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CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
C,ONTRACTOR1INFORMATION
CC,
BUILDINGADDRESS:
CHUNG YIN WONG
PERMITNO03070044
OWNEWSNAME:
1049 SITKA TERRACE
PERMIT ISSUE DATE
)NE`
(408)985-9289
SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER;
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
LICENSED CONTRACTOR'S DECLARATION
Job Description
1 hereby affirm that l em licensed under provision! of Chapter 9 (commencing
p
with Section 7IXM)) of Division 3 of Me Businosa and PMesslona Code, and my license is
in full torte and cffen'
REROOF
License CIi7 Lk. N
Dau Cumnc
_
ARCHITECTS DECLCL ARATION
1 undefmnJ my shall W used u records
plans puhlic
Licensed Professional
OWNER -BUILDER DECLARATION
a
I hereby .('firm that 1 exempt from Me Conine License taw the
3
co
followingmemo.(Section 71OL5,Bmioesssed Profesaien Code: Any city mcounty
1. Co
which squirts a permit enwroct, afar, fmw, demolish, fi sig any stmmam
nnn
re ea
p atm requires the applicantioof for such permit ctoto itis s Law Chtemem
prior m its licensed i Lieenulaw(Ch.pmr9
that PSeuut it) the
Sq. Ft. Floor Area
Valuation
of DivinannWC,mruter
mmcneenud
(commencingwith of Divisions ofthe
vi CstM)ser
egeineuand
on. An
Mat he I! exempt therefrom sed Ne bait for the ellcgcd exemption. Any violation of
hemi'mun and
36205001.00
APN Number
Occupancy Type
Section 7031.5 by Sq applicant for a permit ubjecu the applicant to •civil penalty of
not mom Nen five hundred dollen ($500).
❑ I, as owner of the property. or my employees with cages u their sets compensation,
—
RRe uired Inspections
will do the wort, and the structure is not intended car offered for sale(Set. 7044, Budneas
and Profession Codc: The Conrcomes License law doua not apply to an owner of
propeny who build!or improves Nemo., and who doossuch work himself,r through Ma
307 - INSULAON
ownemployen, prov(ded0m ouch improwmmts a not intended coffered for sale. If,
601 — ROOF TEAR OFF
however, Ne building or improwmenl Is mid within one year of completion. Ne owner.
builder will have the burden of proving that M did not build or Improve for purpou of
602 - ROOF PLYWOOD NAIL
603 - ROOF BATTENS
�I.at the r of pmject ee,704,amtimmaively and Prorating with i 11. Comnuuunu
Construct the project (Seco and CW,:)7he Conuecur.
604 - ROOF IN -PROGRESS
La of ry who
eeme law does not apply loan owner of property who builds or improve Norton, and
an owner rad
who contracts for ouch pmjetV with ttnlracmr(1) licensed pursuant to de Contractor'.
um Lew.
Law.
-I am cacmpt under Sec. . B & P C fn This moan
..
Owns Dau
WORKER'S COMPENSATION DECLARATION
1 heuby affirm under penalty of perjury one of the following declaration:
I haw Oad will muinur. a Cenifcate of Commit te self -imus. for Worker.Canteen-
e Ion, u provided for by Section 3700 of de labor Cade, for the performance of the
work for which this permit is inued.
0 1 haw and will maintain WOrkces CompmWtion InWMce. a required by Section
37 ofthe laborCed0.for the pceformana of Mowers for which this pumitisisaned.
My orsces ComM=,ionlumneecaniuond Policynumbrom:
Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rids, section need not W completed If the permit Is for one hundred dollars ($1010
of Ica)
I certify that in Me performance of Me work for which this permit IS issued. l Nell not
employ.�Y,pq;ft in say nre�afep�s WQ�ome ubjecuo the Workers'Compcna.[.a
'
Law. 0f CY7F/rnia.De ( e
Apq�ca91/��. i
NOT TO A�P LICANT-4. et making this C ' ac of Eaten emption, you should
bt},
a $Object 10 Me WOfkcfi COMP MtiOn previsionsof Me Labor CsMe. you mum
forthwith comply with such provisiOMS Or Mi! permit shall be deemed rewked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that Mem iu construction lending agony for Me performance of
the work for which this permit Is issued (Sec. 3(197, Civ, C.)
Lender's Name
Underi Address
I cerdfy that I haw read this application and scale that 0e show information is
correct. I agree to comply with all city and county ordinances and mule laws relating to
Wilding construction, sed hereby stillborn mpreunlatives of this city in enter upon de
above-mentioned PMKfLy for inspection purposes.
(We) agree to law, indemnify and keep hundlen the City of Cupertino against
liabilities, judgmcou, cam sod npenus which may in any way acme ag.i.m to City
in consequence of the gaming of this pumil.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by:S4tl2i�&o Date
SOURCER G CATIONS. 71ZO
Re -roofs
Type of Roof -
Moore ofA pli MVC ser Data
HA ARDOUS MATERIALS ISCLOSURE
Will Me applicant or futum building uceuput mom or handle haardoa material
as darned by Me Copeman, Municipal Cook, Chapter 9.12. and the Health and Safety
CO.. So 2ss3z255324)?All
ley.
roofs shall be inspected to any roofing material being installed.
Ya AN.
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building Occupant use equipment or devices which
It hanrdous air ontaminants u dcfncd by Me Bay Arca Air Quality Mma,CMCnt
all new materials for inspection.
istrict?
a -,ss
❑Ye! WNo
I he. reed the hasrdws materials mquiremcnu under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505.25333 said 25534.1 understand de if the Wilding
h
does not currently have a unnL Mat II is my responsibility M notify Me occuput of Me
/(vim
myvimmen hie muslWmet'orwissuance0aCCMiicauofOccupanry.
Signature of 4p ep Date
All roof coverings to be Class "B" or better
Owner
or amhmiz d cnl,' Date
VW
CITY OF
UPERTINO
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.
Homeowner's Name: S.W//i r ,alAl -"e
Job Site Address:& .2/ 3ty Leo iJ� s �A�li
Roofing Company Name: eoj!g�643r/�y
A plicant's Signature: 6 Date: % e�
Greg teel
Building Official
Revised 1/30/03
Printed an Recycled Paper
s
•
*Co
CUPEkTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN #
L-�,, 2 !7
(C
V
0
BENERGY
Date:
,/
BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Building Address:
BUILDING
BPLANCHK
Plan Check Fee
_:1k 14,?o
BUSLIC
Business License
�u
Owner's Name:
Phone #:
My//_Z -44/,Vo
1�08> Q!'Gf�.33
Contractor:
Phone #:
License #:
/.Y !c/O.V
O 3 B
76XI3
Contact:
Phone #:
Cupertino Business License #:
B
z2s oo
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
Asphalt Shingles
X Asphalt Shingles
g 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
Commercial ❑
Fire Zone: Yes -E) No IN
Confirmed with anning DePt. if
there are any r strictions:
Cost Project:
Type of Cons!ti
Occupancy gr up:
Qty. if
Ap tca 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
-17 80