05100003 CITY OF CUPERTINO ''�'"` '°" ' nom' ``- `"'`•`
BUILDING DIVISION PERMIT r CC,Ol LRACTT,OR,INFORMATI.O.,�N
BUILDING ADDRESS: PERMIT N0,05100003
7622
OWNER'S NAME: PERMIT ISSUE DATE
LI-HUA SHIH
NE: SANITARY NO. CONTROL NO.
ARCHLTEC(ENGINEER: BUILDING PERMIT INFO
BLDG EIEC! PLUMB MECH
O O D O
u O p LICENSED CONTRACTOR'S under DECLARATION
U I hereby affirm Olt I am fthe a under provision of Chapter 9(commencing Job Description
with Seeuon]IX1U)of Division3of Ne Business eM Professions Code,and my license is
n th infnllfnreean T z- 0 _? '2 REROOF-T/O SHAKES, INSTALL SHINGLES
' L
Cle , , 610> ggg
iL Dam Com ECL ION /� CONTRACTOR: KAS HOME VEMENT CO.
'ty ARCHUECTS DECLARATION �-N/.U�s^h
I m< understand my plans hall k used Public records
JdU
I
C G Licensed Pmfcaluonal
affirm
OWNER-BUILDER ER DECLARATION O
I hereby arm thol I am exempt from the ContractorLiec
s nu Law for OneC
no following reason.(Sm Om 701.3.Business and Professions Code:Any City of county /
$ which requires a Permit to construct.alar,improve,demolish.or repair any structure a
40
prior m is issuance.also requires the applicant for such permit in file a signed stsament
s< that he is licensed pursuant o Nc provisions oldie Contractor's Limnu Law(Chapter 9 Sq. Ft. Floor Area Valuatipffl 000
yl-� (commencing with Section 7")of Division 3 of the Business and Professions Codc)at 1J/
i $ that he is exempt therefrom and the basis for the alleged exemption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of \ar.. q, 4
not more than Bsc hundred dollars APN Number , Occupancy Type
I,as owner of Ne 36611097 . 00 d i4'rY
❑ property, re is employees encircled
ncwagemtlle,(S"e7044.B ration,
will da dmwon.and the Structure is ncies Li ess, a w do for an apply ]oats.Boniness sv r
end Professions Cade:The vesibuctora and
law dots not apply to an owner of Required Inspections
propertywhobuildsorimpmveu himpr,endwho does suchundedi .filfofthmugh his
awn employes,provided pronm ret is sold within
art nor earofc mplcfion.lmed for owner.
however,the building or den of pmenl is sold within one year of completion,the owner.
builder will Nva the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of On propsny,am exclusively convecting with limtued contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractors Li-
cc=law does not apply in an owner of propeny who builds or improves Ikaon,and
who contracts for such pmjecu with a contractor(s)liansed pursuant to the Conos ctars
Lims.Taw.
❑lameaempt under Sec. ,B&PC for Nis mason
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of lamory ore of the fallowing declarations:
I ban and will maintain a CeniGmen of Consent to self-insure for WofkersCompen-
ation,as provided for by Section 37M of the Labor Code,for the Performance of the
.,it for which Nis permit is issued.
❑1 ban and will maintain Workch Compensation Insurance,as required by Section
J70p of the labor Code.Ise the performance of the won for which this permit is issued.
My Worker's C asati0n Ins�unln�a artier and Polity nu
Cartier. r" Polity No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not k completed little Permit Is ruche hundred dollars SKKE
or IcssJ
1 certify Out in the performance of the work for which this permit is isawd,I shall not
employ any person in any manners as as become subject a the Workers Compensation
Laws of ealifomia.Dem
Applicam
NOTICE TO APPLICANT:If,afar making this Cer ificaa of Exemption,you should
became subject to the Wooers Compensation provisions of the labor Cade,you must
.J z forthwith comply with such provisivas or Nis Permit shall WdeemeA mvoked.
Zy CONSTRUCTION LENDING AGENCY
(-� I hereby aRrm Nat Vert is a eonslroetlnn lending agency for the perfemartcc of
the wan for which Nu permit is issued(Sec.iQirt,Civ,C.)
ALender's Name
Z)z Lmar's Address
U Q 1 cmify Nat 1 have read Nil application and ante Our the above information u -
it, F correct.1 Agree to Comply WIN all ally and County ordinances irld Sale IiWl RlaYng 10
0 building convection.and hereby authorize represemativca of this city to enter upon the
r II] shove-mentioned property for inspection purposes
(,CL (We)agree to rase,indemnify and keep harmless the City of Cupenino against
fq liabilities,judgmne ents.casts and c.peond which may in any way sceagainst avid City
U z APPI consequence NDERSTAf the NDfthis Dermis Issued b
^ APPLICA UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT y: Date a'/-
SOURCE ULAT Z _ 9
L �D Re-roofs
Si r o pli VConu r pale
HAZARDOUS MATE RIALS DISROSURE Type of Roof
Willy t applicant or!mus building occupant store of hunand the
Health
and Safi ty
Lined io 25 Cupertino Municipal Code.Chapter 9.12,and tk FlcalN and Safety
ode,Section 255J2(a)?
❑Yes 01k,
1 All roofs shall be inspected prior to any roofing material being installed.
Will the applicano or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hmud0m air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
iWi[l?
❑Yea
1havereadthe ic,Scenuamoarialsrt33and nts 55under ChaPar thsair is Wilding
ria HcolN&SafctyCode.Sectiwu 25505.25573 and 25534.1 underswdtlutifdc building
does not c rely baro a amok Net it u my msponsiM1iliry to notify tk occupant of Ne J f
reyuim swhic nkme 'orer'suanceof.ccoificideaCe pa" .✓ na re Appli nt Date
O_
errrant priced sent f Dam 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
,UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT#
1 .).10 �Los58 7�r G�'l00003
OWNER'S NAME: 501H, f} PHONE #
GENERAL CONTRACTOR: FAX#
I am not using any subcontractors: 4,
Signature Date
Please check applicable subcontractors and complete the followinginformation:
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
e
er/Co tractor ignature Date
Community Development Department
Building Division
1• City of Cupertino
Y 10300 Torre Avenue
CITY Or Telephone: (408)777-3228
CU PEI�TINO 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 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: PV/ /% G/ f A--
Job Site Address: (, z Z O�� f f 3Gofsp e-
Roofing Company Name: S ��" /�+��✓fT <v�
Applicant's Signature: Date: �° f
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOFS/"° c-)
SCUPE{�T
iNO PERMIT APPLICATION FORM
APN # 3 �- e u / , 9 7 Date:
l
Building Address:
LZ l/,4eA 4f 134191:... pPa
Owner's Name: Phone#:
( i << G / f�G/ <} �'/6 ars � l-7T-7
Contractor: 9)r ho"F lAl''-T. c. ,Phone#: Lice e#:
Contact: Phone #.:J/y _ Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
Y Wood Shakes ❑ Wood Shakes
❑ 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.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: z Pe lwoo
O 1 ll /2Po y F w r` KX;iz
Residential Comme ctal ❑
Fire Zone: Yes ❑ N Confirmed with Planning De t. if
there are any restrictions:
Cost of Project: Type of Construction: Occupancy group:
D0
Qty. if
A licab e Fee ID Fee Description Fee Group
jBPLANCHK
MFEE Bldg Permit Fees BUILDING
RGY Ener BUILDING
/ MICRE Seismic Fee Res BUILDING
MICOM Seismic Commercial BUILDING
Plan Check Fee BUILDING
C Business License BLZLDING