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04120114 CITV OF CUPERTINO BUILDING DIVISION'. PERT zca "� �fl � dYt MIR0:DING ADDRESS: - PERMIT NIb 412 O 114 OWNER'S NAME: PERMITISSURDATE .. . .. ..-. >—. ANDY .SUNG NE: -. - SANITARY Ni CONTROL N0. ARCHITECTYENGINEER: - BUILDING PERMIT INFO - - O ELECT PLUMB MMECH 3G, LICENSED CONTRACTOR'S DECLARATION ' o . .I Much,moon Mal I am licensed ands,Provisions of chapter 9 fcomomacm& Job Description IN Section 70110)of Division 3 of the Business and Profeoun%Codo,and my license la gnq_nn reran ra sande 4 Gt O REROOF-ADD 40 YR COMP SHINGLES n Dam << Canuanor. ARCHITECTS ommer. ATION understand my T2�16/O4 .DATES' ROOFING PD FOR BUS LIC ;6 Licensed ProfsesWool - OWNER-BUILDER DECLARATION f 1 hereby.(Sero that l oro rumps from don r Cssion o Ucertse law for the - - - p o following moon.permit o 7(rommut,sh Business and ms.dosiuns Cade:Any city or county $tai which requires a pemot re cores eL alma hnprove,dwmit h ore poi,anY urOcmro FZSn poor issuona.a4u requires applicant for such permit he nloasigOcdsummsnt , ggg Most Valuation Ilcemed purwent to Mm provisions of Ne Commuter License law(Chap=9 Sq.-Ft.Floor Area VaIUBIIOn $ (rnmmencing with Section 7d00)MDivision)of the Bummustnd Prn(asions Cods)a r, A that he is exempt therefrom sed the buil for die Alleged exemption.My violation of $500'0 Section 7031.5 by any applicant for a permit subjects the appncmt m acvll Knotty ofAPN Number - '. G-GOccupanCy�!pe mm Nuve - ' not ofihundred dollars(M). tri. 1.•/ pl,uownerofdmpmpeny,mmyemplaycuwlthwegass'Nehwlemmpenudon, will do the work,and theawnum canal intended worriment forsed.(Sm.7044,Business - �a t-, and Pro(exsi.ns Cade:TM Omaacte?s Liana Low does wt appy re an awns,of '- Required Inspections a �. .,. -�:.-i=,:7" Propetywho bulldsor Improves thereon.and whodoessueh work himsuforNmugh h4 L�fJ - awnemplaym,provided Man such ipepmvepeau uenotinuMed oroRered ref We.H. //'T hessm.,Ne building or improvement is sold wilhmmus year ofcempledon.Me owner- �( Wild"will have Ne harden of proving that he did not build or Improve for purpose of sale.). ❑I.u Owner of the property,am exclusively contracting with renewed contractors;to - eonstrocl the pmjecl(Sec.7044,Business and Professions Code:)TM Contacmr'tU- ^• - J �_ camelnwdaunmapplr man with aof Property veld bedpmimpmvve Comm,sm's whocontractsLacca for such pmjecu wlNeconuwtor(q licensed punwm redo Conuacmr'sLicense law. ❑lam exempt und"9ec. - .B&PC(m Nb maven r Owner Dam _ - WORKER'S COMPENSATION DECLARATION -- "—"—"^"---•' W,- 1 Mmhy slntm under penally of perjury one of die following dcclandou:— 0Ih.veand will maintain•Cath(:camofC.n.nitoull.imumforWofte&Campcn- - • _ _.. _, -, soon,u provided for by Secdan)700 of No Iak,Code,for the perfaemanm of the work for which this permit is Issued. - .. 1 ban and will maintain Worker'sCompensation Insurance,u rcyulrtd by Section •--.. . ,_r. ' of l e toed,Cade.for the performance of ti work for which this Ismailia issued. - My,Workete^Comp�CnuLdan Insunna ani"sod Policy nurgEq a�� urj , Carder, Policy No.7 13 1 } CERTIFICATE OF EXEMFION FROM WORKERS' - COMPENSATIONINSURANCE (Iris section reed sot kcompleod true Permit B foronchuidmddollass(5101) or less.) 1 cer ily Net in Ne performance of the work for which Nis permit is issued.I mail ns. employ anypomen in any mannerso as an,become subject to IN Workcri Comi etsadan Laws of Ctlifaroia Dam - - -' NOTICE TO APPLICANT:If.after Compensation this Certificate the Exemption.you should - become subject y it Worh ri Copepeoution provii mai ofd c ISMr Code.you most .,O foMwiNmmply with such provisions or this permit mail kdamed revoked. . �y CONSTRUCTION LENDING AGENCY t� I krtby Nunn thuthere iaaamNmtiml lending.gomy fm Nepeeformmccuf . 