04120068 a ' CITY OF CUPERTINO ,�- '° a"8Y
BulLmrvc Div,sloN PERMIT .. COUNT Ut I aI)VTUXLM�TIUI� �BUILDING ADDRESS: - R',E ' ROOFING -& CONSTRUCTION 'MVo04'1200'68
' 1031`'5 7TWA.'L -.
OWNER'S NAME:' - PERMIT ISSUE DAM ... _.,
TU-AN CHENG- 15230 CLYD
SANITARY N0. - CONTROL NO.
(408) 925-9995
ARCHITECT/ENGINEER . . - BUILDING PERMIT INFO
BLDG : ELECT PLUMB MECH
—0, - - LICENSED CONTRACTOR'S DEC ATION '
py affirm that I am licaesed under n of Chapter 9(commencing _
Job Description '. .
F �
s with Sec' n7Hf18)rt s o No Buvnessan Proessiunx Code lic.ac is
roll roe andufta '72 ✓t REROOF,' -
z License s
Dote Conmcmr $ C
1 RATION -
1 uns s
records r444f(�1 i��y
n n M
3u. keg tf ' net rl 'gl.
ILDER DECLARATION
I hereby affirm that I am exempt from the Commences License Law for the
�C O following reason.(Section 7W 1 5,Business and Professions Code:Any city rr county
K$ which requires a Permit to construct,alter.improve.&mulish.m repair my structure - p„y f pT 7e,„ ' _
v-'^ prim se its issuance,also requires the applicant for such Permit to Tile a signed statement u.
fZQ that hei¢licenwdpurwanur[be pisrvisiunenfthe Contrnmr'sUcenaLaw(CheprerY , Sq.Ft.Floor Areay((,,,,,,,,))J/ pry/j =4!!b. . Valuation
-. $ '(commencing with Section 7")of Division 3 orthe Business and Professions Code)ur `J /,F!
'ry dol he is asempl therefrom and 0.lindfor the alleged exemption.Any violation of �VVT��J..."'/ !/ 1 () _
Section 7031.5 by my applicant free permit subjcem the opplkaot la a civil Pena.hY of - - er0 0. �._ ...—1 �i'Ar'u�\\.rr(pfi^occupancy Type --
not mom Nan five hundred dollar($500). U(/ \'v)((�L-•�f"
: ❑I,vowner of the property,or mY employeeswiN waBesss their role compensation,
will do the work and Neswcwre is nutimmand orolfamd fonale(Sec.7044,Bwinw '
and Profession Code:The Conummes License Lew draw not apply to an owner or - .. - '' -=-.Required Inspections -
propeny w hr hui ids or f mproves dtercon,and who doessuch work himself or through his ..
.._.... .._ .. . _ t .. _. ._
man employees.Pmvidrri that such entissld wit vent imkrdac aneercd for owmcrL
luilder Neave thgorimproprovinisml he didnone yev ofcompletion.theose of - - - _ - - -'
builder will have W burden of proving dot he did not build or improv for purpose of
❑J.as owner of the property,am exclusively con iseling with licensed contractors N .. _
construct the pmjea(Sec.7044.Bwinese and Professions Cade:)The Conlrinmes Li-
ccnv law does not pply to an owner of property who builds or improves thereon,and
who Law.for such project with acrnsvmr(q Hared pursuant he Ole Contnnoh
License Law: - -
., ❑lam exempt untlu,5ee. - .BkPCfor this reason
Owner Data
WORKERSCOMPENSATIONDECLARATION,-.
1 hereby aftlem under penally of perjury one of the following dulanHrns:
Ih...ed will maintain aCenirncvaof Conwntmvlf-inumfrr Worker'$Crmpen- ' - -
sedon,es provided Be by Section 37W of the labor Code,for Ne petfo..me,of the
work for which this permit is issued. - -
1 have and will maintain Worker's Compensation Inurance,as required by Section .._. .. ._37W of NC Labor Code.for the performance of the work for which this permit iaissum:
My Worker1yCl-n'mpertmoo l grana came and Polflare- -
Ca. u'''� Polity l ` , (� la
CERTIFICAT60F F.�' PfION FRW RKERS' - -
COMPENSATION till '- -- - - -
(Thisvctim,need not Lecomplctcd its he pemnil is Tamm hundred dollars(SIM)
or less.) -
I ser ily Not in the performance of the work for which this permit H issued,I shall not +. -
empleymypeIsoninanymannersoazsobecomesubjecttoteWorkers'Compcnsation
Laws of Califome.Dae
Applicant -NOTICE TO APPLICANT:IL after making this Cenifscale of Exemption,you should - - -- +
become subject in the Worker's Compensation provisions of the Labor Code,you must
0 forthwith comply with such provision or this permit shall M deemed revoked.
