04080095 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTR�,CTR TNFORMAIION
BUILDING ADDRESS: PERMIT NO.04080095
10189 N BLANEY AV
OWNER'S NAME: PERMIT ISSUE DATE
ANGUS CHEN
ONE:
SANITARY N0. CONTROL NO.
ARCHITECT(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Lop LICENSED CONTRACTOR'S DECLARATION IbDescri [Ion
u F 1 hemby affirm Nop
at 1 am licensed under provisions of Chapter 9(commencing
`j with Section)QMgnf Division Sof Ne Business and Prof iium Code,andmYliecnu is
=y mmnmrcead —t. REROOF W/SINGLE
�Ur z License lass tic.N
E Dam co.macmr CONTRACTOR: JOHN HENRY ROOFING AUG ZY 2004
qq CHITECTS DECLARATTq
sand my plans entail the used u public records
iLLGDWG BUIL®ING
Licensed ProfcuionaI
O OWNER-BUILDER DECLARATION
I 1 herchy.(Sec Nal I I.S.exempt from @c Commuter's e:Any c Law for the
OO which
following mission.permit
]rnstrBusiness and improve.
denote Code:Any city or county
$u, which its houapermit oc,does construct,alter.impmsudeermitt ore a sig anyatmcmrc
prior m its issuance,also requites Ne applicant for such permit to Ole s signed mammcm
'a that he is licensed pursuant to dm pmvisiomnf the Contractor's Liana law(Chapter 9 Sq.F[.Floor Area Valuat"000
�rcF$ (commencing with Section 1000)of Division 3 of the Business and professions Cache)or
.. that he is exempt drtmfrom and We btu for the alleged exemption.My violation of
section 1031.5 by any applicant for a permit subjects tiro applicant m a civil pcmlly of APN Number - ane Occu Type
m.,more 0.fiw handled dollars(550)). Occupancy YP
31623038 . 00
wi Las ower of the property, re my employees with wages u their sole compen nness
will do Newons and the swnortimwes mindedoroffewd,Law do forsale(See.in a4,B ter of
and property
oh Code,:The Contactors ndwha taw doh not apply lf rt owner of Required Inspections
man enywho beiIdrorireprows thereon,andw is doesotintworkh roffredthrough his
own employee,provided that such improvements are not arofintended oroRernd the ow er-
boildien the Wilding errimprowmmtissaid within one year of completion,the ase of
builder win have the burden of proving that k did nm build or improv(m purpose of
sok.).
1,as owner of thn property,am exclusively contracting what licensed commcmrs On
construct the pmjcct(Sec.1044,Business and Professions,Cade:)The Contractors Li- .
cc=law doh not apply loan owner of property who builds or improve thereon.and
who contracts for such projects with a contracror(s)licensed pursuant to the Contractors
License Law.
❑l am ammpt under Sac. ,B&PC for this mason
Owner Data
WORKERS COMPENSATION DECLARATION
I hereby Affirm under penalty of perjury one of the following declandmin
1 have and will maintainCertificateaCertificatem cate of Coastal self-mull,for WorkersComper-
olden.a provided for by Mion 3100 of ate labor Code,for the performance of the
work for which this permit is issued.
❑1 haw and will maintain Worker's Compensation Insurance,as required by Section
3700of the labor Cade,for Ow performantt of the work for which this permit is lowest.
My Workers Cgrnpenmdo Imvtarce 'or and policy numb sin:• -
Ca 'err - - Pulley No.:
RTIFI ATEOF (EMMONFR0 O KERS'
JV COMPENSATION INSURANCE
(Thuseclion need not be,completed irtk phmil is potato hundred dollars DIM)
or less.)
1 certify Nat in the performance of the work for which this peoput u humid.l shall not
employ any parson in any manner so u w become subject to ate Wmkenc Complemad ad
Laws or California.Data
Applies.,
NOTICE TO APPLICANT:If,after making this Ceniftcau,of Eacmption,you should
become subject o Oc Wohers Compensation previsims of the Labor Code,you muss
.J z foMwith comply with such provisions or this permit shall bo deemed invoked.
'Z O` CONSTRUCTION LENDING AGENCY
I hereby affirm Nat iMrt is a construction lending agency for One performance of
6i> the work for which this permit int issued(Sec.309].CO.C.) -
A Leachns Name
z Linda's Address
U Q 1 anif,thal I have recd thin application and sum Nu the me.information is
Ig,F counter.I agree to comply with all dry and county ordinates and sum laws relating in
C)UWilding Construction,and hereby aathm orirepresematiws of this city in corer upon the
W ahovetme judmd propertycosts
for ndex,ection purposes.
Cl. (We)agree to caw,indemnify and keep harmlcu We City of Cupertino agairal
N incoidepjudgmcnheemstsand espcmcsmit. may in anY way game againsLuiO City
U z in consequence of We drooling of this permit. /
^ APPLICANT UNDERSTANDS AND WILL COMPLI WITH ALL NON.P Issued by: Date
SOURCE ULATIONS.
e-roofs
pelican on o Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or follow building occupant slope or handle hazardous material
az&road by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
oder.Section 7ss3z(a)1 All roofs shall be inspected nor to an roofing material bei.
❑rh �rve p p y g g installed.
Will the applicant or rumrc building aeupant use equipment or device which If a roof is installed without first obtaining an inspection,I agree to remove
emit havrdoah air contsminants as&find by We Bay Area Air QmhlY Management all new materials for inspection.
DistictT
Cl Yes R(Nm
I have read the hzrardors materials requirements under Chapter 6.95 of We Califor- -'
nu Health&SaletyCode.SecWm 75505.25533 and 25534.1 u sicalsM thatifthe Wilding
does not cunendy haw a unsaid,Nat it is my respumihili,y in notify occupant of the �'
t wh¢hm home[ ommiuma aorz fieam orO Lure of Applicant Date
err mho <d sent Dain All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY 0, Fax(408)777-3333
�UPERTINO
Building Department
JO RESS: PERMIT# v
OWNER'SNMXi2PHONMI
GENERAL CO ACT FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information
14 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
e /Contractor Signature Date ^�
Community Development Department
Building Division
am
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
8UPEQT1N0 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:
Job Site Address: /d I 0-1 �
Roofing Company Name:
A plicant's Signature: —/yr`��� ;7 Date::�T�
Greg eel
Building Official
Revised 1/30/03 .
Printed an Recycled Paper
CITY OF CUPERTINO
' REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # ` / 2) Date:
Building Address:
lJc C �i
Owner's Name: Phone #:
A
Con ctor: Phone#: License#:
Contact: Phone #: Cupertino Business License#:
i o0,
O
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )v Asphalt Shingles
10 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: Y to/- O IJs 7t—-1/
O Ye
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project:�7 ) ov Type of Construction: Occupancy group:
: i
'c ble 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
4�- � �