05070002 CITY OF CUPERTINO '?a'wCwkPskpd{ X :i> 5h'
BUILDING DIVISION PERMIT CONT RACTOYtINFORMATTON:
"*a
r BUILDING ADDRESS: R E 'ROOFING & CONSTRUCTION TII�Ncb 5070002
OWNER'S NAME: PERMIT ISSUE DATE
MICHELLE HWANG 15230 CLYDET.T.P. AVENUE, 0'7/01 /200S
.ONE: SANITARY NO. CONTROL NO.
(408) 925-9995
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ij LICENSED CONTRACTOR'S DECLARATION Job Desc O , o
F 1 hereby arMn that 1 am licensed under provisions of Chapter 9(commencing /gpq [pI
n with Seti0n7000)arD ypryJ, o Buslnessand Prof op,1pQp.and my licmuo is FINA ED
> nfull force and erred. %�"I �2 (�-( � REROOF W/ DECRA STEEL 0 V1LLL'44OJJ FF"'`�
j y Z Licen u Lie.N
Dau ARCFI .C(- Oen, [J _ �s
IundcrmnJ myplans Aft2 be usedu loll �S 2OOJ
�a Limrued Professional pppR' ,■®`��
� 3 OWNER-BUILDER DECLARATION s.J�'�®Itl
Q I hereby oBirtn that 11. exempt from lm ContractorsoLicense LAW o for the B
0 o following moon.(&dart 703 L3,Business and ova.de ons Cade:Any city or county
,�$� which¢quire a pcemil u cowrocL alar,Improve.demolish.or repair any structure
—zi prior to its issuance.also requires me applicant forach permit w rile a signed statement
< thatbofs licensed punuantumepmviaionsafthe ContachsraU..LAW(Chapter 9 Sq.Ft. Floor Area Valuation
�$ (commencing with Section 70fi0)of Division Softha Busimstand ProresaiansCode)ur $150()0
that he u the
exempt mfmm and me buts for de alleged exemption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant An a civil penalty of ApN Number Occupancy not more man five hundred dollars($500). P y •I�JPe
I,uownu of the pmpmy,ser my omployse with wegesutimlr sole compenution,
will do the week,and the aueum lanai intended oraarod mrwe(Sec.7044,Business Required Inspections
mW Pmfeuioe Code:The Cortisone,Ucense n rou Law dot apply an owner of q P
property who builds or(mpmves demon,and who doeslOch work himsel r or through his
own employee,provided that such improeeremu Are notintended oroRerM finele.If.
however,the building or improvement II sold within man year of mmple k n,the owner.
builder will have the burden of proving that W did not build or improve for purpose of
talc.).
❑1,u Owner of the property am exclusively contacting with licensed canuocun m
Construct the pmjm(Sec.7044.Business and Proles ions Code:)The Commoners LI-
«are Law does not apply to an owner of propeny who builds or Improv thereon,and
who consensus for such projects with a mmncur(U licensed purauant to the Contrseura
License Law.
❑I am exempt under S.C. .B&P C for this moon
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby in.under peulty of perjury...fle following doclantiane:
iI baso and will maintain•Certificate of Consent uself-insure forWarkera Compen.
salon,As provided for by Secdon 37M or the Labor Code,for due performance of the
work roe which rola permd is Issued.
I have and will maintain Worker's Compensation Insurance,a required by Section
00 of the debar Code,ror the performance of the work forwhlch this permit u lytied.
My Worker Compensation lnannce carrier and Policy het a/m.l
Cartier. I Paley No.: 'I I
CERTIFICATE OF MEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mats section need not W complemd lithe permit Isforone hundred dollars(6100)
or Mss.)
1 certify that In the performance of to work for which suis Permit Is issued.I Nall nen
employ any person In any moneran As to become subject tome Worked Compensation
Lave of Caiifurma.Dam
Applicant
NOTICE TO APPLICANT:1f,after making this Ccalfica a or Exemption,you should
become abject in me workers Compcnsalon provisions of the Leber Cod4 you must
O O forthwith comply with such provisions or this permit shall he deemed revoked.