Z r~N. CONSTRUCTION LENDING AGENCY - -
r
[-i kfor which thi Net Nerc is e c d(See,3W7,ding agency for the performance of
fx r� Ne work rm which this permit is issued(Sec.J097,Civ.CJ -
W Q Lender's
z Lender's Address.
V Q 1 certify Nes 1 have mad this epplicuion and state Nel Ne above information is -
ly H correct.1 agree to comply with all city and county ordinances and state laws relating to -
OU building mocrmtiun,and hereby authorise reprcunsetlrw of this city to enter upon Ne
(11 above-menduned properly for inspection purposes.
6r (We)agree to save,indemnify and keep harmless the City of Cupertino against
rn liabilitiu,judgmenls.coss and expenses which may in my way accrue agmmLsaid City /
(„) uenc
MonICe of the granting of this permit
APPLUNDERSTANDS COMPLY WITH ALL NO -P INT Issued by: Dat
IFwIL
SfURCErfA 0C ` .. .. •-.•_ CI�� `
ii�A//II--Be l Re-roofs
ommctor Date
SMA IALS DISCLOSURE Type of Roof -
WillNcapplicantmfuturebuil goccupantstoreorhandleba/mMowmamial
v defined by Ne Cupemnr Mmic1 Code,Chaper 9.12,and the Health and Safety
ode,sad.25532(a)?
❑Yes All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or futum It mg occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
It havasdow air com seinen fined by the Bay Arca Air Quality Management all new materials for Inspection.
strict?
❑Yes' No
I have road Ne hwar.s marenalaroquircmens under Chepkr6.95 of Nc Califm.
ofesy Com,S.M.25505,25533 and 25534.Iundcrsetb thetifthc building
docs of cua¢not Nat it is responsibility a notify the occupant of c
req k m tp' soofaCerdnwerr .rex ( PO ignatureofApplicant Date
wnmmwt Date All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CI OF Fax(408)777-3333
'PERTINO
Building De artment
JOB ADDRESS: 031 7 / LA � nc� PERMIT O ` 1 O r
OWNER'S NAME: 4U-AJ CftNPHONE # 6.q - ' T( z 9
GENERAL CONTRACTOR FAX#
I am not using any subcontractors:
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
Roofing — � } ( (V L M fNC .
Septic Tank
Sheet Metal
Sheet Rock
Tile
25ntractor Signature Date
r
Community Development Department
Building Division
:r City of Cupertino
10300 Torre Avenue
CITY Of Telephone: (408)777-3228
Fax: (408) 777-3333
�UPERTINO
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) ln-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 relmovalof all new material down to the sheathing,
..so.a proper City.inspection can be performed:ttza_z.:*7t hest;
7. NOTE:.If you call for-a plywood nail inspection and the job is not ready,
V you will be charged a re-inspection fee of$17618' The re_-inspection fee must
be paid before another'insyectiori can be scheduled.
IMPORTANT:.
L, 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..
/1
' Homeowner's Name: I zr _ li}1�11 G�
lob Site Address: tj� "I ��LAY'. L }1
Roofin Name:
Ap licant's Signa — Date: f SCI)
Greg Casteel
Building Official
- Revised 11/2/04
'Printed on Recycled Paper
J .
CITY OF CUPE�RTINO
REROOH'
CUPEkTiNO PERMIT APPLICATION FORM
APN# 1 Z Date: 12d 10 I()
Building Address: q
Owner's Name: Phone#:
Cont ractor: Phone#: r License #:
�132� e�2 "151
Contact: Phone#: M��. _.. . - _ Cupertino Business License#:
2U 615
Type of Roof Covering:
Existing: Proposed:
❑. _Built-Up Roof ❑ Built-Up roof '
❑ Asphalt Shingles ❑ Asphalt Shingles
.-_Wood"Shakes. ElWood Shakes
❑ Wood Shingles ❑ Wood Shingles y
❑- Other(Specify) Other(Specify)
-Number of existing coverings ❑ . Provide I.C.B.O.Report# 5 �j
'❑ To be Removed _ - ❑ Provide Mfgr.Installation Specs.
I HaveAead; Understand and Will Comply With.Cu ertino's Tear Off Policy:
Job Description I M YL �YlkriNlt� s ..l . (tLf h1L Ol` WoLTV 51wkKel INSTALL,
0;vs. ,,.. , 0011-', wr l I LA5,
'
:Residential. i : .: :-..F 2.Commercial ;❑ ;
_.. " Fire Zone:_ Yes' ❑ . No ❑. - f Confirmed with Pl g Dept:if
there are any restric ons: LJ
Cost of Vu Typo ons tion: Occupancy group:
if
cab Fee ID Fee Descri tion 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•,
z� 3 .