04110116 CITY OF CUPERTINO T��a,i
BUILDINC'DIVISION PL1lLYlITCONTR?iGTORtINl+'ORMATION _ - '-
BUILDINGADDRESS: SUM' S CONSTRUCTION PERMITN(b4110116
1082 HUNTERSTON PL
OWNER'SNAME: PERMIT ISSUE DATE -
WEI-CHAN HSU 347 ESTHER AVE 11/18/2004
ZONE: SANITARY NO. CONTROLNO. ..
(408) 202-6501 "
ARCHITECT/ENGINEER:. BUILDING PERMIT INFO'
MECH
Loa LICENSED CONTRACTORSDECLARATION
F I hereby affirm Net I am licensed under provisions of Chapter v(cnmmmemif Job Description
b with S.,t1q.'1 )of Division 3 of NC Busim Pio femoro C9otle.end mylicenre is
^Od infullf acf(ecL FI� 3} REROOF—REMOVE EXISTING SHAKES (/
j Lj_ License, lass Lic.N I G�
Z—o Date Contracmr INSTALL NEW ASPHALT SHINGLES --_ - -
E'J` ARCHITECT'S DECLARATION
I mnocrsund my-plans ym it he used u p bbd c recd i �-
D
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r �1
'a.jr^ Liccnscq Pmfcsyonel - ff
3 `1f� OWNER-BUIIDERDECLARATION P
1 hereby alron that I am exempt from the Contractor's License Law for the ` -
p 0 (allowing reason.(Section 7(51.5.Business and Profession Code:Any city or county
sa�m which regmima a Permit to construct.alter,improw.demolish,or repair any su is um - -
Fiy prior to is issuame.also¢yuires the applicant for such Permit to rile a signed statement
< thatWislicensedpursuanttothePmvisionnftheComrathr&UcrnaeLaw(Chapter9 Sq. Ft. Floor Area - - Valua$(W00_
$ (commencing wish Section 7000)M Division 3 of NC Business and Profession Code)or - ---- -- —that he is tom fit Nrrefrom and Ne basis far the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant o a civil penalty of APN Number Occupancy Type
not mom than row hundred dollars(ssuBt 36222038 . 00
❑I.0sew e ror the property,or my employees with wagesu wn
their sole mpcauon,
Bus
ss
will do rho work ono e:The Cont a mors Luccue or sew it formic(Sec.1814,wne,of
and Pmrwh ore Gone:The Contractors rad who law des not apply if rt ower of - - Required Inspections
.a property mploy ,provirid thateathereomanowno doesrno,ch vook immadulmralrelNmagh denix - - -'
however,
Wilding or iNatvemech ntpm id ints within
not nun femoRerta fornames,
builder the Wilding or improvementissoldwithin ane)ear of completion,thenames,
builder will naw the Wrdcn of proving that he did not Wild Or improve for purpose of
ale.).
❑1.as Owner of de property em exclusively contracting with licmtsed contractors to _ -
consumer Ne pmject(See.7W.Business and Profusions Code:)The Comacmrs Li.
cone Law dors not apply in an owner of property who Wilde or improves demon,and
who caries!ar such projecs with a conmaetel(s)licensed puiaamto the Conuacsrs
License La-
0 I xm exempt under Sec. ,B&P C for this reason
Ownc Dae
WORKER'S COMPENSATION DECLARATION
1 hereby a Tom took,pcnity of'do,one of tW following declanommi:
1 have and will maintain a Cerdficace of Cement to self-intim for Worier'sCompcn-
ation,as provided ro,by Section 3700 of Ne Labor Code,for the pert me.of Tho . . . " _
wera for which this permit is issued. ---
I haw and will maintain Wakcr's Compensation Insurance,as required by Srcuon
37 No Labor Cade, the puromane,or the work for which Nu permit is issued.
M orkers Compensation lnsur ncq art and Rolicy number am;
C e �' 4 N Policy Nod
CE RCATE FEKEMMNNFROMWORI(ER.T
COMPENSATION INSURANCE
(I action trod not W completed if me permit is froom hundmAdoilam(SHOO)
or less.)
