05070039 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT ,C®NTRAC`TOR INFORMATION
BUILDING ADDRESS: FOUR SEASONS ROOFING PERMITN0.5070039
0206 CAMBPRI-Ey IN
OWNER'S NAME: PERMIT LSSUE DATE
JOOTAE KIM 502 HO S
NE: SANITARY N0, CONTROL NO.
I (408) 278-0330
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT FLUMB MECH
_o Zp LICENSED CONTRACTOR'S DECLARATION I sem B On O I� O
1 hareby affirm that I am licensed under provisions of Chapter 9(ommencing Job Deseriptlo(�n!'nt\-:
its, with Satim7")or Division3ofthc Bu...dProfcssruns Code.an yliccascis U tl kh� Ily
'c„ inmBrnrveaadlrr«�� l('} Z OLS REROOF W/SHINGLES V L'�l
License Class Lia P
C v� Dam co locestr C. Q
ARCHITECTS DECLARATION "L ``c 2005v
I uncersund my plans shall be=0 az public mcorrta 10 �lyl
m fi s
u
Licensed Profcssianal tar's,
`rs3 OWNER-BUILDER DECLARATION 11tl1{n(!1('] f�t)L�}ll
1 I hcmby affirm that 1 am ezempt Truce the COnvaaOYs License Law for Ne
p o following mason.(Section Rn 1.5,Business and Professions Code:Any city or county
K m which requires a Permit to consumer.alter,improve,demolish,or repair any sWcture
100
prior a,its issuancc.alsn,.quires there,licam far such .it,.file a signed statement
Xf0� m Out he is licensed pursuant the provisions of Ne Cmarntod License Law(Chun.,9 Sq.Ft. Floor Area Valuation
" (commencing with Section 7")of Division 3 of NC B usiness and Professions Code)Or
y $
that he u exempt Ocrcrrom and the basis far the alleged csvnpdan.Any violation of
Section 7031.5 by any appliram fora permit subjects the appliam to a civil Penalty of 3 4Q4RQAnbigr0 0 Occupancy T
not mom Nan five hundred dollars(1500). P Y S Pe
❑huavnm of the progeny,or my employees with wagean their sole compertntion,
will do the work,and also structure is not intended mattered forsak(Sec.]Mq Business Required Inspections
and Professions Codc:The COnmctors License Law doe nss not apply m in owner of q p
property who Wildsor improves thereon,and who does such workhimself or through his
Own employees,provided that such improvements am not intended mortared forsake.If.
howercr,aW building or improvement is sold within one Kar of compledon.the Owner-
builder will have the Wade n of proving that he did not build or improve for purpose of
ink).
❑1,as Owner of the property,am exclusively conducting with licensed contractors to
construct the project(Sec.7064,Business and Professions Cade)The Condactofs Li.
cense Law dors not apply to an owner of progeny who Wilds or improve themon,and,
who contracts far such projects with a eontrurods)licensed pumourina to the Conuacmri
License Law.
❑lam emaram under Sew .B k PC for this mazon
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby arfrn under penalty of perjury one of the following declarations:
7C1_c01)y1'iF
hive and will maintain a CONficate,of Consent to self-insum for Worker's Compen-
n.azprovided for by Section 3]00 0(the labor Code,for the performance of the
k for which this Permit is issued
have and will maintain Workers Compensation Insurance,az tryuited by Section
0 of the labor Code.rat the performance of de work for which this Permit is issued.
Wos Compensation Insurance carrier and Policy number are:
CORoliryNo.: b-3C0'+c`I9 t0 000QCERTIFICATE OF FXEMPrION FROM WORKERS'
4a�C/{Ga. COMPENSATION INSURANCE
'
A (lou section lured not Meomplemd if the permit is for one hundred dollars(SIM)
or leu)
I unify that in the stformaae or one,work for which this Permit is issued,l shall not
employ any pomn in any mannerso as ry become subject to an,Workers'Compensation
Laws of Caliromia.Dem
Applicant
NOTICE TO APPLICANT:If.after making this Cenificam Of Escm Psion,you should
Wcomc subject to the Worker's Compensation Provisions of Ne labor Code,you muss
.,z forthwith comply with such provisions or this Permit Out be deemed,.yoked.
z CONSTRUCTION LENDING AGENCY
I hereby aRres that dere is a construction lending agency for the performaox of
a the work for which this permit is issued(Sec.3091,Ci,C.)
W Lenders Name
z Lender's Address
rJ 0 1 certify Nu I have rod Nis application and state that the above information is
IL f"' coney 1 agree to comply with all city and county ordinances and sure laws relating in
0 V building construction.and hereby tradition,topresentatims of this city in closer upon the
A Wvamemidned Property for inspection proposes.
PL (We)agree to side,indemnify and kap humless the City of Cuperdno against
F"V3
liabilities,judgmcnm,cots and err rues which may in anyway accrue against=it City
V z in conuqucncc arm
r the gnntin �� / -�
r-r APPLICANT ERS DS rND WIL COMPLY WITH ALL NON-POINT Issued by: Date Q�
SOURC GULA S. _ �� ' l-s-.
&�
Re-roofs
Signmurt of ApplicanVConaraca Data
HAZA US TERIAIS DISCLOSURE Type of Roof
Will dse applicant or fu riding uccupanummOr handl havaNOe maserial
as def nc0 by dse Cupertino Municipal Code.Chapter 9.11.and the Health and Safety
ade,
a Scmon]5331(q] All roofs shall be inspected prior to an roofing material beim
❑rpt P P Y g g installed.
Will the applicanror future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
! is havardnw air contaminants az defined by the Bay Area Air Quality Management all new materials for inspection.
stilet?
❑Yes W
1have mad the hanrdeus materialsm33-it 55under Chapkdthir rhe Califon- —
riaFicaltbanmaiyhehCritiaSE-15",
does materials
requirements
anti nts un er Chi ter Nazo the Wilding
dors not cunt hoc �mgy r d my responsihiliry m ratify the Occupant of Oc
rcymmm wl mh amen pri6na issuance aracerdfamaracaPanry. Signature of App I ant Date
6—�/ All r verin s to be Class"B" or better
O tie 'a sem Dam g
r �
Community Development
` 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building Department
1 B ADDRESS /� �f PERMIT #.O SU� O03
OZD6 ('�,O v ' L.e
OWNER'S NAME: U00PHONE #
GENERAL CONTRACTOR• ,( FAX #
I am not using any subcontractors: 1,2 74-61-0-r
Signature Date
Please check applicable subcontract rs and complete the following 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
Community Development Department
Building Division
City of Cupertino
I '
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
qUPEkTINO
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.
HomeownerA
Homeowner's Name: d0,Q r /41.7
Job Site Address: .04 (7��llJfiUy
Roofing Company Name: t E9
Applicant's Signature: Date: _of
® Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
ZIA REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
3yz. YZO?'7 _ S-
B,u,ilding Add ss
r✓ U O A
Ow er's ame: Phone#:
Co ctor: Phone#: Lice se #:
72/9
ont Phone Cupertino Business License #:
ee
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shinglesm—,,J Oe / El
Wood Shingles
Other(Specify) i / 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:_
Description:
Residential Comm rcial .❑ .
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: (5
Cost of Pro' t: T of Co ction: Occupancy group:
kz)9 00
Qty. i f
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Ener—gy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING