04100025 clTv of curExTm° XONTYRACTOR INFORMAT70N
PERMIT `^ '
BUILDING DIVISION
BUILDING ADDRESS: PERMIT NO04100025 4100025
1097 HUNTERSTON PT
OWNER'S NAME: PERMIT L6UEDATE
IghkHU CHIH-MING
HE
SANITARY N0. CONTROL NO.
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLDG ELECr PLUMB MECH
C= O O O
u0o LICENSED CONRACfOWS DECLARATION - Job Description
Yw C I hereby affirm Ibis 1 am licensed under pmvidans of Chapter 9(commencing - -
SZ wth6�uon 7x1 IfnivisionJaf Ne Budnena and Pra(cssinm Code,snd mYliccnse is - -- -
o�„ in romeandeffaL, Lx�` LJ/d' REMOVE/REPTT t� [ jyL7n 7�7NGLES
4y_ L' r.c Class Lc,Y { _tY ��'B $_•{t"(i
o- Date ConlDECl er- I NAME$
BFa�$
q�m� � RCHITECTS DECLARAT ON - . . -
'�W U I understand mY Puna shall be used as public records NOVit u. Licensed Professional V I � 2004 .
SOWNER-BUILDER DECLARATION
9y 1 kmby aRrm Nos I am exempt from ft Committal License Law for she
i o a following m (S
ration. ection 7031.5.Business and Prefeadm oCabe:Any city of county
$ which requires a permit to construct alter,improve,demolish,of repair any structure
_i�• prior m its issuance.aku requires the applicant rot such permit File a signed statemmnl Valuation
x< NaI he is licensed pure rml so Ik previsions of ftComrsetafs License law(Chapter 9 . .Sol-Ft.
as (commencing with Section IDA) Division J of lk Business and Professinm Cnde)m
a. do
he u exempt IMmfmm and the basis for He alleged exemption.Any violation of
Section 7031.5 by any applicant for a Knoll lobjecu be applkaIof-civil 1-111 Of 3er00 Occupancy Type
not mart Nan five hundred dollars($500). -
t]1.u awn,of tk PrmP'ssY•m mY unploy,s with wgu ss Ikir sole eompernsatlon,
will do the week.and the swcwrt is no,intended oroffered foradc(Sec.loan,Business Required Inspections
and Prefer ions Code:The Contactor',License law dos not apply to in owner of - - 9 P
properly who bui Ids or improves Hereon,and who does such work himself or through his
own employees,pmviok4 that such impmsememe,art not intended or offered for tile.If.
however.He building or improvement is said within one year of Impletion.the no,
builder will have the burden of proving that he did not build or improve for purpose of
sok.).
ZI 1,as aw a r of the progeny,am exclusively commending with licensed contractors to
construct the project(Sec.70an.Business and Professions Code:)The Conuacwr's Li-
ce.law docs nos apply to am owner of property,who builds ac improves thereon,and
who conuacut for such pmjccu with a comrseter(s)licensed pursuant in the Conuacmes -
License Law.
❑1 stn exempt under Sec. B A P C for this recon
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under proudly of perjury ane of the following draboauolu:
1 have and will maintains Ccnlfmota of Consent to self-insum fm Workers CumPcm
sation,as provided for by Seedan 3700 of the labor Code.fm He pedormsma of the
work for which this permit is issued.
1 have and will maintain Workcri Compensstion Insurance.as tcquired by Section
37W of the labra Cade.for He peAoor.or the wok for which this perch is tamed.
Myy�br is Compensation lmm�na arms,and Policy nnuumberr are'
Carney- Policy No: � `
✓ CERTIFICATE OF EXEMPDON FROM WORKERS' _
COMPENSATION INSURANCE '
(ndS reeriM need not kcompleted if He Permit is fmanclomd dollvs($100)
or kis.) --
1 certify Net in de Performance of the work for which this Permit u issued.l shall not -
employ any person in any manscr he as m become subject to tk Workers'Compcentaion
Laws of California.Data
Applicant
NOTICE TO APPLICANT:if,after making this Cenifate of Exemption,you should
become subject to the Worker's Compcwuun provisions of the lakf Code.You mew
Qforthwith comply with such Previsions or His pore it shall be deemed mvaked.
72 CONSTRUCTION LENDING AGENCY
1-.�n I hemby affon Nat Hcre is a comuuctinn lending agency fm the Performance of
!� ? the,work fur which this permit is issued(sec.304/,Civ,C.)
