04060164 CITY OF CUPERTINO �
BUILDING DIVISION PERMITCC►1V' 'ttA+CTCiR INFURMA.T,Xi
PUILDING ADDRESS: T D ROOFING PERMIT N004060164
22563 WOODRIDGE CT
OWNER'S NAME: PERMIT ISSUE DATE
Ah CHARLIE KIM 3540 MARGATE AVE. 06/18/2004
NE: SANITARY NO. CONTROL NO.
(408) 892-8872
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
op BLDG ELECT PLUMB MECH
L100 LICENSED CONTRACTOR'S DECLARATION o o Q Q
w 1 hemby affirm that 1 am liwnsad undar provisions of Chapter 9(commencing Job Descrlptlf n
Z with Section 7")of Division 3 of the Business and Professions Code.and my license is
2 in mumroeandarc� IQS`. 66 3 %REROOF W/COMP. JU V�
Z'E2 License C Lie.p I
n�, Dose Comramr ` /n
ARCHITECTS DECLARA 200¢
�i 1 understand my plans that M wed an public remrdt
3 3 Licensed Professional
OWNER-BUILDER DECLARATION •it1{YI
i4 1 hereby sM.that I am exempt from leu Ccruncmr'a License Law far the
O O fallowing moon.(Section 7031.5,Business and Profeltiaas Cole:Any city or caemy
$ which requires a permit to consWet,&bar,improv,demolish,or repair any suuctere $9500
FZ�e prior m its issuance,also requires he applicant forsuch permit to file a signed statement
G that he is licensedpurrumtmthe previsions nftheConbuluriLicenseLaw(Chaprer9 Sq.Ft. Floor Area Valuation
KZF$ (commencing with Section 7")of Division 3 ofthe Business and Professions Code)or
`i that he u exempt therefrom and tce basis for the alleged exemp ion.Any violadon of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
oat mart Nan five hundred delta.(5500). er Occupancy Type
0 I,as owner of the propeny,or my employees with wages a Neirsole compensation,
will do thc work,and the Mature is notimeaded or offered far Ne(Sec.7014,Business
and Profesalons Code:The Contractor&License Law doom not apply to an owner of Required Inspections
property who buildsorimpmws demon,andwho di essuchwork himself orthrough his
own employou&,P.Adcd dowels improvements...I intended oroflered forale.If.
however,the building or improvement is said within one you of completion,the owner.
builder will have the burden of proving that M did oat build or improve for purpose of
sale 1
0 1.in owner of the property,am"elusively contracting with licensed contractors to
construct the project(Sec.70,14,Business and Professions Cade:)The Contractors Li-
cense law does not apply to an owner of property who builds or improves thereon,and,
who comment for such projects with a convector(&)limnsed pursuant in the Contractors
License Law ,
O l am"empt under See. ,B&P C for this recon ,
owner Data
WORKER'S COMPENSATIONDECLARATION
1 hereby affirm under penally of perjury once of the fallowing declarations:
1 have and will trainman a Cenificem of Cadent to self-insum for Worker's Compen-
align,a provided for by Section 3700 of the Labor Cade,for the perfarmam of the
2Ifor which this permit is iaued.
have and will maintain Workers Compensation Insurance,a required by Section
37W of Oc Labor Code,for the perfarmance of Ne work for which this remark is issued.
My Werkcre Cnm n&etion In n%anifr and Policy number am: _
Cartier: n 3 ,Policy No.: 14- ISG ,
CERTIFlCATEO EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE .
(Thu uclfto need not ba completed if the permit Isforonu hundred dollars(SIM)
or less.)
1 certify the,in the performance of the work for which this permit is issued.l shall at
employ any person in any restaurant in m become subject to the Workets'Compensation
Laws of California.Data
Applicars
NOTICE TO APPLICANT:If.after making this Cenifreate of Exemption,you should
become subject m the Worker's Compensation provisions of the Labor Cade,you mat
.J O forthwith comply with such provisions or this permit shall be deemed revoked.
'Z V)
NCONSTRUCTION LENDING AGENCY
i+ Ihimb affirm that there is a construction lending acne lar the
(" Y g g y performance of
Q{ the work for which this permit B issued(Sec.3097,Civ.CJ V
f27� Q Undoes Name
Q z Landers Addrcas
U Q I¢oily that 1 have=it this application and sum Nal the shove information is
Vw F coned 1 agree to comply with all city and county ordinances and suis laws totaling 10
0U building construction,and hereby authoria mprearmadv"of this city to carer open the
14 drove-mentioned property for inspectan purposes.
C (We)agree Io aw,indemnify and keep harmless the City of Cupnino against
TR) Iiabilides.judgments,costs and expenses which may in any way accme against said City
U Z in eonaequence of the granting of Ibis permit.
^� APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE RErUXTIt S.
Srgnatumof App$wcnbTIRe-roofs
HAZARDOUS
Type of Roof
Will Ne applicant or fultre building occupant rlo a or handle hazardous material
a defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
oda,Scccction 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
Yu No
Will the applicant or future building occupant use equipment or dcvicus which If a roof is installed without first obtaining an inspection,I agree to remove
mil hanomus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
0 Yes No
I have mad the haardnus materials requirements under CWp r6.95oftheCalifor-
nig Health&SarmyCode,Sections25505,25533 and 25534.1 muccound thatif du huitding
Docs not cu rat we tenant,Nat it u my responsibility m natty Ne ocmad agent Data gcupant of the " v /- '9 0
mquimtrcn w c mustixentpnonoissuanccafeCeNfiareof &Pae. Signature of Applicant Date
D
Owner m L All roof coverm s to be Class"B"or better
amhe
Community Development
{
10300 Torre Avenue
- '` Cupertino CA 95014
Telephone(408)777-3228
CITY 0, Fax(408)777-3333
UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
oNoG 131 Get
OWNER'S NAME: L(nc.r }Ctix7 PHONE y o8 )
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: N-C4 N
Signature Date
Please check applicable subcontractors and com Tete the fo vin 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
/ t
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
4CITY OF Telephone: (408)777-3228
UPEkTINO 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.
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: a(n C-IL c J�"Y%
Job Site Address: a a 5 6 3 A) o-TJ tr-�A 9Q Cf
Roofing Company Name: f D
A plicanYs Signature: o Date: 6 11� o�(
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO ( '
' REROOF ° s7
CUPERTINO PERMIT APPLICATION FORM
APN# -7 ate: o {
Building Address:
Owner's-Name: Phone#:
L°ellcehe V( 206
Contractor: Phone#: License#:
i D 7\ooli
(1 \\ c .tog ) allq io4 I GT6GI .I-
Cont��r ct: ''rr Phone#: Cupertino Business License#:
of e S �L�e / otk
(q 0D ) 6 4 6 S S 5 0
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )( Asphalt Shingles
A Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
0 To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy:
Job Description: p
h C �l\Oji C vJ 0 cock S h C�Pd.S'- JLC I C\C.0 W rt N' Ca N-\ C\.' l.trel
Residential ] Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are an restrictions: 15
Cost of Project: Type of Construe on: Occupancy group:
q S00 _ 11.00
Qt fI
A li able 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�
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