03050131 CITY OF CUPERTINO « ' rr ' ti::t ?''�"
BUILDING DIVISION PERMIT �CONTRACTOR TNS' A, M" ATION�
BUILDINGADDRESS: YING TZU JANG PERMIT N90 3 0 5 0 13 1
OWNER'S NAME: 7 2003
T
E:
SANITARY NO, CONTROL NO,
ARCHI7ECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p p LICENSED CONTRACTOR'S DECLARATION O O O
V1 hereby affirm that 1 aro licensed under provisions of Chapter 9(commencing Job Description
with Section 7")of Division 3 of me Businessand Profc cions Code,and my license is
Y1 m mu force and Affect. REROOF 1r}�1f11 I1��`1n'//f��1r71
Zg1 License Claes Lic.I sa Ota V4r15 URK)
Z113 Oak ARCHITECT'S DECLARATION
I ubcrstsnd my plans shall he omit as public«cards NOV 2 4 2003
gw�U
Lkcnsed professional
5 Oat I am exempt
from
DECLARATION
E 0 Z 1 hereby afftrm mi 1 a1.exempt f.n me C professions
a License Law for the B O n DONG
0 0 which
following A pSmtion Tmmamsc031.5. Itc,improve,
Re,c1ce li Cade:My city or county - IQ)tIrIJ t(�J
S$ which requlrs a issuance.al o m coroa ffic,alters imprsu tit Permit
t nr mash ed Amictmstatement prior msl enseduaim requires thoapplicant for such Committee,
to file a Law(Chapter
mmnmenccmsedpurwamemepmwalsMafthe ofOnBamtwand<na<uonCodkr9 Sq. F[.Floor Area $3�blgtion
�F
(commencing rixemimgection7andth Divisiofr the
me Business and Profession Code)or
S 3$ Nat he u exempt NertGom end the bum far Ne tilt{cd excerption.Any violation of
Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of 3 9&NO4 16TBerO O Occupancy e
not more Nan five hundred dollars(SS00). P y `]P
01,uawnuof Neprpeny,mmyemplo wlthcagesu Noirsolecompeuedan,
will do the work and the structure is notimended oroaered for sale(Sec.7044.Business J U b — Re� d Inspections
and Pmfeselou Code:The Committees License Lew does not apply to an owner of 3 O 7 — INSULA'i`PUN p
property who builds or imaow Nm
ere.and who does sucirauk hiressa f or Wough h4
awn employees,provided mat such improvements sae not intended proffered forsale.If, 601 — ROOF TEAR OFF
however,Ne building or improvement is sold within one year of completion.the owner.
Wilder will have On burden ofproving that M did ret build or Improve for purpose of 602 - ROOF PLYWOOD NAIL
sale'j' 603 - ROOF BATTENS
0 I,As owner of On pmpcny,em exclusively contracting with licensed comracton in 604 - ROOF IN-PROGRESS
construct the project(Sec.7044,Business;and Professions Code:)The Contiacteh Li
come Law does not apply k an ower of promery who Wilds or impmws Merton,and
who contracts for such pmjects with A com user(s)licensed pursuant to the Contrmsaes
L Anse W.
I am axempt under Sm. .B&P C for Nis mason
^^ a2P_2/t^ 7!5n, Data y7 0
�� W KER'SC P SATION OECLA TI
i hereby affirm under peeslty of perjury oce of the foil 'ng declarations: -
ass and will mainwn a CeNfiesk ofConsent m self insum for Worker's Compere
tan,u provided for by Section J7o0 of the ubor Code,for the performance of Nc
work for which this permit ts issued.
0 I have and will maintain Worker's Compensation Insurance,u required by Section
3700 of she Labor Code,for dk performance of Ne work for which this permit is issued.
My Workees Compensation Laurance amu end Policy number art:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This.mdar reed not W completed if the permit is ramie hundred dollars(SIM)
or leas.)
