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04030172 'FCIT_Y OF CUPERTINO '�' `- q BUILDING DIVISION PERMITC,O-NTRAC� R INFORMATION IN ADDRESS: WESTERN ROOFING SYSTEMS PERMITND.04030172 i5NE: ER'S NAME: PERMIT ISSUE DATELUNG YANG 24A'7 AMARAI C-T #Q SANITARY 0 OL NO. (562) 426-7147 ARCHITECTIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 LOp LICENSED CONTRACTOR'S DECLARATION - Job D8*cr1 tl n w I Wreby affirm that lam licensed under provisions of Chapter 9(commencing p ZR. wiNScc4 ] )"'Divi 'on fd+c Busimarjgbiro .da4Cod.allypYlicensc iz in full fo an IDs DC/ /T/J REROOF APR 7 2004 ^ -Do' Liccn Litc.g nF p Cont ARCHITECTS DECr t ��®�IYI� 1i 1 understand my plans shall W used as Iodide records GyU 3 as t;, Licensed Professional O OWNER-BUILDER DECLARATION iI hereby affirm that 1 am exempt from the,Commerce,License Law for the 00 following mason.(Section 7011.5,Business and Professions Cade:Any city or county m which requires a permit to conswce ale,improve,demolish,or repair any orumum prior w its issuance,also requires the applicant for such permit an rile a signed call t�'< that he is licensed innocent to the proviaiov of the Contractor,U..Law(Chapter 9 Sq. Ft. Floor Area Valuation as (commencing with Section 7")of Division 3 of the Business and Profcaaions Code)or i $ that W is exempt Ihertfrom and be basis for the alleged crmnption.My violation of Secdon 7811.5 by airy,applicant for a permit subjects the applicant in a civil penalty of 3 M_N11yD*gr0 0 Occupancy Type not roam than five hundred dollen(53110). ❑1,as Owner of the property,or my employca with wages as their sole compensation, will do the work and the structure is not intended or offered for sale(Sec.7044,Business and Profession Code:The Contractors Licene,Law dos not apply W an owner of Required Inspections property who builds orimproves themon,and who doessuch work himselfor though his own employees,provided that such improvements art notimended oroffemd forage.IL however.the building or improvement is sold within one year of completion,the owner- buildcr will have IW burden of proving that he did not Wild or improve for purpose of sale.). ❑1,as owns of the propany,am eacluzively contracting with licensed contractors an construct the project(Sec.7044.Business and Professions Cade:)The Contruwes Li. cove Law docs not apply in an owner of property who Wilds or improves thereon.and who contracts for such projects with a con far or(s)licensed pursuant to the Conuacttea License Law. 1 am exempt under Sec. .B&P C for this..On Owner Dau WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury oa of l e following declanti er: ❑1 have and will maintain aCcdOne of Covent w self-insum for Workers Compen- sation,as provided for by Section 1700 of du Labor Cade,for the performance of the wort for which this permit is issued. I have and will maintain Worker's Compensation Insivan¢,as required by Section or Ne Labor Code.for the performance of the wears,for which this permit is issued. and Poll,no Cam`arke sC ErIFlCATEOFE%EM srPolicy No ORKE COMPENSATIO SURANCE (Thu union oecd eat W cmmplewJ if the permit is Tercet hundred dollars(51(X0 or lcn7 1 terrify drat in the performance of the work for which his parm,is issued,I shall mot employ any person in any mannerso or to become subject to the Workers Compensation Laws of California.Dau Applicant NOTICE TO APPLICANT:IL after making this Ccnificau of Exemption,you shouM become subject an the Wmncces Compensnion provisions of the labor Code,you most .J O forthwith comply with such provisions or this permit shall W deemed revoked. Z "" CONSTRUCTION LENDING AGENCY 'T+`Z' I hereby affirm that there is a convection lending agenry for the performanm of !Yi > the work fur which Nu permit is issued(Sec.30y97,Civ.C.) [q 0 Lender's Name 1<nder's Address U O 1 certify thor 1 have read this application and ruts that due,above infomuiun u U. P cone, it agree an comply with all city and county ominanm and sou laws relating an 0 Wilding construction,and hereby authorim repglanodivei of his city to enter Upon the W shove mentioned property for inspection purposes gy (We)agree to save,indemnify and tact,harmless he City of Cupertino against I F'fA Imbilides.judgmcnts.costs and expc"v,which may in any way scant against said City U Z in consequence of the granting of this permit. ^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL ON.POINf Issued by: Date rofA"IicuVConvactor ULATIONS.-_ a/ a, /G /�/! f,/L a!'A"/�� ✓� Re-roofs ApplicuVConvactor Dew HAZARDOUS MATERIALS DISCLOSURE Type of Roof the applicant or future Wilding=upan,score or handle hvardou5 material y the Cupertino Municipal Code.Chapter 9.12 and the Health and Safety n zsslz(a)7 �� All roofs shall be inspected prior to any roofing material being installed. m No the epplicmt or future Wilding occupant sou cyvipmem or devices which If a roof is installed without first obtaining an inspection,I agree to remove ous air contaminants a dcfned by the Bay Arca Air Quality Management all new materials for inspection. -/' ❑Yes /J Ir&have alo)thehaYamOviZ505, mgolmmCots14.I u ChaPw dirt in ofthc Califon _/i,/Lt '—'�`-- niceHcaIh&Srfcldit,h,sccdons ncrids 5531anemsuri.el Cha indlhmilthc Wilds dues nor curtendy hove a unaoL Nat it is my rcsptnsihility to nosily thea parlor the r�� ou whihmnslWmmprimwi certCrdreawofq� Signature of Applicant G� Date ner or out m i.d ant % Dae All roof covering o be Class"B"or better Community Development al � Cupertino 10300 Torre Avenue CA 95014 Telephone(408) 777-3228 CITY OF Fax(408) 777-3333 �UPEkTINO Building De artment B I DD ff c PERMIT # U r WNER'S NAME: PHONE # ly GENERAL CONTRACTOR FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 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 Septic Tank Sheet Metal Sheet Rock Tile /Contractor Signature Date jCommunity Development Department j Building Division City of Cupertino 10300 Torre Avenue 4 CITY OF Telephone: (408)777-3228 UPEkTINO Fax: (408) 777-3333 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. e 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 Nam f// Q��/ 011 (/ Job Site Address Z/A !/ ' Ml Roofing Company Na)je: IA Applicant a plicant'sSigna �� Date:< /V ® Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOF bC54 7—a CUPER INO PERMIT APPLICATION FORM 3 11 1 If APN # Date: jQ Building Address: Owner's Natnsv ` { ` b p Phone Contracto . , Phone#: 37j�fO 6 Lic Fe #:C Contact: )Phone Cupertino Business License#: Type of Roof Covering: Existing: Proposed: Cl Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles O 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 ec i tion: esidential Commercial ❑� Fire Zone: Yes ❑ No ❑ Confirmed wi lanning Dept. if there are restrictions: E Cost o Pro4ec : Type of Cos ti Occu groom. Qty. if App41e Fee ID Fee Description Fee Group BPERMFEE Bid Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING i r � 77 70