02050170 TY OF
CI
BUILDING DIIVC'ISSIIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10778/10780 MAXINE AVE 02050 70
OWNER'S NAME: APPLICATION SUB DATE
WANG STANLEY TRUSTEE & ET AL 05/28/2002
t1
PHONE: SANITARY NO. CONTROL NO.
GGOO ARCHITEC'VENGINEER: BUILDING PERMIT INFO
C u_ - BLDG ELECT PLUMB MECH
kkuli LJ f_I fJ LJ
fan
2 LICENSED CONTRACTOR'S DECLARATION Job Description
- i lim 701 that I am.f,ha a under provisions of ns apter Code and(commencing
p
v/tM1senlnn7000)mrDivllon3armeBox.pe:and Prore:alonaeoaeanamyficenee REROOF
ad, is i f' fo ` °J ` L' a 7 g T/O SHAKE, INSTALL 1/2 " PLY & 40 YR COMP.
O a U tc-Y C ma torr
6 3 0.l; ARCHITECV1,D RAq N
°-O g 1 undersmnJ my plans sM1all be useJlc records
ural p O Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm thm 1 am exempt from the Cmdramh License Law for me
t?< following reason.(Section 7031.5.Business and Professions Code:Any city or county
$$ D which requires a permit to construct,alter,improve,demolish,or repair any structure
prior to its issuance.also requires the applicant for such permit to file a signed smtemant
that he is baenud parswnno the ptAmmis of me Commctm's License Law(Chapter 9 5 ,Ft Floor-Area ,• nation
(comriuirafj with Secdonr7000)of Div ision 3 of the Business and Professions Cods) (,'(I;"-j i'�et!q', Lia 2 '0('!:ac�'tA l'�)'�:
or that he is esempt th<refrom'and the basis for the allcicd Gumption.Any violation
-of Section 7031.5 by any applicant for"permit subjects the applicant to a civil penalty
of not mom than five hundred dollars($5«)), rtl e ,. Occupancy Type
01,as owner of the propel,,or my employees with wages as their sole compensation, 395
will do the work:and the'stonCom is not intended or offered for sale(Sec:7f W, - Wred Inspections
'
Business and Professions Code:The Contractor's License Law does not apply to an 307 - I N S ULAT Ift p
owner of progeny Who Wilds or impmves thereon,and who does such work himself
or through his own employees.provided that such improvements arc not intended or _, 601 _— .ROOF.-.TEAR.-OFF-
offered
for sale:If.howevr, he building or impm,anent is scodwithin one year of . '.tt , •rpt 1,
602
oro;Pletmn.theowner-Wilder will have the burden of proving that he did not Wild or - ROOF PLYWOOD NAIL
improve for PurP"u of%aeJ. 6 0 3 — ROOF .BATTENS
_ . me _ .cense — — — — —
CiGnaawn�.nfine 0 .
property,7,am exdiness and
Co licensed contractors 604 - ROOF IN-PROGRESS •"'
_ °nswn the does
(Sec. to an
Business and Professions Code)The Convector's -
-
License Law does not apply u m owner of propcny who builds or
seimproves Merton.
Co vectors License
for.such.Pmjects wim.e.camrncmr(s) licensed pursuant m me ._. . .. .... ........coon_ _ ._.. ... co os..coos._._.....____..._-..... .... .__._.___....
Contractor's o unec Law. c ,
-- Olvm exempt untla Std, �(B,&PCfonhism r s
Owner' . '.I Data " 'I 11YALe®
WORKER'S COMPENSATION DECLARATIONic
p
I hereby arfiren under penalty of Podgynne,of the following declaraJ
tions: UN 0 6 2002
--
I &have and will maintain a CenCountercxte of Conto self insure for Worker's
L pnnivicon, he provided for by-Scnion 3700 of me labor Cada for the B�I�D�IY
perfurmuncc of the work for which this Permit is issued. G
❑1 have and will maintain Worker's Compensation Insunni.as squired by Section
<:.
