03100093 CITY OF CUPERTINO
BUILDING DIVISION PERMIT ;CONTRACT.n12INF,0RMAT10N '
❑UILDING ADDRESS: PERMIT NO 03100093
OW NF.R'S NAME: PERMIT ISSUE DATE
NE: SANITARY NO. CONTROL NO.
AR-HITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MPH
as
o LICENSED CONTRACTOR'S DECLARATION
1 hcrchy affirm than 1 am licensed under provisions of Chapter Y(commencing Job DOSCrlpn00
with SectionT(0)o(Division 3 of the Businca end Piofmsirns Cndc.end my license is
in full forte fife � ?
pa_ L ee"I u2 r REROOF
i�g Dam - °ants r CONTRACTOR: MDC ROOFING
RCHITECTS D ATO ��rr �-
�teU I understand my plans shall W used as public records L
'p Licensed Pndcssinnol
s OWNER-BUILDER DECLARATION
Z I hereby affirm that I am exempt(rum the Comranors License Law for the
.Q O fallowing m son.(Section 7031.5,Business and Prefessinm Code:Any city or county
S$ which requires a permit to convect,alter,improve,demolish.or repair any almnum
prior In its issumm.also ntquima the applicant rot such permit to file a signed statement
IN that W is licensed pursuant o the provisions of the Contractors Lkanse Law(Chapter 9 Sq.Ft. Floor Area ValuatlOA-700-
(commencing with Section 7000)of Division 3 of the Business and Professions Codc)or "
$ that W Is exempt therefrom and the basis for the alleged exemption.Any vkilmim,of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 �iyl�Tdperp p Occupancy Type
not more than five hundred dollars(3500).
0 1,u owner of the p upeny,or my employees with wages as their sole compenation,
will do Ne work,and on,structure is not intended.,.(feud roraale(Sm.7044,Business
and Profusions Code:The Contractor's License taw does not apply to an owner of Required Inspections
propeny who builds or improves thereon.and who Juesmch work himselfonhrough his 305 - FRAME
own employees,provided that such improvements me not inmaded or ffmcd for sale.If. 307 — INSULATION
however.Ne building or improvement is sold within one year of completion,on owner
builder will have the burden of Proving that he did not Wild or improve for Purpose of 601 - ROOF TEAR OFF '
sale). 602 - ROOF PLYWOOD NAIL
I,as owner of the property,am exclusively and convecting with licensedcontractorsto
causeconstuct the Lwdoesnatot pply toanownerofproprty who
Co dei TheeConvector'stherem'a u. 603 - ROOF BATTENS,
cense Lawdoes
such plyman with
aofpmpcny who Wdpursds or ant to
Centro,and 604 - ROOF IN-PROGRESS
who convects for such projects wish a ennoacmr(s)licensed pursuant m the Conuacloh
License Lew. -
❑ lam exempt under Sec. ,BhPC for this moon '
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby arm under penalty of perjury one of the following declarations:
I bats and will maintain a Cenificam of Consent to selLinsure for Worker'sCompcn-
7C300
on,a provided for by Section 3700 of the Labof Code,for Ne performanm of the
rk for which this permit is issued.
I have and will maintain Workers Compensation Insurance,ex mortared by Section '
of Ne Labor Code,far the performmme of the work for which this permit is Issued.
Worker' Cr Penution rsuancc rticr endP icy on"m :J r. Pali< o.:
CERTIFI ATE OFE EMPTION PROh ORKERS'
COMPENSATION INSURANCE
(Thu union need not W completed iOW Permit is foram hundred dollars(SIM)
or less)
1 ccnify Rod in the performance of the work for which this Permit 1s issued,I shall or
employ any Person in any manner an as In Wcumc Subject to the Workers Compema0on
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provision of be Labor Code,you must
:I z forthwith comply with such provisions or this Permit shall W deemed mvnked.
,Z,v O CONSTRUCTION LENDING AGENCY
1 hereby affirm that thea is a co stmetinn lending agency far the Performance of '
X 7 the work for which this permit is issued(Sec.3097,Civ.Cd
YQ Lenders Name
5 z Under'sAddress
;)Q 1 ccnify that I have read this application and state that dtc abovx information is
Fcomma.I agree to comply with all city and county ordinances and mm laws relating to
D building convection,and hereby aulhorim representatives of this city to corer Opera the
W above-mentioned propeny rot Inspection purposes.
ti M (We)agree m ars,indemnify and keep hmmless the CRY of Cupertino against
fqliabilities,judgmcnrs.com and expense which mayinart accrue gaimtstd City
Z
APPLICAeNTeUNDEg TANDit f i s permit 11
L C MPLY WITH ALL NON-P INT Issued by: Date
SOURC LA Ng.
net p licani/Crnvecor c 3 Re-roofs
HAZARDOUS MAT IS DICLOSURE Type of Roof
Will the applicant or future Wilding mmPk1t stem or handle haardous material
as defined by the Cupertino Municipal,Cook.Chapter 9.12,and the Health and Safety
Coda Section 235124)? All roofs shall be inspected prior to an roofing material being installed,
❑Tee :TCN, P P Y g g
WBI the applicant or
future buildingomupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Ir havardnus air contaminants as defined by the Day Area Air Quality Management - all new materials r inspection.
loris?
Oyes '*Vo
I have mad thi haardnus materialN553d
isonderchepmr 695 of the Cali(nry
nae Henithlk Safety talc,Sectio 55 5534.1 unJcrsuntl Nat if Nc Wildingalms not cumen0 ak a moaijisihility m nosily the rccuP t of Nemyui w mustW p striCcnifinem of Oce ancyy Signatbf dfApplicant ate
r rtfithwi.d agent UAll roof coverings to be Class "B" or better
Community Development Department
fe� Building Division
� r City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
U P E IST I N O
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: Gjur1
Job Site Address: P 1 9 d e r) S 60) AU Co oz L,-)
Roofing Company Name: Q
A plicant s Signature: l Date: 9�9D 3
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO b 3 o 9 2
' RE ROOF
cnvo
CUPElkTINO PERMIT APPLICATION FORM
APN # Date:
,BuildingAddress: 10184 Denison Ave.Cupertino,CA 95014
Owner's Name: Wei Lung Sun & Yu Fen Lai Phone #: (408) 255-8647
Contractor: License #:
Contact: Cupertino Business License #:
G011' LA CY Lt 7—
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)
Number of existing coverings L14 ❑ Provide I.C.B.O. Report#
To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cue ino's Tear Off Policy:
Job�pescriptibn: tz Ma✓e. e A,s i n0i waod G4 1,C)0 {p ca cr CA'I
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are any restr' 'ons: LJ
Cost of Project: D,p Type of Congb c 'o Occupancy gro p:
Q . if .
A lie 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