1x> the work per which this permit I.issOcd(Sec.3097.civ.c.) W Q Lender's Name z lender's Address U I cedly Out I have read this application and sum that the allow information is F•' consul.I agree to comply with All city sod county ordinances and suss Iaws reh0ng to - C.) Wilding construction.and hereby Maintain representatives ofthis city re enter upon Ne U show-mendoned property for Inspection purposes. Ly,LL (We)agree to use,indemnify and keep harmless the City of Cupertino Against / r'r/J liabilimajudgmenu,emu and expenses which may in soy soy rectum against laid City / in consequence of the grading of this permit. ,[v ^^ APPLICANT UNDERSfAf S AND WILL COMPLY WITH ALL NON-POINT Issued by: Date SOURCE REGU N , '21-16104 Re-roofs Signature of ApPicarolnumelor Dow H ROODS MATERIALS DISCLOSURE Type of Roof Will the apPncant Or future building Occupant store orlundle huudom MAmdai as donned by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety Co do.Sccdan 15531(x)? All roofs shall be inspected prior to any roofing material being installed. ❑Ya EtIVII Will the spplicwt or future building occupant use equipment or devlas which If a roof is installed without first obtaining an inspection,I agree to remove emit h oArdous air contaminants u dented by Na Bay Area Air Quality Management all new materials for inspection. District? ❑Yen 1_I rvu 1 have mad the Murdnu mamdais mquimmenu under chapter 695 of the Califar r nil Health SafmyCom.Sections 15505.155))and 15534.1 understand that dust,Wilding .�}��J dao not currently have a umam.Nat it u my respomibility re Ivory the occupant of the x•/ • O mquimmcnu soh' schemes poor issuance of B Cenificate of Occupant Signature of Appl' ant Date �� X�� � All roof coverings to be Class"B"or better Owner or uthired Dal Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 U P E IST I N O 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. 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: r,4r— Job Site Address: Roofing Company Name: A plicant's Signature: - Date:�Ll ' co . Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper Community Development r , 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �PEI�TINO Building De artment JOB ADDRESS: PERMIT# // 2- OWNER'S OWNER'S NAME: PHONE # x GENERAL CONTRACTOR: FAX # l' I am not using any subcontractors: !Z11 G • 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 �t Roofing s PS-17 ZSeptic Tank Sheet Metal Sheet Rock Tile Owner/Contracto ignature Date CITY OF CUPERTINO 40 REROOF CUPERTINO PERMIT APPLICATION FORM © 41-/d d//7 APN# �7 � �, � � Date: Building Address: Owner's Na C Phone#: Contractor: PlYone#: License#: -S/a 7 So-S6 qq to ! 2- 9a y Contact: O Phone#: Cupertino Business License#: Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof '% Asphalt Shingles )Vc Asphalt Shingles ❑ 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:,/-,, CL� Residential Commercial ❑ Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if there are any restrictions: LJ Cost of Project: Type of Construction: Occupancy group: OOU � 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