05050039 CITY OF CUPERTINO . ,19 ':i�
BUILDING DIVISION PERNIIT ONTRA TOR INFO` RMATIQN:
BUILDING ADDRESS; SUM' S CONSTRUCTION Pa'IMITN05050039
853 ROSE BLOSSOM DR
OWNER'S NAME: PERMIT ISSUE DATE
Ahk KEN TANG 347 ESTHER AVE 05/06/2005
ONE SANITARY NO, CONTROL NO.
(408) 202-6501
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDGO ELECTO PLUMB MECH
Lpp LICENSED CONTRACTOR'S DECLARATION IObDaSCr n
1 hereby )or Nn I am of
Bd under provisions of Chapter 9(commences Q���
with Section thereby
DthWonthI enBuunprmtl Profrsslof hapten (my culmen is I
n, inruuraaanaeffee REROOF W/ ASPHALT SHINGLE
j 3 License Clue Lic.I
Date w Conucmr '✓♦
ED
ARC Cis DECLARA ON 1
1 understand my plans shall he used u public mcnms /,y��oo�
D /`
5� Licensed Professional
y OWNER-BUILDERexemptDE Ce ContrON t��'
Q 0 1 hereby alarm Nat 11. exempt from the Cssions Cc License Law for the r6R7/
i p O following mamn.(Suction](171.3,Business and Rofndmv Code:My city or county
'11� which squirm a permit m consumer,alar,improve,domnlisb,or mpur any structure Q
-ZS' poorm is issuance.also requires the applicant for inch Permit he Bk a signed staamant
-
08OutNhe is licensed m
d putantm Ne provisions of Na Connector's Uccu eLaw(Chapter9 Sq. Ft.Floor Area Valuation
9 (commencing with Smian]000)mr Oivbion3o(Ne Buuwssand Profpeiav Cade)m
'g OY-• Nat he ts exempt therefrom and Ne bub far the alleged exemption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of
not mom Nan rive hundad dollars(53007. a Occupancy Type
❑i,uawnuofthepmpeny.mmyemploycuwithmgesu Ne4mlecompenudon,
w111 do the work and the structure is trot intended or offered fmanw(Sce.7044,Susinm Required Inspections
and Professions Code:The Committees License Law does not apply m an ownensr of q p
property who builds tar rmpmves desmon,and who dors such work himsel(m through his
awn employees,provided Ma inch improvements am not imeraed amMped forum.If.
however,the building or improvement is sold within one year of compledon,the ownsr-
Wlldp will lave Ne buNan of proving that M did not build or improve for purpoe of
earn.)•
❑1,as owner or the property.am exclusively contracting with licensed canmemrs to
construct the project(Sec.7W,Business and Profusions Code:)The Connector's Li.
cave Law does not pply m an ower of property who Wilds or Improver Marano,and
who concocts for such projects with a conuaetm0)licensed pursuant to the Contractors
License Law.
IamexemNunder Sec. ,B&PCfar Nismuan
Owner Dow
WORKERS COMPENSATION DECLARATION
1 hamby million under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to ne161vure for Worries Compose
nation,no provided for by Section 37M of Ne labor Code,for the performance of the
work for which this permit is issued.
1 have and will maintain Worker's Compensation Dominica,an required by Section
37M of Me lobar Gude,for the peorment rap of Ne work for which this permit in issued.
My Wooba, ComPe don Insurance prim anup olity number am:
Cartier. 4� QrLA Polity Na.;
CE IFICATE OFEfEMPnON FROM WORKERS'
COMPENSATION INSURANCE
(This section wed not hccomplcad if the fcrmit Is forovhundreddoilus(5100)
or less.)
1 certify Met In the performance of Ne work for which Nis Permit is issued.I shall not
employ any person in my mannerso u m become subject in Ne Workers!Companation
Laws of Califamia,Dow
Applicant
NOTICE TO APPLICANT:If.mar making Mu Ceninchm of Exemption,you should
become subject m the Woher'a Compensation provisions of the Labor Code,you mut
O 0 forthwith comply with inch provision or this permit shall W doomed mored.
Z 51 CONSTRUCTION LENDING AGENCY
[-r I hereby effuse Nat Nem is a construction lending agency for Ne performance of
ai > the work for whim Nla permit is issued(Sec.3097.Co.C.)
W Lamicrs Name
z,_ LinderSAdMss
(')Q I certify Na I have mad this application and sus Ma Me arum information 1,
cmoh I agme m comply with all city and county oNinaves and sum laws misting to
Q SV-: building construction,and hereby mthorim representatives or this city m enter upon Me
W chive-memianed Property for WNLMOO ParPaaL
gL (Wes)agree to sive,indemnify and keep harmless Ne City of Cupertino against
r,y rA liabilities,jmdgmanu,costs no expoves which may In my myaccrow agaWt said City
In V v^
APPLICANTUNDERSTANDSAOf the 91111offing Of r
ND
ANTUNDESTADS WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCERE ULATIOt�yS.
Signatures Ars"Contractor S�bD�l Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof -
WIII the applicant or fmurc building occupantsma or handle haudous material
as dented by the CupeNno Municipal Code,Chapmr 9.13.and the Health and Safety
Calc,Section 355334)7 124h, All roofs shall be inspected prior to any roofing material being installed.
❑Yu
Will the applicant or future building=uwm use equlpmem or deviw which If a roof is installed without first obtaining an inspection,I agree to remove
mit huardo s air conumlvnu as defined by Me Bay Area Air Quality Management all new materials for inspection.
DiuricR on
El Yes
I have mad Ne havamnvmaarials requiremenu under Chapwr6.95 o(the Cslifar•
riaHo.tM&Smcly Cam,Sadmts35305,35533md33534.1undcnundthulyda Wilding 2 S ars
does not currently have a ananl Nat it b my responsibility m nudfy the nccupant err Me �-
requircmcnsomichmusthemetpd rmissuua oil Catdficsm of cu and SignatU of Applicant Date
/ys�� All roof coverings to be Class"B"or better
Owner uthavcd;rac Dam
Community Development
10300 Torre Avenue
4 Cupertino CA 95014
Telephone(408)777-3228
c o Fax(408)777-3333
NUPEkTINO
Building De artment
JOB ADDRESS: g PERMIT# csti 5� gc $Coss„� p�
OWNER'S NAME: PHONE v 20 Z Sb
GENERAL CONTRACTOR SHH'/, FAX #
IV I
I am not using any subcontractors:
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
t
04ier/ Cignature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
19UPEkTINO
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: &^ F/f TXN
Job Site Address: �J ` �� 5� 4 l 0 S�Q M
Roofing Company Name: ' 4 &2V,S 771rAe.T_iL6A_
Applicant's Signature: —Date: ( /
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# / Date:
Building Ad ress:
Owner's Name: yg_�c Phone#:
Contractor: T Phhoon #: a License #: p,/-
.S0
Contact: Pho a#: Cupertino Business License#:
J2e2 —SSB .
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ uilt-Up roof
❑ Asphalt Shingles lir'Asphalt Shingles
tl 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: A
Residential Nn Commercial ❑
Fire Zone: Yes E] No Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of oject: Typ tru do Occup cy group:
Qty. if
Applicable 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
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