05080006 'CITY OF CUPERTINO "�'?wry+"�` ^• r
BUILDING DIVISION PERMIT 4CONTRAcT,R MOW.r+,.'fizON`�`;
BUILDING ADDRESS: NEW CENTURY ROOF TILE, INC1--ITNG.05080006
10170 SANTA CLARA AV
OWNER'S NAME: PERMIT ISSUE DATE
MICHELLE WANG 23135 SAKLAN RD. 08/01/2005
NE; SANRARY NO. CONTROL NO.
(510) 780-9489
ARCHITECIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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3.0 LICrNSED CONTRACTORS DECLARATION Job Descripti & /y
w I hereby affirm Nal I am licensed under Provisions of Chapter 9(commencing p q p
withsmton 70(of.(Dividon 3o(the Business and Proltiew.Code,md my became
y
U D
+� in fellfoceend� 2, REROOF W/COMP.
Z
Lmen Chess IJc.•
Dau ComDEC
Ae mall he un DELLA 9 /1
0 n ntand my plana shall W used u Puhlie records
eW Licensed Profcssienal �/ j/
ygc OWNER-BUILDER DECLARATION j�r('
2 q il
I hcrchy salon that I am exempt form the Commclor's Learn Law for the ] 5 •i 7
DO following mason.(Section 703 1.5,Business and Prolesslons Code:My city or county °fit' n f>�
$ which rmulms a permit In construct,alter,Improve,demolish,or repair my sto ctum 3y p7 }s•4 $.6'7 2 0
poor m rmit its issuance,also requires the applicant for such peu file a signed statement
�yg�a that he is licensed pmstment m Ne provisions of theComments's U..Law(Chapter 9 Sq.Ft. Floor Area Valuation
99 (conomcing with Sermon 7M)of Division 3 of Ne Budnm and Professions Crew)or
that W is exempt themfmm and to basis for the alleged exemption.Any violation of
Sermon 7031.5 by any applicant for a permit subjects the applicant m a civil Penalty of erU U Occupancy Type
net mom Nan 11.hundred dollen(5500).
I
❑1,ass owner of the property or mynmployw with wager u Muir sole compevWon,
will do the work,and Ne mummer is net mmMed or offered Immix(Sm.7014.Badness Required Inspections
and Prefesdesu Code:The CmueanmYs Littre law don.m e apply m an owner or q P
Property who builds or improves Merron.and who does mals wort himself or through his
now employees,provided Moet such improvements an out Intended m.Bemd for salt H.
however,Ne Wilding or improvement is sold within one year of completion.Ne outer.
Wilder will have the Wows of proving that Its did ret build or improve for purpose of
tak.).
❑1,as Owner of tW pr.peny in exclusively contracting with licensed mnbat7es,in
consumes on project(Sec.7014,Business and Pmftion.Code)TW Co.0 es U.
cem a taw does not apply be to owner of property who Wilda or improv therein.and.
who contracts for such projects with a eonuxemr(a)licensed pursuant to the Contoweres
Lice.Law.
❑1 ore exempt under Sec. .B d P C for this mason
Owner Dau
WORKERS COMPENSATION DECLARATION
I hereby al lon under penalty of perjury one of Ne following declvaMom:
than rind will malnuin In.
CeNOcate.f Caruent m xelfdmure(m WmkeYs Compere
salion,as provided for by Section 3700 of the Labor Code.for on performance of the
wank for which this formal,Is Issued. ,
❑1 have and will maintain Worleces Compensation Insurance•ss outputted by Section
37W of Ne Labor Code•for the performance of the work for which this permit is issued.
My We Com pmalion Ince oc cartier and Policy{p(p/9�be am .�, D�
Canter Poliry No.406
ERTIFICA •EK PITON FROM WORKERS'
COMPENSATION INSURANCE
(Thissceton recd nombo(omPlcad if the permh Isfmooe hum bodmiam(SIM)
m less)
1 modify the,in the performance of dm work for which this permit is Wood,I shall not
employ any cnon in my manner an as u hecomesebjecl to mho Workeos Componseden
Laws of califemia.Dau
Applicant
NOTICE TO APPLICANT,If.after making this Certificate of Exemptron.you should
become subject an Ne Worl e's Compensation provisions of to Labs Code.you mus
.,O forthwith comply with such provisions m this permit shall be desed contrcontrol.mwk
'Zti'ti CONSTRUCTION LENDING AGENCY
[—t IWmhy affirm that Nen is a connection lending agency for the purformarce of
C> the work for which this permit Is issued(sec.3097.Civ.C.)
QLenses Name
r7 z landefs Address
U 0 I certify Nm I haw mad No application and fume that the above infmm elm,is
w I" correct.I agree to Comply with all city and county ordinances and state laws elating In
0 U building construction,and hereby authorise representatives of this city to enter upon the
W oWn-mentioned property for inspection Purposes
(We)119f10""
g to sew,indemnify and keep hamless Ne City o(CuPenino against
i:y fA Ilabllites'in nu.cauande which may In my way sane agdnsudd City
to curnU F77 APPLIC oNDeg to Ihl D WILL COMPLY WITH ALL NOP INT Issued by: Date
SOUR L ON
Re-roofs ^—
S' ofApplWn mor D
H RDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future building uceu eanl store or handle basements material
as deRrmd by the Cupertino Municipal Code.Chapter 9.12,and Ne Health and Safety
IDiscrict?
ale,sand..vsu(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yoe
will thea applicant m ream Wddin occupant ran If a roof is installed without first obtaining an inspection,I agree to remove
It ha'rardnus air conuminmu u dcRncd by Nc Bay Ann AirmOwlity Ma rem�h all new materials for ins ection.
❑Yee Ata
I read the ha taltregmremmus under Chapter G95 of Ne Califon.Hca mycode, ass %t533aru12553/.l undematlthaaNe lbuildingm t mhy ve m em It u my mspomlbilltym notify Ne asupam of the
wh m prior w boumce ora cenlGcate of Oc ignature of App]iean Datif
r.r.ath. xe -41P dift
te All roof coverings to be Class"B"or better
}
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
C OF Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT #
56Fr aG v 6
OWNER'S NAME: Ul&ktL& PHONE #
GENERAL CONTRACTOR: FAX#
I am not using any subcontractors:
ignature 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/Contractor Signature *Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
C U PEI�TI NO
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 com 1 with the above stated policy on re-roofing.
Homeowner's Name: !��
job Site Address: 10170
Roofing Company Name: &;I" I`•Led.E'!
Applicants Signature: AM Date: (�,5�
Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN#�_ / � Date: ` D
Buildin Address:
teo
O is7 am : Phone#:
7
C ntracto Licens7e#:
S
Co t ct: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
Wood Shakes O Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide l.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 escription:
'T — —
Residential 9 VC mercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are any restrictions:
CostofProject:( Type ofConstructi Occupancy 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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