05100007CITY OF CUPERTINO
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BUILDING DIVISION PERMIT
CONTRA X 'INFORMATION
; 1
BUILDING ADDRESS:
MICHAEL LUNNEBORG ROOFING
PERMIT NO. 05100007 -
7582 KIRWIN IN
OWNER'S NAME:
PERMIT ISSUE DATE
YI WE BING & WEI LI
1328 WHITE OAKS RD
10/0-1/2005
NE:
SANITARY NO. CONTROL NO.
(831)278-1837
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
lob Descri�i�
1 hereby affirm that I an licensed under provisions of Chapter 9 (commencing
with Section 70fN) of Division] ofthe Business and Profcssiure Code, and my beers¢ is
Infall force and effect
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REROOF-T/O SHAKE, INSTALL. L
ci 7 Z-�•�
Lic.a
Li"nx class _ti
Dau Irl^9J Cumncur - -
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WEIGHT METAL TILE
C ARCHITECTS DE ARAN /
I shall x used u uMic rcrords
_
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\ �V 2005
undcrsunJ my plans
Lkensed Pmfcssional
OWNER -exempt frOECLARATION
BUILU
1 xrthy affirm Nm I am exempt from txRContractor's License Law for tw
following reason. (Section RIJ IS, Business and professional CWc: Any city or county
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which requites a permit m construct, Jur, improve, demolish, or repair any structure
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prior ter its issuance, also requires the applicant for such permit to file a signed statement
Conba<wr'sLicense Law (Chapter 9
Sq. Ft. Floor Area
Valu$ih(b
-398
that he is licensed pursuant to the provisions nfthe
(commencing with Section 70(a)) of Division] of the Business and Professions Code)or
that he u exempt therefrom and the buss for the alleged exemption. Any violation of
APN Number
Occupancy Type
Section 703 L5 by any applicant for a permit subjects On appEomm to a civil penalty of
not more than five hundred dollars ($!ao).
35922024.00
❑ Lo the property, eompewness
wiNwagu uNeiime
Required Inspections
the work. remYcmricade offered (Ser.
will ho rework
cureisnor's ntaplyin an
Licence, Law ownBuser of
and Professions Code: The Conmcton. License Law arcs not apply lf an owner
Code: The
q P
his
who buildsorimputes thereon,andwho doessuchwmkhimuBor is
edthrough
cert employees, provided such improvementstic not intendedmoedon, forsoleOnow.r-
own em
however, Or building orimprovementishathwithin one year of
pr
for the
improv purpose of
builder will have site burden of proving that he did not wild m improve for Duryose of
sale.).
❑ I. as owner of Ne property, am exclumvely contracting with Ikcued conuacame u
construct On project (Sec. 7osd, Business and Professions Code:) The Conuacur's Li-
cense law does not apply to an owner of property who builds or improves Ihemon, and,
who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's
License Law.
1 am caempt under Sec. . B R P C for this reason
Dat
WORKER'S COMPENSATION DECLARATION
1 hereby aRnn under penalty of perjury mote of the following domhom ons:
1 rove and will maintain a Conifcau of Consent sev.msam for Wmkerseompen-
on, es provided for by Section 3700 of tx labor Code. for the Performance of the
Iner
rk for which alis permit is issued.
1 have and will maintain Workers Compensation Insurance, as soda ircd by Section
M of Oc labor Code. ror the perforntanec of the work for which Nis permit is issued.
Wmker's Compensation Insurance carter and Policy nmber are:
rier. SfA�fC s�
' - CERTIFlCATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
musuctiou need not wcnmpleud lithe permit is foronebundred dollars ($IW)
or Itis.)
1 emsify that in the performanec of the work for which this permit is island. t shall not
employ any person in any manner x u to become subjauo the Wofkeri Compensation
Laws mcmiforniii. Dau
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject a the Worker's Cam Notation provisions of the labor Code, you mum
forthwith comply with such provision or Nis perm it shall be deemed rcvmkcd.
CONSTRUCTION LENDING AGENCY
Ix, Oat them isaed(Sec.3 lending agency for the performance of
wick Oil
the work ror which Nis pcmtit is issued (Sec. ]097. Civ. C.)
