06020101 CITY OF CUPERTINO
BUILDING DIVISION PERMIT W0NTRACTORANFORMATION '
BUILDING ADDRESS: LOS GATOS ROOFING PERMITNO.0 6 0 2 0 10 1
1030 RAINBOW DR
' OWNER'S NAME: PERMIT ISSUE DATE
TONY LIU 888 FAULSTICH CT 02/16/2006
NE: SANITARY NO, CONTROL N0.
(408) 298-9399
ARCHITECYIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uWp LICENSED CONTRACTOR'S DECLARATION
�uC 1 hereby affirm that I am limned under provisionsfof Chapter 9(mylia=is Job Description
ZW In th Section 7g50)Of Division 3afthc Business alb Profcssiou Code.entlmylicense is
5,'y= Locnlxcacl;a rad erceey. 3� sees S'�� d7 REROOF--T/O SHAKES, INSTALL SHINGLES
1g,to Data
OH COmranar
I� ARCHI7EC1'S DECLARA ION Gp� AJti�' 0
a
U 1 undemunJ my plans shall he used a public rewrds r106 i�jILI
k G I Licensed Pofessional L
ERl
S OWNER-BUILDER DECLARATION
�<2 1 hereby affirm that I am exempt from the Contractor's License Law for the _f �OO�
ZOO following rearm.(Section 7031.5,Business and Pofessloo Cade:Any city.,..my V¢
<m ff which myuires a Permit to construct,tlwr,Improve,Carousal repair Cut Y structure $9 2 9 6
n
y_y pnon its issuance.also requires the applicant for such permit to file a signed statement
Es`e that he is licensed pursuant to the provisions of Nc Connectors License aw(Chapter 9 Sq.Ft. Floor Area Valuation
yh (commencing with Section 7000)of Division Sof the Business and Profatioo Calc)or
y�$ that he is exempt thcafrom and the bub for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjccs Ne applicant o a civil penalty o! cU T e
not mora than five madred dorsa.(s500). r PanC Y YP
❑I.0 Owneroftdepmpeny,mmyemploycuwithwagesutheirmlecompcnsaunn,
will do the work end the stnctum is not intended or offend forsale(Sec.7014,Business
and Prefessio s
Code:The Contractor's License Law doe flat apply es an owner of Required Inspections
property who builds m improves dre.,andwh,di essuchwmk himself m tough his
own employees,provided that such impmwmens are not intended OroRemd forsale.If,
however,the building or improvement is sold within one year of complcuon,the owner-
builder will haus the burden of Proving that he did not build or improve for purpose of
sale.).
❑I,as Owner of the property,em exclusively contracting with licensed contractors to
construct the pmject(Sec.7014,Business and Profassimu Cade:)The Contractors Li-
cense Law docs not apply to an owner of property who builds or improves themon.and
who contracts for such pmjem with a contractor(s)licensed pursuant o the Convector's
License Law.
❑l am exempt under Sec. ,B&P C for this mum
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hmeby affirm under penalty of p do,oro of the following declarations:
I have and will maintain aCer iffcam of Comm to self-into¢for Wmkcre Compen-
ssdon,az provided for by Section 37M of the Labor Code,fm dre Performance of the
work for which Nis permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Saturn
J700 of the lsbm Cade,fm the performance Crude work for which this permit is issued.
My Workcr's CCmpensams Insursntt cortin and Policy number are:
Carter: STgI� F� Policy No.: Z279—Z0!U
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tbb section need not he complcwd If tde permit is fbronc hundred dollars(SIOfB
or less.)
I ccnify Nat in the pctfhmmncc of the work for which this permit is issued.I shall am
employ any person in any manner an az to becomcsubjecuo she Workens Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject Of the Worker's Compensation pmvisiom of the labor code.you mus
.JO forthwith comply with such provisions or this Permit shall de deemed revoked.
'Zz CONSTRUCTION LENDING AGENCY
Pn Idereby tiirm that them is a commaction lending agency for the Performance of
a> the work fur which this permit is issued(Sec.3097,CO,C.)
0 Lendcr's Name
z Lenders Address
U Q 1 cenffy that I hew read this application and show Net the show informetiun is
IA F correct I agree 10 comply with all city and county onfinances and sate laws Mating in
p U building construction,and hereby euthoriel refrexnalives Of this city to chief upon the
fA ahovc.menuunedpmperst for and
inspection purposes.
F LL (We)ag.0 to save,indemnify and keep harmless the City of Cupertino against
Z incoisesits ceofth,cossand espcacsmit. may in any way eccmc against said City
U z A consequence of the granting Of this permit /
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 2—/6—41
SOURCE REGULATIONS.
Signature of ApphanVComracmr Data Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future building occupantstore,arbublc bvallou material
az darned by the Cupenitm Municipal Code,Chapter 9.11,and the Halth and Safety
ode.Orn 1ss3z(a>7a All roofs shall be inspected prior to any roofing material being installed.
Will Ne applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it handout air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
strict,
❑Yea �1
Ihave,&S.Rlfthehaxardnus ces MYials 533 ad nts 534.I adcoptefd.95 of the Wilding
ieHealth&entlyhave.Sento firmh is MY soand2553d.l Mnotif do OCCUP(thbuildih
Joos not currently have a tenant thou it b my rupouihilitY to notify the maupant of the !l
rogaimmetu war mast met prio trance of,Certificate Of 7 Ocef ancY. Signature of Applicant Date 3` �d
Owner or auuhomed agent`"�' t All roof coverings to be Class "B"or better
F" Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408) 777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
�l d ars lek V 6060 (, 0 20 (' o
OWNER'S NAME: L/ t) PHONE # 2- S
GENERAL CONTRACTOR: G o s G,q ti.S 2.00Giti6 FAX # -Z9 ,?- 93-2 /
lam not using any subcontractors: � �/�� a/ o�
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
Owner/ ontractor �gnature Date
Community Development Department
- - Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408) 777-3228
• CU.PE��lN® 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 appfied with first obtaining all inspection
and written approval from the buildinganspector. 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. d pl5naood 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 insDection-
I understand and will comply with the above stated policy.on re-roofing.
Homeowner's Name: / Gt
•---^--_-.--_ 4Db-S]te Addxecs:_._.-,_•—_. IO
__-__. . ....__._.Rodfii[ _Com-an -Naiitei '- - -- ` — -
A p11 is Signature: Date:
Greg teel
Building Official
Revised 1/30/03
Palled o,Recycled Paoer
CITY OF CUPERTINO
REROOF o o "/
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Address: /
ow 46
Owner's Name: Phone#:
l� vt �D� 82-
Contact:
2So3.
Contractor: hone#: O License#:
Contact: �- Phone#: Cupertino Business is e#:
� �
Type of Roof Covering:
Existing: Proposed:
❑ BuiltUpRoof ❑ Built-Up roof
❑ Asphalt Shingles � Asphalt Shingles
Wood Shakes ❑ WoodShakes❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 1 ❑ 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:
5FircZone:
l Commercial ❑
Yes ❑ No Confirmed with Plann ng Det- if.there are any restrictions:ject: 9 / / Type o Cons`- ti Occupancy group:
/
Qty- if
A licable Fee ID Fee Description Fee Grou
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Ener--v BUILDING
SEISM)CRE M B.IILDING
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BUILDING
BUSLIC Business License BUILDING