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04060146 CITY OF CUPERT[NOr: ea azw 71 - tf^-xlaelz:: BUILDING DIVISION PERMIT CONTRACT3®RNF ORMATION,fig. BUILDINGADDRESS: R E ROOFING & CONSTRUCTION P1,1004060146 ' 10305 TULA LN OWNER'S NAME: PERMIT L55UH DATE VIPA & BING TSE 15230 CLYDELLF, AVENITE IFONE: SANITARY NO. CONTROL NO. (408) 925-9995 ARCHITECVENGINEER: - BUILDING PERMIT INFO BLDG EIPCf PLUMB MECH 0 0 0 0 4 o p LICENSED CONTRACTOR'S DECLARATION I hereby aMma that I am licensed under previsions of Chapter 9(commencing Job Description with Section 7")of Division 3 of the Businessand Prof=tun Code and my license is ^ y infullfnrceande -� �-S�)1/' EROOF License Ire LIc.M n Q Date' G C ARCHITECTSS DECLARATION L\ ATION I understand At,plans mull he used An public ncnrN 30 Licensed Profession.l y OWNER-BUIWER DECLARATION 1 herehy affmh Nat I am exempt form ft Contractor's Leen.Law for Ne O O following reason.(Section 703 L,5,Business and Professions Cade:Any city ar county g which requires a Permit to construct,alar,improve,demolish,or repair any structure prior b)its issuance.also mquims the applicant for such permit to file a signed stammem 19000 qFF O hat he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 Sq.Ft.Floor Area Valuation 5$ (commencing with Section 7")of Division 3 of the Business and Professions Chem)or that he is exempt Neufrom and the bunts for the alleged Ascription.Any violation of Sccdon 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of 3 5URNZEUG—ro 0 Occupancy•type not mom than five hundred dollars(SSW). C 1,As,owner of the pmpmy,or my employ=wide wages As Ncb mi.compewtion, will do the week and theauumure isnot intended orof(aed mnam(SAC.7044,Business Required Inspections and Pmfessiam Cade:The Conuseme.License Law d=net apply to An owner of 9 P property who builds or improve thereon,and who d=such work himself or through his Own employ Wiping or provemimprmemmuarenot earoedaoRered(tie We.If, however,the building m improvement is held within one year of completion,the owncP builder will have the burden of proving that he did not build or Improve for purpose of mlcJ. ` co 1,as owner of ct property,.B eucas and cofeemong wide:)The conuacmn W /no wov=e Ne project(Sec.]Oath,Business and ity wh i bui Cade:)The Contemns n ` _ aose ntr d=not W ts owner of property who builds or ant to dim themon,and 16 `yy`TQ whocontractsLace for such projects with s contractor(s)licensed pursuant m du CanuenoM1 / License law. ❑lam exempt under Sea .Bk PC for this myon Owner Dau u WORKER'S COMPENSATION DECLARATION 1 hereby affirm under penally of perjury one of to following deelantim r. 1 have and will maintain A Certificate of Consent to nelf-insum for WorkmesCompen- moon,As provided for by Section 37W of Ne labor Cade,for the performance of Ne .,it for which this permit is issued. C 1 have and will maintain Worker's Compewdon Ituu .,As required by Section _ 37W of the LAW,Cade,far the performance of dee work for which this permit is issued. My Work��ye..Cumpe nlnsunnce artier and Policy nu ran: O .. Canter.J 1 FIT V %) Poliry CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Phis section need not he completed lithe permit Is for One hundred dollars($100) or less.) 1 certify that in the perfaemance of Nc work for which this permit is lured,l that not employ any person in my mannerze un in become subject to the WorkcW Compens.6. Laws of California.Dau Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should haeme subject An the Worke's Compensation provision of the Labor Code,you must .J O forthwith comply wide such provision or this Permit shall he deemed revoked. _r h CONSTRUCTION LENDING AGENCY (r Iherehy