04110018 CITY OF CUPERTINO �+i(eexY#+R,.4w2c+ma-_wa< ' dTj'�''�xS,'•.{' ' 'h' `s^-''
BUILDING DIVISION PERMIT VCONT1�liCT®i2INTO1V.aATION
OUILDINGADDRESS: OLD COUNTRY ROOFING PERMfrNc.4110018
2 87
OWNER'S NAME: PERMIT ISSUE DATE
GORDON LIU 125-B GROBR
ONE: SANITARY NO, CONTROL NO,
(707) 864-5557
ARCHITEC AINGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
I� 0 0 0
Z, LICENSED CONTRACTOR'S DECLARATION Job Description
/I I Wmby affirm Nn I am limned tendered Pr fess of Chapter an(commencing P
^� wlN�von7IXN1)ofDlvialonJofNC Businw pb Pmfcsriom Code.end my license in bl)
a- REROOF W/COMPARCHITECTS DECLAR T Ni nd u dersund my plana shall he usepublic mcmus 0
i8 Licensed Pmfemi...1
OWNER-BUILDER DECLARATION
f I hereby affirm that 1 am exempt from tW Canuanars License law for the
00 fallnwing muscle.(Section 7071.5,Business and Pofc.iou Code:Any city or county
K$� which requires a permit to construct,after,impmw,demol W,nr repair any atracture
Fiy prior to itsusuance,also total.tWappliesnt for.uch Permit to IIIc a signed steemcm 14000
< NatMislicensedpursuanttotheprovismosoftheComrscu'sLk<nse Law(Chapter 9 Sq.Ft. Floor Area Valuation
2�0 (commencing with Section 7")of Division J of the Business and Professions Code)or
�.. that he Is eumpo therefrom and the bun for the alleged exemption.Any violation of
Section 70713 by any applicant for a permit subjects the applicant to a civil penalty of
not mom On five hundred dollars($500). ¢ Occupancy Type
0 1,u owner of Ne pmpeny,m my employm with wm u ftirmle compenudon,
will do Ncwork..d the someone is not intended"offered intake(Sec.IDN,Business Required Inspections
and Professions Code:The Convectors License Isom d=not apply b an owner of q p
Property who buildsor(mprons thereon,and whodoemuch work himulforthrough his
own employ=,provided that such improvements tie not intended aroRered fault If,
however the building or improvement is cold within one year n(completion.the owner.
builder will ban the When of proving Nat he did not build or improve for purpose of
uN.).
0 I,as owner of Ne pmperr,am uclutively contracting with licensed contractors to
construct Ne project(Sec.7044.Business and Professions Code:)The Convector's U.
taus law d=not apply to an owner of pmpeny who Wilde or Improves Roman.and
who contracts for such projects with a eonumetnr(s)licensed pursuant to me,Contractors
License law.
0 I am uempt under See. .B k P C fa this recon
Owner Dow
WORKER'S COMPENSATION DECLARATION
I hereby nature under penalty of perjury otic of de following decimations:
I ban and will muiouin a Certificate of Consent m self-Inure for Weasels Compen. _
737M
ion,u provideA fa by Section 3700 of the labor Code.(m the performance of me
rk(or which this pa.[,is issued.
1 have and will maintain Workers Compensation Insurance,as recruited by Section
of the labor Code.for du performance arms work for which this permit is issued.
!Workers Compensation luumece mmier and Policy number ere:
mer: /G�7atuP �/er,fL110 Polley .: l-� GSfrZi
CERTIFICATE OF EXEhIPgON OMWORKERS'
COMPENSATSONINSURANCE
(Thu sation deed not W completed Irma permit Is foronchundmd dollars(SIM)
or Ru)
I certify that in the performance of the work for which this Peonit is issued.I mall ata
employ any person in any manncren u to became subject to the Workers'Compensation ,
Law,of Califamia.Date
Applicant
NOTICE TO APPLICANT:If,after making this continue or Exemption,you should
become Subject 0 the Workers Compensation provisions of the labor Code,you must
0 Z funhwuh comply with such provisions or this Permit Mail W accrued revoked.
Z'O CONSTRUCTION LENDING AGENCY
Thereby affirm Nat mart is a contraction lending agency for the Performance of
C> tint work(ser which Nu permit is issued(Sec.7097,Civ.C.I
4 Q leader.Name
Lender's Address
V Q 1 cenify that 1 have read this application and sum Nat Ne show information is
W E-r 'correct.1 agree to comply with all city and county oNinanm and state laws meeting to
Q V building construction,and hereby auNorme representatives of this city to anter upon the
W above-mentioned property for inspection p rposea
(We)agree to an.indemnify and keep harmless Ne City of Cupertino against
IA liabilities judgments.cats and expenses which may in any way¢cmc against mid City 1'
CJ Z in consequence of the'renting of this Ptedol.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURC GULATIONS.
( 'e Re-roofs
Signature of Appinspi Canvactor Data
HAZARDOUS MATERIALS DIRele $URE Type Of Roof
Will the applicant or future building occupant sole a(handlc hvsNous materiae
as dlil 1 by Ne Cupertino Municipal Code.Chapmr 9.13,and the Health sed Safety
code. 0y.25s73(a)7 All roofs shall be inspected nor to an roofing material beim
❑Yes de P P Y 8 g installed.
Will the applicant or future building occupant use equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove
my h..,dous air canumi...0 u defined by the Bay Are.Air Quality Management all new materials for inspection.
D
istrict? /
0Ycs pNu
I have mad the buuthms maurlals equircntents under Chapter 6.95 of Nl Califor. /J /
u &Safctycodc,Sccuau 35505,25573 and 25534.I undersand Nat if NC Wilding
= comentiy ban s ummt On it u my mspouihilisy m fury the occupant neon
sabc Iprior of�anar,m ofS Cenirca¢arocarp.nry. SI�gDaI re of Applicant Date
Ow erdrauthorredagent Dem All roof coverings to be Craisg"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: PERMIT#
ao F(�7- C oOJKC; 00 / 00 (1?
OWNER'S NAME: Co o L, / U PHONE # V OP 31.-;? P5oo
GENERAL CONTRACTOR: OJ CptA tyrjZ /
I am not using any subcontractors:: � � ��- oS— o q
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
Septic Tank
Sheet Metal
Sheet Rock
Tile
Owner/Contractor Signature Date
Community Development Department
Building Division
/ City of Cupertino
10300 Torre Avenue
OCITY OF Telephone: (408)777-3228
��I�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,
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: L o r� o A) L �I
Job Site Address:
Roofing Company Name: CO CJ A/i YL7 112,0 Q f I/0 G
Apficant's Signature Date:
• \,AI4S1I�1LX�Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper -`
1
CITY OF CUPERTINO
REROOF
�CUPETINO PERMIT APPLICATION FORM
APN #3rJ9 /3 06 / Date:11. _ 044
Building Address:
Owner's Name: Phone#:
Go o L. �
Contractor: Phone O License#:
OL,?, COv1NT ooh 6 �� 830f G-: � -7- �s /
Cont ct: Phone#: Cupertino Business License#:
CY D �- 7 F-C 1,3 ao O 3�
Type of Roof Covering:
Existing: Proposed:
-- ❑. Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles 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 Com 1 With Cu ertino's Tear Off Polic
Job Description: l�Cf r7'70 ✓ � L X I cS T i A_)
Residential ` f Commercial .❑. _ ..c .
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
0 00 it moo (= 3
Qty f
Ap icdble 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