04070195 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT � Rl� TQ Il 'FU4IA 'YONa N-
BUILDING ADDRESS: -T D ROOFING PERMIT NO.04070195
2260
OWNER'S NAME:. PERMIT ISSUE DATE
ji 1h BOCHING CHENG
ONE: SANITARY NO. CONTROL NO.
408 892-
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
a o 0 0
_pp LICENSED CONTRACTOR'S DECLARATION Job DCSCTI bon
x 1 Warty affirm Nat 1 am licensed under provisions of Chapter 9(commencing p
'n< with Section 7001)ol'Division 3 of to Business and Profcuium Code,and my licenses ,yea!
In fail roma do If o2 n`L REROOF W/COMP. AU
;�� LmmmGl e - 9 Can, G le 200¢
n f,O DdN O� CanLr4br
^� ARCHITECTS DECLARATIO
$ I understand my plans shall W used m public mcor a
76S v`®
;p Licensed Pmfcuinnel
OWNER exempt
DECLARATION _
I hcmhy alarm that 11. exempt from to Cosine, o License Law for the
p O following reason.(Section]1131.5,Business and Improve.
uimu Code:Any city or county
$to which requires a Permit Ie cares th L aloe nt fmve,h porreiit fi repair any structumeneem
to prior m its issuance.alas requires LW applicant forauch Permit m ilia a signed summem
�x�x< Out he is licensed pursuant the provisiouof Ne Contmelm'i License law(Chepmr9 Sq.Ft.Floor Area Valuation
tt
yF$ (commencing with Section 7")of Division 3 of Ne Businessand Professinm Code)or
that he is exempt therefrom and the basis for the snuffed exemption.Any violadon of
Section 7031.5 by any applicant for a Penh subjects the applicmt in a civil penalty of 3 tAP51, p&Ber 0 0 Occupancy Type
not mom than five hundred della.($500).
e.
❑I,u ownuofthepuperty,ormy employees with waguaz lheirsok,mrsienmtmn,
willdo the work,and Neawctuu Is notimmnded oroffe.d forsale(Sec.]044,Busimm
and Pmfeuimu as
Code:The Convectors Lime Law does not apply m an owner of Required Inspections
ro
ppertywho builds orimpraves thereon,and who doessuchwarkhimaeVar through his -
own employcea,provided Our such improvemanu am notimnded proffered for sale.If.
however,the building or improvement is mid within one year of completion.Ole owner.
builder will have the burden of proving that he did not Wild or improve for purpose of
tile.).
❑1,as owner of the property,am exclusively cantrecting with licensed contractors to
contract the project(Sec.7044,Business and Professions Code)The Convmuri Li-
ccme law docs not apply in an owner Of property who Wilds or improves Neaten,and
who contracts for such projects with aeontracm bd licensed pursuant in the Convectors
License Law.
❑l am attempt under Sec. .B k P C for this moon
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following chma.tion:
1 have and will maintain a Certificate of Consent to self-mature for WurkeraCorepen-
scion,as provided for by Section 3]00 of the Labor Code,for the performance of the
work for which this permit is issued.
have and will maintain Worker's Compensation Imu.m
n ,m required by Section
3700 of the Labor Code.for Om performance of to work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
Cartier: SZ - Policy No.: a2 I
CERTIFICA %EMPI70N FROM WORKER
COMPENSATION INSURANCE
(Thu section nmd not W cnmplemd if the Permit is free=hundred dolls.($m0)
or to'.)
1 certify that in the Performance of the work for which this permit is issued,l shall not
employ any person in any manrmrm u in become subject to the Workers'Compensation
Laws of Califomia.Dam
Applicant
NOTICE TO APPLICANT:If.after making Nu Cenifeam of Exemption,you should
become subject In the Workers Compensation provisions of to labor Code.you moat
^O ferdlwith comply with such provision or Nispenin shall W deemed beveled.
z'y CONSTRUCTION LENDING AGENCY
[-� I hereby alBnn that there is a construction lending agency forte performance of
ai 7 the work for which this permit is issued(Sec.3097,Civ.C.)
0aQ Lenders Name
z lenders Address
U 1 modify that 1 have read this application and most that the shove information is
W correct.l agree to comply with all city and county ordinances and sum laws totaling in
building construction.and hereby authorise mpruenWims of this city in enter upon the
above-mentioned property for inspection purposes.
y (We).,me to save,indemnify and keep harmless to City of Cupertino against
fn liabilities,judgmcnu,costs and mistress which may in any way accost against mid City t
V Z in consequence of the granting of this Permit.
"-' APPLICANT UN E ANDS AND WILL COMPLY WITH A NON-POINT Issued by: Date
yW�
SOURCE REGU 5.
30 0.t Re-roofs
Signature of ApplicanUConlrumr D
HAZARDOUS MATE DISCLOSURE Type of Roof
Will to applicant or future building num.or handle havmdoua materiel
az defined by the Cupertino Municipal Cade.Chapter 9.13,and the Health and Safety
ode,Smtiea,355320r
[2 yea, No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or fulcra building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit 111L.M.s air contaminants as defined by the Bay Area Air Quality Management - all new materials for Inspection.
District? ��1///
❑Yes ®Nu
I have mad the haallous mastrialsmyuimmcnu under Chapmr6.95 of dm Calif.,
nia Health Safety Code.Sections 35505,35533 enJ25534.1unJcrsund Outifdm Wiling o
docs not cu en y ave a tom nL Nn it u my rasin notify the¢cupam of the v
uqumon w mus tbemetpHonoiuummofaCcnifcampfQcup}^er. Signature of Applicant a[e
i I, . 130 o I All roof cov gs to be Class "B"or better
Owner or authorized agent Datc
Community Development
' 1 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building Department
JOB ADDRESS: PERMIT # /
,21603 'W0CA "CLge Ct V OLI0 7 019 ,.,:,
OWNER'S NAME: U- en PHONE Ko8 446 16.24.
GENERAL CONTRACTOR: T D Roo r FAX #
I am not using any subcontractors: T ,iq I o i
Signature Date
Please check applicable subcontractors and complete the f owin 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 Sl Date
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: _�o n�� 19 an eh a
Job Site Address: d .2 6 0 3 W ui j art cl Re (L+
Roofing Company Name: — D 2 0 vi
A plicanYs/Signature: Date: All l o�(
\�t/ +WDL7v
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEk INO PERMIT APPLICATION FORM
APN# 3 4 a _ 15 - O Co % Date:
T
Building Address:
AIPoo3 Wooc1 rt -( 9-9- e't
Owner's Name: Phone #:
ne(il r1 e h q o 8 4 q G 1
Contractor: Phone#: License#:
T D n Cyog ) ayq ioy � 666a�
Contct: Phone#: Cupertino Business License#:
rest'., e go CN 99a SS's-A
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 Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
1rienNoJc VJooc( CL LQ_
Residential ® Commercial ❑
Fire Zone: Yes ❑ No ® Confirmed with Planning De t. if
there are any r ctions:
Cc of Project: Type of ConstfVctio Occupanc up:
C) Soo — )ik - r po r-
Qty
A is 1 / 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
U
06
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