affirm that Nem is a Construction lending agency for the Performance of !Yi> tie work for which this permit ts issued(Sec.309],Civ.C.) QLenders Name Z Lenders Address ' U2 1 eeelfy that I have read this application and sum that the W.infmmaurn u IS,f•' correct.I agree to comply with all city and county ordinances and sou laws mladng W 0U building construction,and herebymthorim mpresenmdm of this city W enter upon the W move-memionul property for inspection Proposes. (We)agree W muse,indemnify and keep hnmless the City of Cupertino Against y liabllitlea,judgments,casts and expenses which may in any way Accrue against mid City U Z in consequence of the granting of this permit. �--� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: . Date ;Will REGULATION _ Re-roofs n afAppli HAZARDOUS MATERIALS DISCLOSURE Dau Type of Roof Will the applicAm Or renew building occupant a.m.,handle hvalloun trauriai ed by the Cupertino Municipal Code,Chapter 9.12.and the Halth and Safety ection 25532(.)7 All roofs shall be inspected prior to any roofing material being installed. ❑Yrs 0N the applicant or future building occupant run equipment or device,which If aroof is installed without first obtaining an inspection,I agree to remove vardous air contaminants u defined by the Bay Arca Air Quality Management all new materials for inspection. ? ❑Yes Chit, 1 hrvc mad the haaaelu s 2550512553 firemen 5 under Chepmr6.95 it the Wilding nus outhurSrelyhow.Seco=hat iti myrsponsi M.1 undersfM occupant building J=out cvrtcnthy hese a anent.that it u my responsihility tu notify Nc aceupant d(Ne 'Z nqui must`me u «ditataafa q. Sign ureofApplicant Date 0 error aumorimd agentDaW All roof coverings to be Class "Br Of better Community Development 8 10300 Torre Avenue Cupertino CA 95014 Telephone(408)777-3228 CITY OF Fax(408)777-3333 �UPEkTINO Building Department JOB ADDRESS: 16365 <LA LAw� PE # OWNER'S NAME: V 1 PA -5� PHONE # 2 — GENERAL CONTRACTOR: FAX # I am not using any subcontractors: Signature Date Please check applicable subcontractors and complete the following information: 63 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 RoofingL'KV-- OY-P WCL wAµ5 Septic Tank Sheet Metal Sheet Rock Tile er/C actor Signator . Date Community Development Department * s Building Division t- City of Cupertino 10300 Torre Avenue t Telephone: (408)777-3228 qUPEkTINO CITY OFFax: (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 o"(n re-roofing. Homeowner's Name: �1/�p A N� I / Job Site Address: Iv�� Roofing C pany Na I )� S CQ) 5TMWC,1-I 6V k/c . A plican 's Signatur , Date: I b I O Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO IWO REROOF v CUPERTINO PERMIT APPLICATION FORM APN# Date: Building Address: 1 /t I t! '-LA LAw�, Owner's Name: V <5 Phone 1�� I e Contractor: � C(1)✓�•( �j Phone#: U� 626- License#: � jZUI� IN 2U�c.116U �132� � 277r� �) Contact: Phone#: Cupertino Business License#: oJcSvlc �� 0�6 zl-?'�I Type of Roof Covering: Existing: Proposed: ❑ Built-Up Roof Cl Built-Up roof ❑ Asphalt Shingles ❑ Asphalt Shingles K Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood ShinglesI l AWL I � �� ❑ Other(Specify) X Other(Specify) 1 Number of existing coverings 1 _/Q_ Provide I.C.B.O.Report# 2 `J in 5.t # 5� To be Removed ❑ Provide Mfgr. Installation Specs. /\ Y • I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: Job Description: I.AC l m 0)�- W oUYJ pv l /(Kts uSTAI t, Q/W II Z" C P i[STM l�/�,7LI ResidentialCommercial ❑ �I t . A 29.5 Fire Zone: Yes ❑ No Confirmed with Planning Dept. if there are any restrictions: LI Cost of Project W Type of Construction: Occupancy group: Qt . A Gc bl 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 O 3 � p 0 - � 0