05090146OF CUPERTINO
° C0 12ACTUR TNI`OMAi'II
FCITY
BUILDING DIVISION PERMIT
,;
ILDINGADDRESS:
OATES ROOFING
PE1MITNG.05090146
1682 WESTSHORE CT
WNEWS NAME:
PERMITL4UEDATE
KYUNG HA KOH
5496 BUTANO PARK DRIVE
09/21/2005
ONE:
SANITARY NO. CONTROL NO.
(510)750-5644
ARCHITECT/ENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
Job Description
I kreby afrirm that 1 am licensed umber provisiom of Chapter 9 (commencing
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with Section TOM) dDivision 3 of the, B"I ProfcuW. Code,a mylke.eis
in fall fora. adercecl.
REROOF--T/O SHAKES, OSB,
LicDannse clan
Dam Co
.RESHEET
"'gtHD 40 YR. COMP. SHINGLESa
ARCHITECTS DECLARATION
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1 understand my plans shall he mad u public records
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LKented Professional
OWNER -BUILDER DECLARATION
I Wroby affirm that I em eumpt from the Crnuunoes ISanse law for ma
C['tY
following mLWn. (Section 7031.3, Business; and Pmfeselnm Code: Any city nr county
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which requires • permit m construct, alloy. improve. demnlixh, or rtpalr any structure
prior m its issuance, also requires the applicant for such permit to File a signed statement
ConuacmesLcc.c Law 9
Sq. Ft. Floor Area
aluat
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N u he b licensed pursomm to the provisions of the: (Courser
(commencing with Sued 7000)of Division 3 of doe Dust. And! Professor. Code) m
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at ho, thomfmm and the insist for Ne alleged exemption. My violation of
Ne b exep
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Section 7031.5 by any applbant fm a permit subjects Ne applicant to a civil penalty ofApI3j
not mom Nan five hundred dolWs($500),
1, u mna of the propeny. w my employm whh ages u tMr wle compcmtion,
Required Inspections
willdo the wmk,mel the structure i mainlonded muttered Portal. (Sm. 7044, Business
And Professions Code: The Commerce, Lla.e Law dm not apply m an owner of
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property who builds omimpovea Nerem. andwhr dmsuchwurkhlmself or through his
own employ., provided that such Improvements we not intended mattered fmsale. if.
however, the building or Improvement is Sold within one yaw of compledon, the number.
builder will haw: the burden of proving that he did not Wild or Improve for purpose of
'k.).
❑ 1, as rower of the property, am exclusively conhwning with licensed conuennre to
construct the pmject (Sec. 7014, Business and Professions Cade:) The ConuSomr'a U.
ceras Law dm not apply to an owner of property who holds or Improves thencon, and
who contracts for such projects with a conuador(O licensed pursuant to Ne Comommes
Lke.e Law.
O l am exempt under See. , B At P C for this recon
-
Owner Dam
WORKERS COMPENSATION DECLARATION
I hereby alarm under Penalty of pedo, one of the (allowing decWliona:
I haw and will maintain ACentficate of Consent to self -insure for Wori Compen.
'tion, u provided for by Section 3700 of No tabor Code, for the performance of the
work far which this permit is issued.
❑ 1 ban and will maintain Workers Compensation Insurance, u required by Section
3700 of the labor Code. for 0mc purformarce niche work for which this permit Is issued.
My Workers Compensadm I.unnce artier and Policy number am:
Carrier. Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Crab suction need nmbocompleted if the permit Is form hundred doll. ($100)
or k')
I certify that in the performance of the work for which this rental, is issued, I shall net
employ any person in my member' Y An bceomC'bject to the Worked Conrpa ourdon
.
Laws of California. Dam
Applicant
NOTICE TO APPLICANT: IL of cr making this CcniRam of Exemption, you should
become subject to the Woker's Compensation provisions of the Iahor Cade, you most
forthwith comply with such provisions "is permit shall be lamed mvoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that thea is a construction lending agency for doo perfurmaroa of
,
the wort for which this permit is issued (Sec. 3091, Ch. C.)
Undoes Name
tandeea Add.
I country that 1 haw mad this application and sure haw the show infmmadun is
'
torten I agree An comply with all city and aunty ardinuses and some laws mtsting on
Wilding construction. ad hereby auNorim representatives of this city In color upon de
above-mentioned property for Wpcdon purposes.
(Wc) agree In indemnify and keep harmlc' the City of Cupntino against
Wbilides,judgments. costa and expenses which may in any Soy amus Against said CityIn
neo NDEdive RSTOungf Nm WILL MPL% WITH ALL NON -POINT
App
sou c tau
.a J
Issued by: Date �i v/ O P
Re -roofs fes'
Type of Roof
Signature of AppliaMCommcmr Dam
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future Wilding occupant nom or handle haamdous material
As defined by the Cupertino Municipal Code, Chapter 9. 17, and the Health and Safety
we, zss3z(.>7
All roofs shall be inspected prior to any roofing material being installed.
Oyes
❑Yu ON.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicemr or future Wilding occupant use equipment or devices which
It hwardnas air contaminants' defined by the Bay Area Air Quality Management
- all new materials for inspection.
District?
❑Yes 0 N
;r/7J�G•iyN/'//n •.
under Chapter or.e��`�
Glding
Ihewread the ha'ntnmm5505,
nias SafetyCade, Sectio Lbalfthe
emd25S3liftymunderstoodychumftho
5e33a d255
th I Is limn;
dm not c try haw a ren"' N II b my reaponsNllby u nrtil'y No eccupul n( tioc
note
mqulmmc hichmu rfoism, arACentnesmafOccepmcy.
Signature of Applicant Date
w.Owner
All roof coverings to be Class "B" or better
ser wlboriacd agent Data
C
X
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone (408) 777-3228
Fax (408) 777-3333
Building Department
JOB ADDRESS: 11.1p2
U2e6_
PERMIT # 6 S- O 1T 0 1 y L
OWNER'S NAME:
PHONE # 7;157-/y
GENERAL CONTRA OR
o��
FAX #
I am not using any subcontractors: (0.� eAr — -
Signature
Please check applicable subcontractors and complete the following information:
Date
O er/Contractor Signature
a� c
Date
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
O er/Contractor Signature
a� c
Date
CITY OF
UPEkTINO
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
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: y u,,L, cl HP, )
Job Site Address: F2-
Roofing
ZRoofing Company Name: /
Applicant's Signature: �'i'---- Date: �os--
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
,
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN #
_11 36 / `3 O Z
Bld Permit Fees
Date: � � /as
Building Address:
//G 9,2z 0.".. c
Owner's N e:
BUILDING
Phone #:
a K.
BUILDING
S;Lq -/q- 7 9
Contractor:
Phone#S�o SAO -SGS
License #:
G l2yo g
Contact: TPYvt O
Phone #: _
Cupertino Business License #:
Business License
Type of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
* Asphalt Shingles
Vo 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 Coal
ith Cu ertino's Tear O f Policy: ❑
Job Description: 7'6
�/D y�
Residential Commercial ❑
Fire Zone: Yes ❑ No ,❑
Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Projyct:ao Type of Construction: Occupancy group:
Qty. if
ADDlicable
F1
1=117
Fee Descrirotion
Fee GrouD
BPERMFEE
Bld Permit Fees
BUILDING
BENERGY
Energy
BUILDING
I BSEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
Seismic Commercial
BUILDING
BPLANCHK
Plan Check Fee
BUILDING
BUSLIC
Business License
BUILDING