1 tenth that in rhe performance of tW work(o,which this permit is issued.1 shalt not -
employ any person in any manner an az to breomr subject to the Woken ComPemauon
Laws Of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making Nu Certificate of Exemption.you should
become subject an the WorkmS ComPrmmom provisions of the Labor Code,you must
.J O forthwith comply with such provision or this permit shalt W deemed revoked.
Z tiCONSTRUCTION LENDING AGENCY
E-. I hereby affirm Nn Vert is a construction tending agency for the performance of
�i > the work for which this permit is issued(Sas.3097,CO,C.)
W Q Lenders Namc
7 2 Lender's Address
U0 I ce,ufy that 1 naw read this application and sum that the above informaiun is
(y Pcorrect.I agree te comply with all city and county ordinances and sure laws misting to
U building convection,and hereby auNonae repsma(mms Of this city to enter upon the
W above-mentionoo Properly for impaction purpoxs
(~y (We)agree in ave,indemnity and kecp harmless the City of Correction against
rn liabilifies.judgments.toss and expenses which may in any way acsue against aid City
of do,
U Z APPL CANTeUNDERSTANDS Aof rs purnil.
ND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
eA--- /�
Re-roofs
Srgn arcof ppcVQQo -Iate
kRDOUS
'
MATERIALS DISCLOSURE Type of Roof ,+
cd Nc applicalterfotum building Occupantatomor handle Health and
C"
acfined by Ota Cupertino Municipal Code.Chapter 9.12,and she HcaIN antl Safny
Cado,Seeuan 25532(x)+ All roofs shall be inspected prior to any roofing material being installed.
oyer 1!5�o
If a roof is installed without first obtaining an inspection,I agree to remove
) Will the applicant or future building occupant tiro equipment or devices which g
71.
mit hxrardio s air conuminan dullard by the Bay Alia Air Quality Management all new materials for inspection.
istrict?
o Yesa
1 have sal the hasidnus materials req.i...under CmpW,6.95 oldie Calif., G
Health&Safety Cote,Seeuon25505,25533 and 25534.1 undersand thaifNe Wilding ( 7
ocs not currently ham a tenant.that it a my responsibility ra nmuty the mcupant or the / /
q 'remcnor which must W met prior w issuance of a Cc feale seri,anc. SI nature Of Applicant - ate
B I'-0
loig'
nm or art iacd agent Date All roof coverings to be Class"B" or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building De artment
JOB ADIWESS.
l68 L nL PERMIT # �/ /
r �(
OWNER'S N s- PHONE&Z4tt
GENERAL C ACTOR: N Yr Gum s% ooc r, .FAX #
I am not using any subcontrfactors: e4�
�� Si tune 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 SLtm
" Goy sl�-&cfrrgtrlt
Septic Tank
Sheet Metal
Sheet Rock
Tile
fi
01 e /Con actor Signature j _ Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
OUPEkTINO
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 " 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.
Homeowne ame: NL - e-/tat" -AS
-' Job SiteAdd4•�ss (09 2
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Roofing Company Nine: S ti r- S C-0 IV S`i1z(a(Tx_c'�✓ Gz).
A plicants Signa tul : )gat1, ll ( a-`(7�
• Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
am
CITY OF CUPERTINO
I(IIZEiZOOF a 0/1U/1k
�CUPEICTINO PERMIT APPLICATION FORM
APN # O3 Date:
Building Address:
lvflz -LluvT�:,�Ps7�lv
Owner's Name: J C--T _ C�AAl �S u Phone
rV
Contractor: Phone#:A 6 Z D y iso License#: pp ,
YA S�fl� �SyMS COrKZ�Gt1-7,1 7
Contact: Phone#: Cupertino Business License#:
Sar/ Q-oh Z6 S_9&
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ .Built-Up roof
❑ �P sphalt Shingles Q*' Asphalt Shingles
2� Wood ShakesElWood Shakes
❑ Wood Shingles ' - _ ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
`19/To be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read; Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
K< w; YZaa_ Kofi S ys aNsr . ��� as��� 5�
Residential - Commercial- ❑
Fire Zone: Yes ❑ No ❑ Confirmed 6th Planning D' t. if
there ar an estricti
Cost of Project:- Type of Const ction: Occu ncy oup-
�DO0 g(>6 /
Qty>i fl
Appficae) 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
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