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04070133 (2) 1 CITY OF CUPERTINO BUILDING DIVISION PERMIT kCONTRACTQR I40 A'TI(JN. , BUILDINGADDRESS: T D ROOFING PE ""'04070133 10692 P OWNER'S NAME: PERMIT ISSUEDATE Alk SHUO HAO CHEN 3540 MARGATE AVE- n7 /22 /2nn4 ONE: SANITARY NO. CONTROL NO. (408) 892-8872 ARCHITECT/ENGINEER: - BUILDING PERMIT INFO BLOCELECT PLUMB MECH p 0 0 0 0 +app LICENSED CONTRACTOR'S DECLARATION I bcnby affirm that I am licensed under provisions of Chapter 9(commencing Job Description withllfor n]01 of Division 3af the Buvnasand Profession Cade,and mylicenuia MALE D r � in mummeanderet. as REROO LA j Z Lke u.Cas Ln.g at Fg p Dala Contractor f a< ARCHITECTS DECLARATION Z I understand my plans shall he used as public recede ao� Licensed Professional SEP t 2004 3OWNER-BUILDER DECLARATION 1 herchy nfOrm Nat I am exempt Irons the Commcmrs License Law for the p ZEEfollowing mune.(ScxMn 7031.5,Business and Professions Code:Any city or county $tai which mquirm a permit to convect.alley,improve,demolish,or repur any structure FZa priono iesu isenec,alw requires lheapplicant forsuch permitto Ole a tigned.ulemnnt p C that he is licensed pursuant to the prevision ofMeContractaraLicense Law(Chapter 9 Sq. t. Dor Are Valuation (commencing with Section 7")of Division 3 of rhe Business and Propessinna Code)or .. that he Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects Ne applicant,o a civil penalty of gr0 Occupancy Type not mom Nan five hundred dollen(5500). ❑I,as owner of the property,or my employees with wages m their sole compensation. will do the work and the structure isnot intended or offered for sale(Sm.7044,Business - Required Inspections and Professions Code:The Contractor's License Law dean not apply to as owner of q p property who builds or i mproves thereon,and who does a uch work hpmsel f or through his own employees,provided Net such improvements are not intended motioned for sale.IL however.the building or improvement is sold within one year of completion,the Owner. builder will have the burden of proving that he did net build or improve for purpose of .ole.). ❑h as owner of the property.am exclusively contracting with limmed commeran to convect the project(Sec.7(44,Busineu and Profaasioos Code:)The Convecmrs Li. cense paw does not apply to an owner of property who Wilds or improves Nereus,and who contracts for such projects with a moranor(s)licensed pursuant to the Convectors License taw. ❑1 me exempt under Sm. .B&P C for this reason Owner Data WORKER'S COMPENSATION DECLARATION 1 hereby rufhm under penalty of perjury one of to following declara0mu: I have and will maintain a Cenifiam of Consent to self-insure for Warkere Campers retire,m provided for by Section 37011 of Ma labor Cade,for the perfam once of the work for which this permit is issued. 3/1 have and will maintain Worker's Compensation Insurance,as required by Section 3700 of the labor Code,for Ne performance of Ne work for which this permit is issued. My Worker's tC`omppeensation Insurance carrier and Policy number am: Cartier. Slr\ lY .J i t ry o1 Policy No.: CERTIFITCAT OF EXEMP770NFROMWORKERS' COMPENSATION INSURANCE .. (Thu section need not be completed B set,permit is forane hundred d.tlars(EIW) nr leu.) 1 certify that in the performance of the work for which this Perrot is issued.I shall not employ any person in any manner an as e become subject to the Workers'Comincre len Laws of California.Dee Applicant NOTICE TO APPLICANT:If.after making this CendicaM of Exemption.you should become subject Io Ne Worker's Compensation provisions of the Labor Code,you mat O forthwith comply with such provisions or this permit shall he deemed revalued. „z,I CONSTRUCTION LENDING AGENCY ' Ihereby all.Our there is a convection lending agency for the performance of 6i > Ne work for which Nis permit Is issued(Sec.309'1,Civ.C.) Q Lenders �z Land eexAddress U I certify that I have road this application and sum that Me above information is N conccL I agree to comply with all city and county ordinances and solve laws relating to pU building construction,and hereby authorise npresenutiva of this city to enter upon the W .hove-mentioned Progeny for inspection Purposes. (We)agree to save,indemnify and keep harmless the City of Cupertino against wy,,i liabilities,judgments,coats and expenses which may in anyway accroc against said City /J' U z in consequence of Ne granting of this permit. ,•^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:34toD e SOURCE R U IONS. .w rias )0* Re-roofs signa�Applicaro Commetor HAZARDOUS MAARIALS DISCLOSURE Type of Roof Will the applicant or future building mcupantstore or handle haymdous material az defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and safety ode.secaon 25532(a)? y a All roofs shall be inspected prior to any roofing material being installed. ❑Yes , Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove m11 bayardous air contaminants as defined by see Bay Area Air Quality Management all new materials for inspection. Diavict? ❑Yes ��j No I have mad Ne hcespouematedalsmquircments under Chaperti.95 clone Califon Get nia Hcalm&Safety Code,Scetions25505,25533 and 25534.1 understand that iflhe building �� ,l ys�j( '� does not curter I h ve a mount.Iha1 it u my msporuibihly m redly the occupant of the {'_111 UUU I requimmamspbib ustbcmetprioruissuanccofeCeniOcateaOccu r. Signature of Applicant Date dL ZLI� x1aa�04 Owner or authorised agent Date All roof coverings to be Class"B"or better Community Development 4 `E 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building Department JOB ADDRESS: PERMIT # P !n/ o /33 � o6ga- ehh�e � ,.,7' a OWNER'S NAME: S R ckQ CCA¢n PHONE # 0 8 9 54- a.1- GENERAL Q- a.a✓GENERAL CONTRACTOR: T . D Too , n I FAX # I am not using any subcontractors: I SIHBaam C T 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 Plumbing Roofing Septic Tank Sheet Metal Sheet Rock Tile -JAff 77114 �a O Owner/Contractor Signatu6 Date Community Development Department Building Division City of Cupertino MR. 10300 Torre Avenue CITY OF Telephone: (408)777-3228 U P E IST I 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. 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: SV%" o K aA Job Site Address: fD`) Roofing Company Name: 1 R o o Y1 q A phcant's Signature: Date:-+—� o • Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper 73 � � g � � r �n � SU r) �G�� t CITY OF CUPERTINO REROOF CUPERTINO PERMIT APPLICATION FORM APN# Date: Building Address: f6 S 11 \N -f C', Owner's Name O) Phone#: Slflf � �.« (yo8) 9 3 q 4 So Contractor: /� Phone#: License#: i D Roof'; y) KoB) .249 Io4-a- COT 66a29- Cont : hone#: Cupertino Business License#: ctres�; � 1E00%" hone S9A 88T�0- Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles '( Asphalt Shingles 'A Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ Provide I.C.B.O.Report# XTo be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ Job Description: ' (� ELK J c-0 m Ire-move v400d S�nc�Pa,a I «'1' CL LQ- w. So y P Residential Commercial ❑ it O S(3 30 # f""' 30 I� Fire Zone: Yes ❑ No E5 Confirmed with Planning Dept. if there are any restrictions: LI Cost of Project: Type of Construction: Occupancy group: $ S 300 -- TI,le- - wo f Qty If ApplicolDe 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 • 22397