3700 bb the Labor Code,for the performance of tho work for which this permit is
T issued MY Worker's Compensation Insurance airier send Policy numher are: --. ..,- .... _ - _ s „e-,.,..... ,
,.... ... .. ... - . _. . .....sons......_. . .. ._ ._....___._ . .
Policy No: , . ff .. 11 J-: _. .. .
CERTIFICATION OF EXEMPTION FI!OM,WORKERS,^ . ��'` ♦ 1Z:asx.l is }f`, 5" 'll I.il?-'.I '•� 7
COMPENSATION INSURANCE s' 11
.. . .. IC , .._. ... - ._ . . ..._. _ .._.._... ......coos. ji
"t (This sen on'necd not W completed if the permit is for one hundred dollars
..... . .. .....
, 1 c tuft'that in th a iii an
aof th k fo which tors pertnn a issued,l t fE
' n q /, ro t 5pme b i t th Workers
CC?mPe pl L syorC l q, D I f 2 8 T'L ID O L
pt ,. -
as
OTI T PPLI ANTI of making n cute of Exemption you should
Z esuhj na thew k C pet p nn ofth Ln rC J.you s
Q Q
forthwith comply with h p -ons or thispermit shall be deemed mocked.
.z 2 P __ -- ._ . . -- - . . . -- — - -" 0
of die work for which ih1.k tis 0ON LENDING AGENCY
a i ,Iherehy off rmCONP TrftU(:ro'onmm�ion lending agcncy for ihe performance � 't' ' �
trot _
A Lcnde Name
U Q 1 nee to comp ad all city nt d ,am ban aW a of rmmion rc
(L.U cunt t I g t comply.with II an and countyordinances' d rote I crier
Q W robuilding wntmed dl farms m p t i :of th sett'mercer upmn
} CL. .the eW(We)ai,omcd pmpcny for inspection purposes. _ -
F, Z 1Walgtisave,oath leand keepburros,yinthe Cityof Cupertino SL said
U V1 liabilities,judgments. osis d islet which may:n any y sero against said 1
APYIICAIT UNDERSTANDg ANDwILLCOMPLY WRH ALLNOY-POINT Issued by: Date V V
O 1. E RTGULATIO)} r 1 1 1 s 40 Z
tom.-lam"' .
:jn t pp Alt tat tp oat '. Re roofs
HA]ARDOUS h1ATERIAIS DISCLOSURE
W II the applicant future occupant at=orhandle naan nd Type of Roof.
as defined by theCupertino
uppn n Municipal Code,Chapter 9.12,and theHealth nmaterial
Cdd Stratum 25532001 a (.a ' !�'.
-' oY=� '" 1 ! 'MN°'' I r , , `ATI roofs shall be inspected,prwr to.any.roofing.material being installed.,.,. -- ,
�P Wit I th pplico t or future h dpding occupant use equ t or devices which If a roof is installed without first obtaining an Inspection, I agree-to remove
cm t ha bair contaminantsdf ned by me Bay Area Air Quality Management
Dnt n+ all new materials for inspection. Applicant understands and will comply with
oY ! all non-point source regulations.
I have read me hazardous material requirements under Chapter 6.95 of me
'Cahfomia Hwlth&Safety Crde,Seniors 25505,255]3 and 25534.I understood mm _
[ifthebuildingdoes not currently have a minim.that it is my responsibility to notify the - si S L
mc'apam of the requirtmemsswhic un b<me poor m issmnce of a enificate uL
'- ups"et' ignat e of Applicant Date
�. 2 y
re umer,. inert Date All roof coverings to be Class`B" of better
- - - 'OFFICE
Building Division
' 10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 that the
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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
,, iomeowners/Name: ;'�—P A l� JW L G
ddress: l g / - 7 ' �
Peroofing Company Name: I Q XDhi�4,
Applicants Signature: Date:
f -_
Joe
(Chief Building Official)
6/25/01