01080096 (2) CI BUILDING DPN
ERONO
PERMITCONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22102 HIBISCUS DR GLADYS KWOK 01080096
AskO\yryyly-ys'pp1E KWOK APPLIC TION 5 B DATE
iL1111YS 08,202001
PHONE: SANITARY NO. CONTROL NO,
a ret z ARCHITECfIENGINEER: BUILDING PERMIT INFO
z"1 BLDG ELECT PLUMB MECH
fan
Z i LICENSED CONTRACTOR'S DECLARATION Job Description
oz.-_ 1 hereby affirm Ih.,1 am licensed anile,foraskions of Chapter 9(commencing REROOF.
p_1_w with Section 7000)of Division 3 of me Business and Professions Codc.and my license
y Y f J is in full force and effect.
z
License Class Lic.p
DamContractor
a n0 ARCHITECT'S DECLARATION
1 understand my plans shall be used as public recants
r
a S pe O Licensed Pmfcssional
OWNER-BUILDER m the CoATION
I Hereby.(Sm ,hnt 11, ,sero,from the Cosion,Cod License tyor for,hefollow $4500
tZC whichinquire%n.(most ]oast et,alma send improve.
demolish.
Code:Any city ourauum,
E which rcquirta a pctmino coast et,alttc improve,Jcmolish,or moat,any vmnure
a 3 FE_ pnorto its icnrome.also nyuires the applicant for such permit to plan signed interior - - - - - - - -
iiislicensedpunuanftdtheprriummnsofheCortraaolsLicenseLa.(Chipir9 3 @OF2CF Valuation
(�ommeneing with Section 7010(1)of Division 3 of the Business and Professions Cafe)
.,that he is ekemprshi,mfom and the basis for,he alleged eSempidn.Any violation -
of Section 9011.5 by any applirnn,fora permit subjects Iheopplicaut,o a civil penalty
of not more than eve hundred dollars WWI, 3 0 5APN ISE . ,b: '. . Occupancy Type
°Las owner ofthe prnpeny.or my empwyees with wages as their sale compensation, 307 INSULATION
will'd ss,a work,and,he struode:The
is nofinm's o,License eredLaw race afenot apply Tau. 6 01 - ROOF TEARcIdtDO]"Inspections'
'of dote work.an o th Code:The is n t intens d oro Law dila not apply man
owner of prop,my Who Wilds or improves thereon.and who does such work himself 602 - ROOF
or,borough his awn employees.provided,luare t such improvements nm Md PLYWOOD NAIL_
imeor _
frenal for sof If. a nth bull g p cmeu old rhino y f 603_ ROOF _BATTENS ;
camp), nth rW'Idp IIh ,W Nd fpm ugtht dd ,Wild -
rep f purposersl 1 V7trusting j(_ 604 - ROOF IN—PROGRESS
a I tl p p IY I ly ,h l c d t9 .to .. k co , ,th P 1 t(s ]fyiJ B e as pmreu ono Cd )Thethaimm )rot h .contracts fo uch projects w m a commnnrls)I se p uant.n-IhpCa, , e'mL unx la 991 afar ce - R B&PCfonbois rtawt � .
_ Dw
` 'WOR .R'S COMPENSATION DECLARATION C
I hereby uffirnm under pcnuhy of perjury mm of,he following declarations
i :• ° 1 have and will maintain a Certificate of Convert to self-insure for Worker-is
Comparison... as provided for by Section 3701) of the Labor Code, for ,he
_ performance ofine work fur which mis person is issue.
°1 have and will maintain Worker's Compensation Insurance.as rryuired by Section
37M of the Labor Code,for,he,performance of the wart far which this p unit,is
issued.My Wodeh Compcnsa,ion insurance curtipr end Polity number are
Caerier ,.. r.s. f I:g.Policy No ., .. i ["I s. •t s-.1.0. I
CERTIFICATION OF EXEMPTION FROM,WORKRRS„`„ s �-
- COMPENSATION INSURANCE I,;,;. _ _
..s,. ... . � .. ....._. _._ �. _- ... - __._ ..-..
I” Alii secuoa sed not be mmple,ed if the.it,,for dam hundred dollen
IS IBB)or less.)
l It a irpl thio in person n in any maof,fie work foe which mis ctPermit. e tial b:1 L, �) ,i
Comons employ any person in any manner so as,d became subject sa the Workers' '
Compensation Laws.1 California:Date
Applicant
11
NOTICE TO APPLICANT:If,aev mak ng tris Ccnificale of Emmilxltuu,you should
Z 0 become mbjem is Ihp Worlers Compensation provisions of the Ly Wr Cede,you must'
fonhwi,ti romply with such provisions of mis permit shall W dmmed revoked.
CONSTRUCTION LENDING AGENCY
I hereby allireaaha Idem is a consuu<tion lending agercy formic perGmnarce
W of the work for which,his Forn is issued(Sec 3M.Civ.C.)
a.Q -Lenders Name- _- _ .._ _ _._ _ - . . - .. _ _ -_ _ .. ---.
,U.,Z -LeideisAddress -' r
`
I� 1[n fy,ha,l h mod this uppli , d mm that ItiW nformmion is
fa..F e, I agreeta comply,with all city and county ordinances and state laws relming
- :-.0 In budding cons,niction.and hereby authorize representatives of this city to enter upon
W the above-memlnne property far inspection pugmoses.
F" a. (We)agree to save,indemnify and keep harmless the City of Cupenino against
(A) liabilities,judgments,coils sad expenses which may in any way action against said
-
V.Z City in conxquence f,he gaming i f,his permit.
APPLICANT UNDERSTANDS A.' WILL OMPLY UTH ALL NfaOINT
SOURCE REGULATIONS.', J/' ,1/w Issued by: Date
Signature at npplicanl/Contractor - - .' D:ria Re-roofs
HAZARDOUS MATER; DISCLOSURE
-Will th pit c nt future b Id ng c pa i ,am or n ndl harm us ramal TI ype of Roof
as defituad by the C nd em Municipal Core Ch p,a9 12,and be Health and Safety t
Cd Seem n255ve; , 1 I VINo .• t• `
All roofs.shall be inspected prior to any roofing.material being installed. . -
,t•nr W511 the agplicant or future building accupart use equipment or dex ite, hilh If a roof is installed 'without first obtaining an inspection;;I agree to remove
emit hadadous sir cnmaminantaa it III by she Bay Area Air Quality Management
District, all new materials for inspection..,Applicant understands and will comply with _
DyesNo
all non-point source regulations..
I have realm 'bazati materials Tey net urme Chapter 695 of the.
Calfa Health&S Safety Code Sectons 25$0515573and 15534.lunderstood that -�'�/'/��p /LO
sftheti ld'ng doe no,currentlyh tenant.that it is my po'sM1fryt afyshe
occupant of the require n,s which must be mem poor, I once of a Cemrmcme of
sill s
� .SignatureofApplicant _ . . Date
ow er or aamo ilea agent Delp All roof coverings to be Class "B"or better
OFFICE . .. _.... .. . ..
• Building Division
t 10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEI�TINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of 1/a" 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 of inspection.
We understand the above/policy on reroofing and will comply with this policy.
Homeowners Name:
Address: 2 2- 1
Reroofing Company Name:
Applicants Signature: C5 �� • -'� Date:
Joe Antonucci
(Chief Building Official)
6/25/01