05090052 CITY OF CUPERTINO
BUILDING DIVISIONPERMIT CONTRA CTORINFORMATION
BUILDING ADDRESS: WOODS ROOFING PERMTr No05 O 90052
10394 O ANGE AVE
OWNER'S NAME: PERMIT ISSUE DATE
JIAN LIN & MIN LUO 2179 STONE AVENUE STE 22 09/08/2005
ONE: SANITARY NO. CONTROL NO.
(831) 637-5576
ARCHITECrfENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
D 0 D O
u00
LICENSEDmthatICONTRd under
SDECons of CON
1 hereby )orm that I am licensed under provisions of Chapter 9(commencing Job Description
with Section 7000)of Division Sof the Burin MRofcssiouG a, dmylicc xis ( €i 1 II � � I��
imm�mnaanaaffa�a • REROOF-TSO SHINGLES,. NSTAliL1COMP. ?1SHINGLES
iq= Liccnx Class j Li LM
n=p Date
ARCHITECTS DECLARATION
a�¢ 1 undersand my plans shall be used u public mcmds
OCT 3 ZOD5
O Li,e.d Professional
5 OWNER-BUILDER DECLARATION
I I hereby alErse that I am exempt from the ConuxWrs Uccnx Law for the vr�y, Ln{ erg.]
i e O following mama.Section t 71131.5.Business and ve.dimou Cods:Any city or county G 'd YI t'[i n 7l .)I�yN ` $13 2 O O
y m
which requires•permit m construct.alae improve,demolish,of repair any stmcwrt YYxxKKJJ lel.W f:L
Fly prim W its issuance.slid requires themplicantfor such permit to Elea signed suumnit
< that he islionscdpurmanttothe pmviss
ioofthcCpnbLaw w(Chapter9 Sq. Ft. Floor Area Valuation
s�a (commencing with Section 7")of Division 3 of the Business and Professions Code)or
that W u asempt therefrom and do buts for to alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3MMARCT00 anC OQeD
not more Nan frvc hundred dollars(5500). Occupancy y Type
0 I,u owner of Ne propcny,or my employees with wages as their tole compeuaton,
will do the wod:and Ne mexu re is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Canneries License law does tat apply W in owner of Required Inspections
property who builds in im prows thereon,and who dos such work hi mxlf or through his
own employees,provided that such improvements are not intended mothered forsele.If.
however,the building or improvement is sold within one year of completion,the owner-
builder will have We Wrden of proving that W did not Wild or improve for purpose of
sale.).
❑1,as owns,of the prcapen,an exeluively contracting with liaised contractors to
come=,the project(Sec.7044,Business and Professions Code:)The Contractors Li.
come law dos not apply to an owner of property who Wilds or improve thereon,and
who contracts for such pmjccu with a contractor(s)licensed!pursuant W the Contractors
Licertse Law.
❑I am exempt under Sec. ,B k PC for this moon
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declamtiou:
I new and will maintain a CertiGam of Consent to self.irmic for Worker's Compcn-
smon.u provided for by Section 37M of to LaWr Code,fm the performence of the
work for which this pemeh is issued.
1 have and will mainuin Workers Compensation Insurance,u required by Section
37U0of We Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compen_SBltion lvuanna artier and Policy number art:
Cartier. S - -a---R_ Policy No.: 2--"
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tuts sermon need ttot W c.plcwd ifsW permit isf000 hundred killars(31M)
carless.)
I anify that in We pefformuec of the work for which this pmmit is issued,l shaft nm
employ any person in any manner so u W Wcomc Subject ca tW Wmkers''Compesation
Laws of California.Date
APPlicam
NOTICE TO APPLICANT:IL after making this Cenifucate of Exemption,you should
become subject W the Workers Compcaudim provisions of the Labor Code,you most
.J z foMwith comply with such previsions or this permit shall be domed molded.
z CONSTRUCTION LENDING AGENCY
[+ l hereby aRrm Wt there is ac...dnn Imilm,agcoy for tbe performence of
6$ the work for which this permit is issued IScc.3097,Cr,C.) '
Q Lmdcr's Name
D z 4nderi Address ,
U Q 1 certify that 1 have mad this application and sate that the aeove infom atun is
t2.P corrtcL 1 apo to comply with all city and county ordinances and sue laws mining he
0U Wilding eortnuction.and hereby authotm represenutivs of this city to enter upon the
yabove-mentioned pmperty for iupccdon purposce.
(We)agree W sale,indemnify and keep harmless the City of Cupertino against
CA Imbilites,judgmcnts.cots and aNnv.which may in any way accrue against.uid City
U z in consequence of the graming of this permit.
~ SOURCE ULAERST ND D WILL MPLY WITH ALL NON- DINT Issued by: Dale
f Of—
Sigmmrt al ApphesndConnamor Date Re-roo6
fs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding uoupant store or handle hazardous maedal
u defined by the Cupertino Municipal Code.Clupar 9.12.and de Health and Safety
"dowode,Section 25532(x)?
pro man-- All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant or future building=open[use a If a roof is installed without first obtaining an inspection,I agree to remove
Pp g p a Air Qu or devices which g
It harardnus air conuminana u defined by the Bay Area Air Quality Management all new materials for inspection.
District'
F1 Yes
Ihe-&Safet me harmless Socma25505lsmquirtmentsundcrdcmuo donof0e Wilding
on Hwlthh emIyOrMc.W am. eal t.25533and 25534.1 indcrsund a rccu c Wilding
doanot cru,w2 lut.,L en t.thatit' by respom' jlity WnatlytW acupmtofWe
rtyuirtmcnuw mhsstW i u'suenoof cnifml of Occu
Signature of Applicant Date
�JS
Ownermaathnria<d agent �[ rime All roof coverings to be Class "B"or better
Community Development
10300 Torre Avenue
I
si Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS: /O 3 9'4f PERMIT#6 5 O 0 O S 2
OWNER'S NAME: PHONE # 4/tl
GENERAL CONTRACTOR BQ FAX #
I am not using any subcontractors:
ignature 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
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contrac or Signature Date
¢^ Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY Of Telephone: (408)777-3228
U PE INTI N O 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.
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 /4 ', per foot slope and demonstrate
that there is no ponding.
2. An LC.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:
¢�z
Job Site Address: 103
Roofing Company Name: �� 'S 471 - ti
Applicant's Signature: _� a
C17-I
Date:
Greg Casteel
Building Official
Revised 11/2/04
Panted on Recycled Paper
a, 1�� .
CITY OF CUPERTINO
L'� REROOFTy
CUPEkTINO PERMIT APPLICATION FORM
APN # >� / � �� Date:
Building Address:
/Q 3 ' Ovt
Owner's Name: Phone#:
Contractor: Phone#: License #:
�"
s & 5Vd - 03-03 325 / 3 /
Contact: L Phone#: A J� Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
,d Asphalt Shingles '* Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
9 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.
Ak I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: 710 z�
Residential 15CL. Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: _ Type of Construction: Occupancy group:
/3, z v
Qty. if
A licable 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 I Business License BUILDING