06020133 CITY OF CUPERTINO ^ `uczx,ms;
BUILDING DIVISION PERMIT M�CONTRACTOR INFrQRMA'CION%
kM s^X . 'mss, f'5 '7 „^L
BUILDING ADDRESS: ROOFING PERMIT NO.Q
10352 TERRY WY
• OWNER'S NAME: PERMIT ISSUE DATE
NING HSIEH 1696 VALLEY OAKS DR. ' 02/22/2006
ONE: SANITARY NO. CONTROL NO.
(408) 842-1057
ARCHITEC IENOINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u00 LICENSEDCONnsed A. , DECLARATION `
; FF 1 Mrcby affirm that I am licensed untMr pmviuonm OfChapmr Y(commencing Job Description
iW with Sceuon74)(M)of0iviaon 3 of the Business and Pmrcssinns Code.and my license is
+may inrnnmrceandc(fect. pp r REROOF—T/O SHAKE/INSTALL SHINGLES (CLASS A)
��? License Cl L'¢.N dG�/is II
Dam Coca., b-4 z. c..._,. 7/16 OSB + 30LB FE - HINGLES
As shall CPSDECblicmc do LIFETIME WARRANTY)
i U 1 understand my plans shall IE used u pubic DECLARATION
000
soy Licensed Pofcaum"31
$ OWNER-BUILDER DECLARATION
9<f 1 hereby affirm that 1 am exempt from the Contractors License Law(or the MAR 2006
a C O following Mason.(Section 7831.5,Business and Pmfossiota CWe:Any city or county n1` t�
z m which mquirms A permit m construct.she,improve,demolish,or repair any stmcmm
yin priorm;¢issuancc.auo tequims ton Applicam fmrwch Mrmiuo Rleasignca stammem -
Ei`e that he islicAnsed luummot In be provisions of th,Conarmtor's License Law(Chapter 9 Sq.Ft.Floor Area luaton
yt- (commencing with Section 7")of Division 3ofun,Businessand Professions Cock)or $19000
y 5 9 wt M6 exempt themfmm and the baso for she alleged eaemption.Any violation of
Section 0831.5 by my Applicant for A permit subjects the applicant to a civil penalty of APNthfiNumber (]CCU
not mom an n hundred dollars(5518). Occupancy Type
D I.As owner of the property,or my employees with wages An their sole compensation,
will do Ute work and the structure isnot intended or offered(m sale(Sec.1064,Business
and Profession Code:The Contractors License Law docs not apply m an owner of Required Inspections
property who builds orimprases themon,andwhu doessuch work himself or through his
Own employees,provided that such imprnvcmcnts tae notimendcd oroffemd for sale.If,
however,the building or improvement is sold within one you of completion,Ne owner-
builder will have the burden of proving that he did not Mild or improve for purpose of
.Jr.).
D 1,as owner of IM property,am exclusively conuaming with licensed eonuanors to
coosbuct the pommel(Sec.AM,Business and Professions Cade:)The Contractor's Li.
me Law docs not apply be an owner of property who builds or improves themon,and
who contracts for such pmjects with a contractor(s)licensed pursuant to the Contractors
License Law.
D I am exempt under See B&P C for this recon
Owner. Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under totally of perjury Arte of the following declarations:
1 have and will maintain a CeniGrnte of COtamnl to self-insure for Workcea Compen-
sation,ss provided for by Schon 37M of the Labor Cade,for the performance of the
work for which this permit is issued.
til hers And will maintain Workeh Compensation Insvrance,ss teyuimd by Scene.
PIX)of the Labor Code,for the performance of the work for which this permit is issued.
My Wmkce.Compensation
sslns Am' canner and Policy number an::..O
Cartier. S�/1 — Y' � Policy No.: e*3.�Z WG—
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
or less)(Thu .b
section need not M completed if the permit is fotoumhod dollarspl IBB)
I ccnify that in the pc,fom arec of the work for which this permit is issued.I AMll not
employ any person in any mantarm u m Mcome subject m tM WorkersCompensation
Laws of Califooia.Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Esempuon,you should
become subject to the Workers Compensation provisions of the Labnr Code,you most
.J ,z fAMwllh comply with such lmvisinta or Nis permit shall M doomed mvokcd.
ZO CONSTRUCTION LENDING AGENCY
[-r IMmby aRrm that them is A comtructinn lendingagcncy for me perrmet an,of
D: the work for which mise pepma is issued(Sec.3841,Civ.C.)
W� Q Lendcr's Name_ -/
Lon
z der's Address
U Q I reMly Nat I have mad mise application and mute mat the above information is
LL. F eonett I agree to comply wise all city and county ordinances and state laws relating to
0 U building construction,and hereby authorise representatives of this city to enter upon the
�0. aMwdmenuonmdproperty
costs
(m impecuon which m.
H (We)agree to save,indemnify and keep harmless the City of Cupertino against
Uzin couem,judgments.cosuand of this Permit. may in anyway acme against mid City
in cansegOctmc of me granting of mise permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:S4Date '�. Z—r. L
SOURC R LATI
�60_
�)3,�... _
Signaum of pplicam/ ontraclor Re-roofs
HAZARDOUS MATERIALS DISCLOSURE m Type of Roof
Will tM applicant or future building Occupant store or handle harsrdous mawrial
As defined by due Cupenino Municipal Code.Chapter 9.13,and the Health and SafetyAJ& -
odc,5cction33533(a)? All roofs shall be inspected prior to any roofing material being installed.
Y.
❑NA
Will mea applicant building Occupant If a roof is installed without first obtaining an inspection,I agree to remove
PP g pan vu equipment or devices which g p g
it banrdops air conmminants As dcbnca by the Bay Arca Air Quality Management all new materials for inspection.
isbict?
❑Yes DNA
I have mal the hvanlnos mamrials rcquimmcnu unacrCMptcr 6.95 of the Califor-
nia Health&SAfc1y Cedc,Sections 355)5,25533 and 25534.1 undersmnd mathm ifMilding
docs not c mently have A tenant.mat it u my mspooibility to notify the occupant of to ` Z
mymrem cramp m priArm;rsnanmenracervratr0famyanoy. Signature of Applicant Date
�i z� iY
Dwnc,m .eaagent Darc All roof coverings to be Class "B" or better
affin
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
� CITY OF Fax(408)777-3333
UPEI�TINO
Building De artment
JOB ADDRESS: PERMIT #
'd'3 Szd'2- d �2 3
OWNER'S NAME: lir PHONE # _3
GENERAL CONTRACTOR: ;, �. J / 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
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
OU 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.
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: IV6- c5i cw
Job Site Address: /035-t- LVA"
Roofing Company Name:�/�� S� !1/�J /�3i1i'zri(T ALp( $A�i)
Applicant's Signature:'/ '=
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
G - CITY OF CUPERTINO v 6 0 /3 3
REROOF
CUPERJINO PERMIT APPLICATION FORM
APN# Date:
S / ° Z zv� 2
Building Address:
v3SZ WAY,
Owner's Name: Ph e#:
a IA& 145(64
Contractor: Phone#: License It
`J v 3063`7rf
Contact: / Phone# Cupertino Business License#:
Type of Roo Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ fycphaIt Shingles L"Phalt Shingles
ood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Num r of existing coverings j ❑ Provide I.C.B.O.Report#
o be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
M&loDescription:
WS_(ALL- 7 "6S& -F 3e(b. elei.7l- lWc*t7•Si�i�lr �[ iw�E
Residential Commercial ❑ S"R t,
Fire Zone: Yes ❑ No Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupangrou
ODD �v
Qty. if
Alicable 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
333 °
� 26� '