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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