Z CONSTRUCTION LENDING AGENCY
[..i 4 1 hereby.Mon that lure is a construction lending agency for tiro peformance or
C'> les work for which this permit 4 issued(Sec 3097.Civ.C.) .
�W Q Isnders Name
7 z Lenders Address
U 0 1 certify that 1 have read this application and sum mat me above infotmWon Is
0!'. building 1 agree u compcounty ly with all city and couordinances and sum laws relating to /
p rU^ building clmsWCOon.and hereby sumach rtntyuuvof this city uenurupon me S
above-mentionM property for inspection purposes
G (We)agree m caw.immunity AM keep harmless the City of Cupertino against
fA Iiabili Mgmenm,cosh and expenses which may to any soy amus against said City
V APPLICANT UN DS Also WIL PLY WITHA N N-PO Issued by:34�� Date
SOURCEREGU
Re-roofs
Si{nmum ppli car Dam
H BOGUS ATERI DISCLOSURE Type of Roof
WII t w future bulldin cupont sham or haMle heaAow mamrial
u defined b IN Cupertino Munici de.Chapter 9.12,Ind the Health cad Safety
IMIjotie,SecYuan z(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑ rs No
Will lm applicant or ral building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It hum ons air eoomminante delned by the Bay Area Air Quality Mau ZgnituTe-ai
mfo ins action.
uuict7
❑Yes No
Ihave tool the hoerdnum laismqulmmcnmunder Chaper6.9 fum Cali Of. I
.is & ode,Sectom73Ntl,25533od25534.lun&nmdLhat thcWlding
d tly ho non nsibility LO Of y lM torthe
qulmm nor an or cerium of Occu ry. ICaDI Date
f 1 U
Dam All roof coverings to be Class"B"or better
cr a
r
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building De artment
JOB ADDRESS: �zo Gh PERMIT# O'q - 6—1 G O V 2
OWNER'S NAME: t G{ &L/l% AW PHONE# 0 / 25 2- 61C
GENERAL CONTRACTOREZu UY-t n! FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
60 SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
Am Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing r pn SLA
Roofing t lrlrl k-k
Septic Tank
Sheet Metal
Sheet Rock
Til
ntractor Signature Date
Community Development Department
Building Division
SlITYOF
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
U P E TIN 0 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 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 statedpolicyon re-roofing.
Homeowner's Name: M � 0-,l(kitit/U5-
Job Site Address: 2-0935
1�
Roofing Com Name: V U 1
Applica Ys Signa ' re. Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
I REROOF U S't> o U J�
CU
PEkTINO PERMIT APPLICATION FORM
APN# � �q ^ I � /.� � Date:
Building Address: ZO S 315 l � o6 I � 6
Owner's Name: 'n AU�j L,6 � 1' Pho e�
Contractor I( VIU1 / Phone#: I �Z License#: 2-7e)-
Contact:
-7e)-Contact: Phone#: LrU Cupertino Business License#I:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles -�„ ❑ Asphalt Shingles
Wood Shakes ❑ Wood Shakes
Wood Shingles ❑ Wood Shingles 'CAA 5� L, �7
❑ Other(Specify) 1� Other(Specify) -
Number of existing coverings 7— .9, Provide I.C.B.O.Report# 4+3(o I
9C To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Com 1)iWith Cu ettino's Tear Off Policy:
Job Description:jetAaW 6-11?0r4 ( 2 : L^,IQ 6`F 1''%Uoy- I N 5 T&A, 1,I�,/n1 �F1ti(
CJt1.{t
Residential ❑ Coriimercial _❑.
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Projek.: I OUQ l,U Type of Construction: Occupancy group:
Qty. if
Applicable Fee lD 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