a0 7.37 -
GENERAL CONTRACTOR: a
FAX #
I am not using any subcontractors:
Signature
Please check applicable subcontractors and complete the following information:
Date
e /C actor Signature
10/28/03
57_ z)
�� Date
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
ewmp ,
Fj $2 146
Septic Tank
Sheet Metal
Sheet Rock
e /C actor Signature
10/28/03
57_ z)
�� Date
It V
CITY OF
UPEkTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Building Department
Subject: Re -roofing policy for the City of Cupertino
Telephone: (408) 777-3228
Fax: (408)777-3333
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.
,./p
Coen - clre
Homeowner's Name: '�9 dod agd
Job Site Address: e-,4 914O /V
Roofing Company Name: ELJyDP C f rr i i�7it
A plicant's(Signature:
(, Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
Date: 5Z2L�bL7'
•
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(Cas
CITY OF
CUPERTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN #
Bldg Permit Fees
Date:
BuildingAddress,.W 2/0Zv Clss;c
C4Cu r�'Hv C!d 9�0lCF
Owner's Named n
7(�Ltbci at+llCt�{
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�lsN
Phone #:
if% %.)'- '.�%36
Contractor:. �k b
Phone # 1 �') �� 5,1K
/
License #: Q�37
Contact: �� Cin +eri ayt
Phone #:1
Cupertino Business License #:
BUILDING
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
q( Asphalt Shingles
Asphalt Shingles
❑ Wood Shakes
❑ Wood Shakes
❑ 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:
Residential Co
ercial ❑
Fir one: Yes ❑ Nox,
Confirmed with Planning
there are anrestrictio LJ
Cost of Project: Type of Construction.V Occupancy group:
r
gocir /
Qty. if l
AmAi able 1
Fee ID
Fee De.-crintinn
Far (: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