04040089 (2) CITY OF CUPEW11NO `" •' � �" + '' ^.
BUILDING DIVISION PERMIT ;,CONTR 'CST, R INF , I2, ATION',
BUILDING ADDRESS: WINTER ROOFING INC PERMITNO04040089
� 71320 T)g Fog ng
OWNER'S NAME: PERMIT ISSUE DATE
KENN YUAN 151 WYANDOTTE DR "20
ONE: SANITARY NO. 104RIN
4083638052
7�n�,
C(IITECrIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARAi'ION 1 hereby affirm matI am licensed underprnvisfunsorChapterv(commencinglob Descriptionn; th Section7k)(Fof Division 3 ofbeB,oxofwvand Profesains Code.and my license ix zease la anderma �SREROOF APR
cnx Class _ {�Lic.a le Cnnlra T_ S " p4
SS A crm3-CCSDECLARATION� 20
$a C d 1 understand my plans shall he used as public records
t iJ H Licensed Pndcssional
S OWNER-BUILDER DECLARATION
<y I hereby affirm that 1 am exempt fmm me Contractor's License Law for the
00 following reason.(Section 7031.5.Business and Profusions Code:Any city or county
K w ftii which requires a Fcrmil of construct,aper,improve.demolish,or repair any structure
_¢a prior In its issuance.also requires the applicant forsuch permit It) a signedsmmmmnl 87600
Nnthc islicensed pursuant the provisions ofthe Contractors Liccnsc Law Sy. FL Floor Area Valuation
tt
XF" (commencing with Section 7")of Division 3 of the Business and Professions Code)or
that he is exempt thcmrrom and the hasis for me alleged exemption.Any violaion of
Section 7031.5 by any applicant for a pcmtii subjects the applicant o a civil penalty Of 3�)`fi4Qili}IhcrO 0 Occupancy Type
not more man five hundred dollars(SSW).
❑ L as owner of the proporty,or my employees with wages as their sole compensation,
will do the work,and the strunurt is nut intended or offered I...1.(Sec.7044,Business
And Prafessiora Code:The Cammuclod Llcenk Law docs not apply to an Owner Of Required Inspections
property who builds or improves thereon.and who doessucb work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
bovs,or,the building or improvement is sold within one year of completion,fie ow,nor
builder will have one burden of proving that he did not Wild or improve for purpu or
sale.).
LD 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(See.7014,Business and Professions Code)The Contractor's Li
ve law docs not apply to an owner or property who Wilds or improves mcmon,and,
who contracts for such projects with a contractm(s)licensed pursuant to the Contractor's
License Law.
E] 1 am exempt under Sec. B&P C for this reason
Owner Date
WORKERS COMPENSATION IIECLARATION
1 hereby An.under penalty of perjury one of he following declarations: -
IhaveandwillmaintainaCcnibcmcof Consent to self-insure for Worker'aC moM,O-
salon.as provided for by Section 37W of the Labor Code.for the pcRmmana Of the -
work for which this permit is issued.
Ave and will maintain Worker's Compensation Insurance,ss required by Section
W of me Labor Cafe,for the performance of the work for which this permit is issued.
My Worker's Co pens don to ooc ca and Policy number am
Carrier: Policy No.:
oc3GL '
CE. IFIC EOF E7UMPTION FROM WORKERS
COMPENSATION INSURANCE
(Th'¢axonom need not W eomplcled if the Permit is for one hundred dollars($1IX)
Or less I
1 certify that in the performance of he work for which this permit is issued.1 shall not
employ any poison in any manner sen as to become subject to the Workeri Compcnsalion
Laws of C.1domot.out
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
WCome subject to the Worker's Compensation provisions or the Labor Code,you must
.J O forthwith comply with such provisions or this permlt shall M docmctl rcvOlwd.
Z�
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a conswclinn lending agency for the performance of
a did work for which this permit is issued(Sec.31y17,Civ.C.)
4] 1-cool Name
6. Lender's Address O
az -
V 0 1 ecnify that 1 have read this application and State that the above information is
D, f^ correct.1 agree to comply with all city and county ordinances and auto laws relating to
pU building construction,and hereby authonn,reprcumabves of his city to enter upon the
4 above-mentioned property rot inspection purposes.
(We.)agree to sa,indemnify and keep harmless the City of Cupen ire againsl
Ffin Ito di 1,it judgments,eostsand expect swIt ch may in any way Accrue against said City
V z IMIL
APP(. cNTeUNDT:RSn/(OSmt D WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOU C 'G LATIO S —
ndiC
L — Re-roofs
Sign fApplmcaHAZARDOUS MATERIALS DISCLOSURE Date Type of Roof
Will the applicant or future building Occupant store or handle hvardous material
As defined by the Cupeninn MuM 6 9
I Code.Chapter .11,and the Health and Safely
Code,Section 35532 aj? All roofs shall be inspected prio to any roofing material being installed.
E]Yes
Will the applicant or future building occupant use equipment or devices which If a roof is installed without fir obtaining an inspection,I agree to remove
top haeamoua air cn idm ort,as defned by the Bay Arca Air Quality Management all ne materials for in 3ecti
laden /Vs-/„// /
Dyes
I have read the havNnosmme'alsre rcments under Chapter R.'15 of the Califnr
niancalth& adely Cud c,Scetiurs 5,1 Sand 15534.1 undcrsmntl mmirthe M1uilJing / 1`�`S ba�
docs not c Orly haute a¢via it i y respuremility to nodfy IM taupanl of me f�
require n which mu W p r seance Ofa Cenificat ep-11papcyo. Signa Teppllcant Dat
C�
0 ern I ori, agent LL Date D All roof coverings to be Class "B" or better
- - Community Development
10300 Torre Avenue
J Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building De artment
JOB AD • SS: PERMIT # � 6 CTD
OWNER'S N + PHO # — p�
GENERAL CO ACTOR: FAX #`
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors 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
c — `oC
e / orK Signature Date
CITY OF CUPERTINO
REROOF a
CUPEI�TINO PERMIT APPLICATION FORM
APN # Date:
Building Address-
0
G
Owner's Name: Phone#:
C�n�ractor: Phone License #:
Contact: Phone #: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ B��'It-Up roof
El 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: )
ar � ti c /
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are an restrictions: i5
Cost of Project: Type of Construction: Occupancy eroup:
Qty.
A i b e Fee ID Fee Description Fee Group
MBSEISMICOM
EE BldgPermit Fees BUILDING
Y Ener BUILDING
CRE Seismic Fee Res BUILDING
Seismic Commercial BUILDING
HK Plan Check Fee BUILDING
Business License BUILDING