03100220 CI'fY OR CUPER'fINO r x - , -
BUILDING DIVISION PERMIT "tCONT"C"Ti R INFO ]NATION ;*
BUILDING ADDRESS: R E ROOFING & CONSTRUCTION P1R@CPNe0310022
1228 RUPPELL PL
OWNER'S NAME: 15230 CLYDELLE AVENUE PERMIT LSSUE DATE
WANG TAK T. AND ELAINE Y 10/31/2003
NE: (408) 925-9995 SANITARY N0. CONTROL N0,
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG EO PLUMB MECH
100 Q O
0o LIC BNSEDCONTRACIOR'SDECcm,OfCON Job De
l AL
I 1 hereby affirm that 1 am licensed under provisions of Chbpmr Y(cnmmcncing
r e20. with Serino 7UM)of ispp� f c Busincsavnd P�sufassinns odc„eIW license is
in loll force and effe . !/�(ql 1/L Ll'�(! REROOF
..'n License Class Liv;
a,12 Dae conlncO Nov 9 2003
v � ARCH CTS DECLARA
f u 1 undersun m plana she I M used as public rds ,
'u.� aneroid Professional ./ BUILDING
sig OWNER-BUILDER DEC R TION
<F 1 hereby affirm Nal 1 am exempt from the eminences Licenae Lew for the
O o following mason.(Second 7031.5.Business and Professions Code:Any city m county
5$ which requires a permit m construct,alter,improve,demolish,or repair any structure 1 8 O 0 O
prlonn ill issuantt,'I'D requimsthcapplicam frsuch permit w Ila a signed Statement
�o
mo
is licca dpursuenumm novisicnsaf the Commcwr's License law(Chapter 9 Sq.Ft. Floor Area Valuation(commooring with Section IDOB)of Division 3ofthe Business and Professions Code)ser 36230037 . 00
�.. that he is exempt therefrom and be basis for the alleged exemption.Any violation of
Section 7031.5 by any Applicant for A Permit Subjects the applicant to a civil penalty of ppN Number
Am mon than fivc hundred dollars(ML Occupancy Type
1,u owner of the property,or my employees with wages u Weir sole compensation,
will do Ne work,entl Ne swnum isnot intended ar o((crt0 fonelc(Sec.7Wa,Beat..
and Prfessions Code:The Contractor's Limttse law docs not apply to an owner of - Required IDSpeCIIODS
propeny who builds or improves thereon,and who does such work himself or through his
own employees.provided that Such Impreverenta we not intended or offered for sale.If,
however the building or improvement is mid within one yea,of completion,the owner-
builder will have the burden of proving than he did not Wild or improve for purpose or
sale.).
❑1,as owner of the property,em exclusively contracting with licensed conuenon to
Cotstrct the project(Sec.7014,Business and Professions CMeq The Contractor's U.
cense Law docs not apply to an owner of propeny who Wilds or improves thereon,and
who contracts for such mejece,with a contractor(,)licensed pursuant to dm Contractor's
License 4w.
Q l un eaemps under Sec. .B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
have end will maintain A Cenificam of Consent sel6imum for WorimesCompen-
too,ss provided for by Section 37M of the LAM,Code,for On pespoom an.of she
w foi
hich this permit is issuctl.
I hand will maintain workers Compensation Insurance,as required by Sectio7 ofLabor Code,for the performance of the work for which this permit isi eJ.
My ore CnmpensSl' Insure ce canner and Policyn re:
Canicr.I Polity - J '\
CERTIFICATED EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
]a..)(Mar Section need not he completed if the permit is for one hundred dsdlars IS 14)
nr
1 cenify than in The Performance of the work for which this Permit is issued,)shell not
employ any person in any manner,m ss m bremne subject to the Workers Compensatlon
Laws of California.Dem
Applicant
NOTICE TO APPLICANT:If,afar making this Cenifcam of Exemption,you should
become Subject to Ne Wurkefi Compensation provisions of the Labor CMA.you mum -
,� forthwith comply with such Pmvisinm nr this perm it hall W deemed revoked.
OCONSTRUCTION LENDING AGENCY
l hereby ARrm Nat then I..comwminn lending agemY fm the Performance of
1' the work fur which this permit is issued(Sec.3097,Civ.C.)
jj Q Lender's Namc
7 z Lenders Address
;)0 1 ramify that 1 hese mad this Application end sue that the above information is
y f~ conch.)agree to comply with 411 city and county Ordinances and sue laws relating to -
�U building construction,and hereby authorise mpmsenmives of this city to enter upon the
„ W 'have-mentioned pmpcny for impectien purpose'.
r gy (We)agree to save,indemnify and keep harmleu the City of Cupertino against
h Iiabllitiea,judgments.costs and expenses which mayin any way accrue against mid City40 /q
con race of Inc gown ng his of tPermit,
PURGE ONATI _ A COMPLY WITH ALL OP issuedPPLICA by: Date
iLP
Signaw of rtanVConwn r '/ A�
Re-roofs
.�r5{� HAZARDOUS MATERIALS DISCLOSURE we Type of Roof
NM1q the applicant or lliwre building Occupant store or handle noust ous material
u dSdWd by[be Municipal Code,Chapter 9.12.and Ne Health and Safety
dc,Section 25532(e)?
❑Yea A
n All roofs shall be inspected prior[o any roofing material being installed.
WillJetapplicanbudding occupant use equipment orJcvmes which If a roof is installed without first obtaining an inspection, I agree to remove
nxardnw Sir contadofired by the Bay Area Air Quality Management all new materials for mSpeCtlOn.
el?
❑Yes Nu
I have mad the hmardous materials reyvircments under Chapter 6.95 of the airm. - I i
&Safelyus SecdoI.dow. .25533 anJemolitlunJersuM thatifthe puilJing / "a t Cj�/ 1 �vf '\
Jess no,c pJy hn a. r that i pomibilm m nodfy occu `m1n the f 1 Q t U
requirement
Int um W me wiss9an of a eni0cae of u c.
/— _Signatur of Applicant Date
ane nramth 'edasent / D e All roof coverings to be Class "B"or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
aITYOF Fax: (408)777-3333
CUPEkTINO
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 nabrove stated policy on re-roofing.
Homeowner's Name: l \K " `�
Job Site Address: 12 Z� 'II l P LL L AZ,;�_
Roofing Com y Na —P\- `i T, b� 1 N �' CEJ S gun l
s
A plicant's ignature• Date: '
-3k I0
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTIN0 3 Z�
REROOF
CUPEI-TINO PERMIT APPLICATION FORM
APN # 2 / b O Date: ' fl 31 )U 3
Building Address:
Owner's Name: WAN � one L [_ D Ph #s 44- -72L1 - J`54
-i
Contractor -iOdf 1N �M��nr0: I���j- tri RLicense� Z cy q
Contact: � Phone #: SME Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles r y / ❑ Wood Shingles
Other(Specify) r 1 r rtt I Other(Specify)
Number of existing coverings Provide I.C.B.O.Report# ale
ATo be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: 'ft,G RGW OX(`+'n IJ k l LA^lCNLcly- 4�1 n" f-AA'X"t l Iv TA1,4_ 1`46W z
eo x o # Oaef �ul�k, 'V1LLA Lk tr —rlt�
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are anv restrictions: IJ
Cost of Project j p e f Con truc ion: Occupancy group:
l0 G ,
Qty. if
7licable Fee ID Fee Descri tion Fee Grou BPERNIFEE Bld Permit Fees BUILDING
BENERGY Ener BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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