H] A Lender's Name
=,Z Lcndcr's Address
[)Q1 certify that I have read this application and state that the above Information is
(-' conte,.I agree In comply with dl city and county ordinances and state laws misting an
nd
0 building construction,
soave.mdeyamhandkee hadentiss the Hiscity menter upon
ga lk
r IT7 shove-mentioned property for inspection purpoics. \
(we)agree m save.indemnify and tecp harmless He City of Cupcnino against •scs (A
Iiabil4ml,judgments,cos.and eapic whichmayinanywayaccrucagdnatild Cily
fJ Z in consixmrace of He granting of this permit. Dalt: V
'-' APPLICANr UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SG�fRCE RE�IfLATIOrs.
IN
yo GLS Re-roofs
Signmurt of Applian AZARDOUS MATERIALS DISCLOSUREarector / Date Type of Roof
Will the applicant or future building Occupant store of bandit h liamons materiel
as deOlmd by the Cupertino Municipal Code.Chapter 9.12,and dic Health and Safely
Imd.ode.Simon.255324)7 All roofs shall be inspected prior to any roofing material being installed.
0Ya 6Na
Will the applicant or fnuI 'If a roof is installed without first obtaining an inspection,I agree to remove
uture Wilding
mit hmards air contaminants as
the B me equipment or device which as definedby He Bay Area Air Quality Management all new materials for inspection.
istrict? ./s❑Yes o I have read the haardousmaterials requirements under Chapter695 ofthe Califore ikalth&Sde,Cade,Sass,.25505.25533 and 25534.1 toolmaumd lhatifNe Wilding
not cancolly have•tenant Na flouryat it my responsibility to ury de oecupant of the
quimmen.which muslbe mel prior in issuance of a CcNfcate ofcy. S' ature of Applicant —Date
apamV_oy All roof coverings to be Class "B" or better
Owner arm homed agent Dam
afTY01F
Community Development
1030 Torre Avenue
Cpertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
UPEkTINO
Building Department
JOB ADDRES PERMIT 2
OWNER'S NAME J IPHONE #
GENERAL CONT CTOR: a,-Il-a,7 Con FAX # ted' _/87
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
lambing
Roofing
Septic Tank
Sheet Metal
Sheet Rock
Tile _
�`�
Owner/Contractor Signature Date
i ;a1 Community Development
10300 Torre Avenue
t y, CuO"noj'PL
J5014
*� 'eleRhone(408) 777-3228
CITY OF Fax(408) 777-3333
�UPEkTINO
`7j Bvii At --De artment
JOB ADDRES S:i M 6� ` PERMIT !!.,,D
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: !/i,C;77 Cow Yi— fico-7 FAX # 4�a,d 7,'1-7 _ IS J
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
1' Electrical
Excavation ' _4
Fencing / ('" )
Flooring:.CarpetingZ 7 7` _ 6 " 7c 3
Linoleum Wood
Glass / Glazing
^' Heating
Insulation
- Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
f Paving
(Plastering
'Plumbing. 11,,,„Ie e r �r" AZ
Roofing '
Sep •tic Tank r ' Lrn i ;✓ / y
Sheet Metal ���, /f/�,, /o%el oc i
Sheet Rock
Tile ,
Owner/Contractor Signature Date
Y
Community Development Department
Building Division
City of Cupertino
s I 10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
OUPER,TINO
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.
3. 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.
a 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: Cir/i/ /Lli'dc�; />t/
job Site Address: /,097 >n7�,es7tt`>7 ,�L
Roofing Company Name: S i 1A!,r ! 67w Y�g71 erl
A plicant's Signature: C/ii;I/ Date:
�JVo✓�"
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOFCITY
�CUPEI�TINO PERMIT APPLICATION FORM
APN# Z ��� Date:
Building Address: 10,97
1 oas—
Owner's Name: Phone#:
CH1H Mi,JCT HU
Contractor: S,r1&aA) 5Z v7zz� -I0 /Phone #:(7409 fX72zV13 License#: 1879/8
Contact: ra M P one : (f OK) Cupertino Business License #:
9�i_ z/zy
Type of Roof Covering:
Existing: Proposed:
❑ uilt-Up Roof EI Built-Up roof
6Y Asphalt Shingles & -Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ./ ❑ Other(Specify)
Nu ber of existing coverings�/� !4z (3 Provide I.C.B.O. Report#
Nu
be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: !ze"As,
Residential P., Commercial ❑
Fire Zone: Yes ❑ No p Confirmed with Planni -De t. if
there are any restri ons:
Costo r jec : Type of Con ton: Occupancy grou
Y
y. if
/ApRl'lqable 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
MW X27367
2- 26"'. 7,bl'