03100224 CITY OF CUPERTINO. >•;� S - g t '%. ne. p,
BUILDING DIVISION PERMIT CONTRACTOR INr,O�tMATION *;
BUILDING ADDRESS: ROOFING PERMIT NO
'20093 WHEATON DR
OWNER'S NAME: 691 W SAN CARLOS PERMITLSSUEDATE
SAMSON HUANG 10/31/2003
IFINE: /9-877T- SANITARY NO. CONTROL N0,
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDC ELECT PLUMB MECH
0 0 0 0
300 LICENSED
u❑ CONTRDECLARATION
I nereny arnrm that I am licensed maimpramsmna,rChapter 9 commencing Job Description
�ZW with Scnion]IX1o)nf Division3of goc Rusincsa and Pmfcssinns Codc.andmyliwnsc i, '
'.oy in fullfnrccantl « r. REROOF
a�? Llccnsc Chao Lic.M �1 ,
D Contrano
ppwwwy ARCIIITELTS DELL TION J
2 W< 1 undcrs,and my plans shall be used es p tic recnNs //
ay. LLLIa Professionalce
f0
5 OWNER-BUILDER DECLARATION
a X 1 hereby nl Orm that 1 em exempt from me Cm neemr's License Law for the
p O following reason.scemn 711]1.5,Business and Professions Code:Any city or county
e m which requires a pimr to construct,alMr,Impoin,demolish,Or repair any structure $13165
°zy
Her to its isionce,oat mquims theapplicam for such permit m file.signedsmmment
main.,heislicensedpursuantmthepmvisimm.ftheContractorsLicenselsw(Chapter9 Sq.Ft.Floor Area Valuation
(commencingwith Section 701)0)of Division3 ofthe Businessand Profcasiona Code)or
Nal he is exempt therefrom and me basis far the alleged exemption.Any viola loo of 31623057 . 00
Section 7031.5 by any applicant for a Permit objects the applicant to a civil penalty of ApN Number Q
not more mGG❑ araC an five hundred dollar,(5500). Occupancy Type
❑I,as owner of the property,or my employees with wages as their sole compensation.
will do me work,and the structure is not intended or offered for sale(Sec.70 ,Business
and Professions Code:The Con,rsctoh License Law docs not apply to an owner of Required Inspections
property who builds or improves thereon,and who doessuch work himself or through his r
own employee.a,provided that such improvements are not intended oraRered for sam Ir.
however,the building or improvement is sold within mm year of completion,the owner.
builder will have the burden of proving that he did not Wild or improve fur purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
consumer the project(Sec.7844,Rusinrss and Professions Code:)The ConVactor's Li.
cense Law does not apply to an owner of pmpeny who Wilds or improves themon,and t
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's -
License Law. t
❑Lm sxempt under See. B&P C for thismax.a.
wncr Dale
WORKER'S COMPENSATION DECLARATION
1 hereby affimt under penalty of perjury one of me following declarations:
I have and will maintain a Cenificate of Consent to.sei6insure for Worker's Compere
anihm.as provided for by Section 37M of On Leber Cade,for the performance of the -
work for which this permit is issued.
❑ 1 ban and will maintain Worker's Compensation Insurance,as required by Section
37110 of the labor Code,for Ne performance mdo,work for which this permit is issued.
My Worker's Cnmpensefian Imumnee carrier end Policy numhh
SptsjgcPolicy No.: (I
[J" CERTIFICATE OF EXEMPTION F WORKERS'
COMPENSATION INSURANCE
(This action,need not becomplesed if the permit is rorane hundred dollars($100)
or less)
I certify that in the perfam ance of the work for which this permit is issued.l shall not
employ any Person in any manner so as to become subject to the Workers''Compensation _
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Cenilicuc of Exemption,you should "
become subject to the Worker'a Compensation provisions of the Labor Code,you must
O '.forthwith comply with such provisions or this permit shall W deemed revoked. -
h CONSTRUCTION LENDING AGENCY
I hereby af0rm mat there is a construction lending agency for the Performance of
Y, 7 the work far which this permit is issued(Sec.3097,Civ.C.)
ALenacr's Nam.
� z Lender's Address
Q I comfy not 1 have mad Nis application and sure that the above information is
y f~ correct.I agree to comply wire all city and county monances and state laws relating 1.
DU building construction,and hereby authorim represenalivns of this city to enter upon the _
G 'hove-menfiuned properly for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
ii liabilities,judgments,costs and expenses which may in any way accrue against said City
J Z in consequence of the granting of this permit. D
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUtREGULATIONS.
^^d2 _ja�, Re-roofs
5 az cot ApplicanUC mracfor - arc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant at future building Occupant store or handle hevandous memos]
az defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
dc.Sc.0on z5532(a)7 All❑Yea �Na roofs shall be inspected prior to any roofing material being installed.
win me aPpucam or future building uccurnal use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it haraNnus air contaminants as do Food by the Bay Arta Air Quality Mwag meat all new materials for inspection.
Diaoict] P
❑Yea VaNe-
I have mad me haeradousmamrials requirements under Chapmr6,95 argon Califor.
nig He.ith&Safcly Cadc,Sections 25505,25533 and 25574.1 understand that ifthe Wilding
does not cuncndy baro a tenant,out it is my,..,.ibility m nouty the occupant of the
ON, menu which must W mel prior a issuance ofd Cenincam cu ancy. S ul of Appl' ant. Date _r
wncr raumoriac gen, - , Date All roof coverings to be Class "B"or better
a Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
CITY OF Fax: (408)777-3333
UPEkTINO
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 on re-roofing.
Homeowner's Name: `Y�MF �CN1 ` J1G,
Job Site Address:
Roofing Company Name:
A plicant's Signature: �� �- /Q �t Date:\.D1
1
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF ° �� � 2 z
CUPERTINO PERMIT APPLICATION FORM
APN# f Date:
Building Address:
Owner's Name: Phone#c
L' • —Ib
Contractor: Phone#: License#:
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
o Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ 'Wood Shingles
Cb- Other(Specify) \L.Q. '® Other(Specify) Vf'�
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr. Installation Specs.
�• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
JobDescription: c r�l�)cam(2.� 45hb-\�_e N% -x\\ y2 eq�" R'\�AwcD
Residential �_ Commercial ❑.
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are ansYrictions: LJ
Costo oject: Type of.Construc i Occupan grow .
�—
Qty. if
A • ale 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
2 