'
ANature
dd
Lcndcr's Addrcv
1 certify that 1 have read Nis application and sate that the awve information is
comma. I agree to comply with all city and county ordinances and sate laws totaling to
building construction, and hereby authorise representatives of this city to cnterupon the
above mcnuoncd property rot inspection purposes.
(We) ague to save, indemnify and keep harmless Ne City of Copenino igairm
Iiabilidesjudgments,eosts and expenses which may in any way accrue against said City
in consequence of the granting of this permit
PPp(CANT UNDERSTANDS ND WILL COMPLY WITH ALL NON -POINT
Issued by: Dale
RCE REGULATIONS.%Re-roofsgneirc
Type of Roof
�ppbnHAZA DO DelcHAZARDOUS MA Ic DISCLOSURE
Will theapplicantor (Muni boldingoccupantstoreor handle
Heallousmaterial
Ocnned by lw Cupertino Municipal Code. Chapter 9.11, and she Hcatth and Safety
;isurict?
calk.Sccumi255J1(a)7
All roofs shall be inspected prior to any roofing material being installed.
Dyes NoWin
IIf a roof is installed without first obtaining an inspection, I agree to remove
the appleant or future wilding occupant use equipment or devices which
:It haszrdous air contaminants as defined by the Bay Arca Air Quality Management
all new materials for inspection.
❑Yes
I have real the hmaN�ws materials reyuiremena under Chapur6.95 e(thc CaOfor-
nia Ficslth& SafcsyCodc. Sccuaa 25505.15517 am1255 W.I undcnaM thuirtx willing
d no, currently here a tenant that A is my responsibility as airy the occupant of the
,unemenawhich us,xpriortrRnraCertificate ofOccupancy. /
Signature of Applicant Date
All roof coverings to be Class "B" or better
O rte ter authon'r.cd egcm Dam
b Community Development
10300 Torre Avenue
r� Cupertino CA 95014
Telephone (408) 777-3228
CITY OF Fax (408) 777-3333
�UPERTINO
Building De artment
JOB ADDRESS:
PERMIT #
SUBCONTRACTOR
OWNER'S NAME: 100, I U—C G`,
PHONE # t : 2s s S7f
GENERAL CONTRAC OR: ,• 'rte )�,.v S ,,,
FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
9
Owner/ Contractor Signature
Date
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
9
Owner/ Contractor Signature
Date
M
w ,
CITY OF
UPEkTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Building Department
Subject: Re -roofing policy for the City of Cupertino
Telephone: (408) 777-3228
Fax: (408)777-3333
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.
7. NOTE: if you call for a plywood nail inspection and the job is not ready,
you will be charged a re -inspection fee of $176.18. The re -inspection fee must
be paid before another inspection can be scheduled.
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:/ ` we
Job Site Address:
Roofing Company Name: I.Je1krr"' citM 1
Applicant's Signature: �1 Date:
® Greg Casteel
Building Official
Revised 11/2/04
Printed an Recycled Paper
rl
cin of
CUPEkTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
or/ Ta - U%
APN #
Bldg Permit Fees
Date:
BENERGY
Energy
BUILDING
Building Address:
Seismic Fee Res
Owner's Name:
BSEISMICOM
Phone #:
BUILDING
BPLANCHK
Plan Check Fee
Contractor: /
Phone #:
License #:
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Contact:
Phone #:
Cupertino Business License #:
r.c,nAE6u!r
K 3I Z76
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Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
❑ Asphalt Shingles
Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Other (Specify)
❑ Wood Shingles
'YF Other (Specify) f,e,4.,LI *•�2_
Number of existing coverings
7a Provide I.C.B.O. Report # 4-7n 2,(p
❑ To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy'
Job Description:
S�n: L 1/E
c yII (�� �i� AI .
1`�1 1 I
NS I
Residential\42
Commercial
Fire Zone: Yes ❑ No ❑
Confirmed with Planning Dept. if
there are any restrictions:
Cost of Project:
Type of Construction: Occupancy group:
f S
�'
Qty. if
Applicable
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
q 331 q 7 G