04060050 CITY OF CUPERTINO �" � ✓�`=w "" - '� "' "*"�' -
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION-,
BUI LDING ADDRESS: GUANANTEED ROOFING PERMIT NO 04060050
O W NER'S NAME: PERMIT ISSUE DATE
0 RONY FENG 2190 STO R AVP
NE:
SANITARY N0. CONTROL NO.
408) 265-6383
ARCHr1'ECrtENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
�Oo LICENSED CONTRACTOR'S DECLARATION Y 'VY Gs
y V C I hereby affirm that I am licensed under provisions f Chapter 9(commencing Job Description FUt(Y�f C{L�\+\�LED
c with Sectio MMID)of Division 3 of NC Busincssan" ,.Cion Code,andmyl"lcc .is µ—o
in tun mice cffmt. ' ry REROOF
;�? Ljcense Cus
onte --i--'— JUN 16 2004
Sop 1 Comracwr
aJ' ARCHIT
cysTC ^
/
iC. LicensedP Professional
S UIL®BNG
OWNER-BUILDER DECLARATIONor
�
1 berth,affirm that 1 am ucmpI from the Conm tam's License Law far the
0 o following reason.(Section 7031.5,Business and Pmfcainu Code:Any city or county
K S ff which sequins a permit to construct.alter,impriaw demolish.or repair any smcmrt
wi6 prior bs is issuance.also requires de applicant for such permit to file a signed statement
££ that he is licensed pursuanuotoprovisions ofdue Commcmr'sLicense Law(chapter 9 Sq. Ft. Floor Area Valuation
Y€$ (Commencing with Seaion7")of Division 3 of the Business and Professions Code)or
that o is exempt therefrom and the basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of 3WNQ4u@*erO0 Occupancy Type
not mom than five hundred dollars($500).
❑I.uowncr of the pnoprny,mmy cmploysss with weguuthev sole compewdon,
will do thework,and the swctu ,is not intended oraRemd fmsa)e(Sec.7W.Business
and Professions Codc:Thc Contractor's Limits,Law does not apply in in owner of - Required Inspections
property who builds orimproves thereon,and who does such work himaclf or through his
own employees,provided that such improvements art not intended oro@red forsalc.It,
however.Ne building or improvement is sold within one year of completion.the owner-
builder will have the burden of proving tat he did not build or improve for purpose of
sale.).
1,as owner of the propeny,am exclusively contracting with licensed mnvuwrs in
construct the finance,(Sec.7W.Business and Professions Code:)Tho ConmCurox Li-
cense law does not apply to an owner of property who Wilds or improves themon,and
who contracts for such projects with a comm Iorbq licensed pursuant in to Contractor's
KIKL rise Law.
I w ucmpt under Sm. .B k P C for Nis reason
Owner Date
WORKERS COMPENSATION DECLARATION
1 hereby sffum under penalty of perjury one of Ne fallowing dalmatians:
1 have and will maintain aCmificae of Consent to self4osum for Workcr'sComIen-
,cion,as provided for by Section 3700 of do Labor Code,for Ne performance of the
.,it for which this permit is issued.
1 have and will maintain Workars Compensation Inwranm,as nequimd by Section
3700 of the labor Code.for the offorraucc of the wort for which this permit is issued.
My Worke'y Compensation Insunncc carrier and Policy number an.-
Ca
rc:Ca Pol' .:
CERTIFICATE OF EXOM WORKERS'
COMPENSATION INSURANCE
(rds aeetim dad at W eompl,ted if to permit isforane huolooddnllan(SIM)
ar less)
1 cenify that in the perform ace af the work for which this Permit is issued.I shall net
employ any person any/ net an u tq 5; b.CuI CWina;
Compcmation
Laws afC lifomia. a l A
Applic v / , a�
mmf
NOTIC APPLIC NT:Iffte
,ar maki �Ona Cer if aEscmptiourryousbould
Weare subject w the Workei s CampemaX.provisions of the labor Code,you mow
.JO forthwith comply with such provisions or this permiuhall W deemed maniacal.
zo CONSTRUCTION LENDING AGENCY
EK I hereby affirm Nat there is a couwctinn lending agency for the Performance of
!Y> to wurle for which this permit u issued(Sec.309?,Civ.C.)
aQ Lenders Name
Z Lenders Address
O O 1 certify that I have mad Nis application and arae that Nc above Warrenton is
D. H correct-I agree to comply with all city and county ordinances and stats laws minting to
0 U building construction.and hereby auNoriao representatives of this city in enter upon the
} shove-mentioned property far inspection Purposes.
(We)agree w save,indemnify and keep harmlw to City of Cupcnino against
F" rap liabilidea,judgments,Cass and expenses which may in any way ammo against said City
U in consequence of the granting of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POIM Issued by: D e
S LICANT UNDERS�.
/L(riYt�s 106& G4 Re-roofs
Si of ApplinnVConommr arc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Wil to applicant or Rome Wilding caput more or handle avadaus maerial
u Ocfncd Cupertino Municipal Code,Capeta
Chains,9.13,and the Health d Safety
otic.OVby ddue,C323532(a). No All roofs shall be inspected prior to any roofing material being installed.
wul mm amteant or sewn bausmg oceapanr ort egaipment or decrees which If a roof is installed without first obtaining an inspection,I agree to remove
.mit harzrdo.air contaminants as delimit by the Bay Arca Air Quality Management all new materials for inspection.
Divvies?
❑Yes )KN.
I ban mad thc hamrdous materials mquiements under Chaper6.95 a(the Califor-
nia)ealtdb&
alifor-nia)ealth@ Safety Code,Sections 35505,25533 and 25534.1 understand Ourfthe building t�/'f \ //
does not currently have a repent,that it is.my msprosmility w notify tie occupant of the V ,nv/ T '/ vl ,/ f�f'
mquimments chmuwto tpriorwssuanaofaCortiof up y. Signature of Applicant Dae
Owner orautht�cJagent G Dow All roof coverings to be Class "B" or better
Community Development
10300 Torre Avenue
Its
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building Department
JOB ADD S: MWIT # 6 Ds',6
i L D4
OWNER'S NAME: Q y -s-
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
65 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Linoleum/ Wood
is Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing y� e
Septic Tank
Sheet Metal
Sheet Rock
Tile
IO r/Contractor Signature Date
Community Development Department
Building Division
a City of Cupertino
10300 Torre Avenue
' Telephone: (408)777-3228
CITY OF
U P E IST I N® 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.
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: 0 -Yl
Job Site Address: J K 2- 2424L 17 �71 /�
Roofing Company Name: CM /1 a 1 �.OQ �)�Q�(TX fi/N r.
A plicant's Signature: rillaO)z&= &Gvt,P,Q DDate:40
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPER1INO PERMIT APPLICATION FORM
APN # Z 6G Date:
O - ate
Building Address:
Owner's Name: Phone#:
Contractor: Ph ne# License#:
Contact: Ph e#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
`❑� Asphalt Shingles X Asphalt Shingles
Jam' 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 Polic
Job Description:
Residential Commercial ❑
Fire Zone: Ye No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Projec Type of Constructio Occupancy group:
Qty.
A ca b Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commerci BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License 'BUILDING
7 �7
Ise