1 anify th in the performance of Ne work for which Nis permit u issued,l slWl not
ernployanyp�r�ain in ymannersoubbcc...mbjecim Ne rYers'Corp��atia.
Law.of Calif. // 77 //
Applic t
NOnC PLICA NT: of i ac g Nu Ccni tea emption,you should
become Jmt te the Work a ampensation prevision Ne faha CMA,you must
.7. Z fonhwit nmPlywiNauch pmvisiom or mi.permiuha W deemed revoked.
z ^' CONSTRUCTION LENDING AGENCY
(—m IV] I hereby affirm that Here is a construction lending agency for me patimmarec of
Ci> the work for which ria Karen is issued(Sec.3097,Civ.C.)
U Q Isnder'I Name
Lcndees Addma
IL,Q I ccnee that 1 have mad this application and auk Nu the above information is
0 U correct 1 onto te comply with s11 city and county ominances and sank Om r Upon
to
�O alurm-eenuned construction.and WmbyeuNmirercpresenutiws of ON city menkrupnn dk
[xl shave-(We)agree
to s ny for impcNon lacep brainless
�'fY es ju agree m save,indemnify and hip hymn the City of Cupcnim againliabilst
Z incoitiesunce of ui.comsthe gran and expensesron. theyinany way mems egeln.t mid City
fJ.z in consequence oNDERS ANDSsuis permit.
APP ICARF ULAI DNS AND WILL COMPLY WITF .L NON-POINT Issued by: Date
s RC EG CATIONS. /yi/f
� d Re-roofs
sigmm of pplica Conummr Oek
HAZARDOUS ATERIAM DISCLOSURE Type of Roof
W.IM pi cam or forum Wilding occupant nom orhandle hoodoos material
u defiend by N-'Corenina Municipal Code.Chapter 9.12,and the"calm and Safety
wt,sE]tYazss3x(.)7 SAG No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or(union building occupant um equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
he Andrus air contaminants As defined by me Bay Area Air Quality Management all new materials for inspection.
mitt?
❑Yes No
I hove read the hundous materials requirements under Chapter 6.95 of the Califar-
nieHealth&Safety Cate,Scene.Z5505,25533 and 25534,1 umDysmntl Nuif me Wilding it
f cunendy have•tenant Nat it u my responsibility to On
occupa t of me
mcntswhichmunWmetpriorteissuenccofeCcnibca f cupanc Signature of Applicant Date
J2 0
ret arcd.�•nt oak All roof coverings to be Class"B"or better
Community Development Department
Building Division
aM71 - City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
f1UPERJJ1N0
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 1s 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: P'� C-X s
Job Site Address:
7i0 G q 3 AV L� e14 F_f"ol x
Roofing Company Name: aLqu_� —
A plicant's/Signatur Date: 7,10 3
Greg eel
Building Official
Revised 1/30/03
Printed an Recycled Paper
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent,spouse or child) will perform: –
A. All the work authorized by this permit
B. A portion of the work D
C. None of the work
If B or C is checked,com Tete 2 or 3 below MAY 2 7 2003
2. A state licensed contractor will be hired to do:
ByBy_—r— Q_
A. _ All of the work
B. _ A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
be performed
3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side).
Property Owner's Signature: – Date:
Job Address: #
u� r-c alb
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
CITY OF CUPERTINO b 3 , b 1,
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 'C�j// Date: �—/L7( °3
Building Address:
Owner's Name: P ne#:
Contractor: �,' Phone#: License#:
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
g Wood Shakes ❑ Wood Shakes
❑ Wood Shingles Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide LC.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
Am
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: � �
Residential Co ercial AA
Fire Zone: Yes ❑ Confirmed wit lanning Dept. if
there are 4M
y rest •ctions: LJ
Cost of Proj 2 Type of Cons n� Occup cy oup
-
Qty. if
Appljclq&lFee 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
r
77 s� .