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04100025 (2) clTv of curExTm° XONTYRACTOR INFORMAT70N PERMIT `^ ' BUILDING DIVISION BUILDING ADDRESS: PERMIT NO04100025 4100025 1097 HUNTERSTON PT OWNER'S NAME: PERMIT L6UEDATE IghkHU CHIH-MING HE SANITARY N0. CONTROL NO. ARCHITECrIENGINEER: BUILDING PERMIT INFO BLDG ELECr PLUMB MECH C= O O O u0o LICENSED CONRACfOWS DECLARATION - Job Description Yw C I hereby affirm Ibis 1 am licensed under pmvidans of Chapter 9(commencing - - SZ wth6�uon 7x1 IfnivisionJaf Ne Budnena and Pra(cssinm Code,snd mYliccnse is - -- - o�„ in romeandeffaL, Lx�` LJ/d' REMOVE/REPTT t� [ jyL7n 7�7NGLES 4y_ L' r.c Class Lc,Y { _tY ��'B $_•{t"(i o- Date ConlDECl er- I NAME$ BFa�$ q�m� � RCHITECTS DECLARAT ON - . . - '�W U I understand mY Puna shall be used as public records NOVit u. Licensed Professional V I � 2004 . SOWNER-BUILDER DECLARATION 9y 1 kmby aRrm Nos I am exempt from ft Committal License Law for she i o a following m (S ration. ection 7031.5.Business and Prefeadm oCabe:Any city of county $ which requires a permit to construct alter,improve,demolish,of repair any structure _i�• prior m its issuance.aku requires the applicant rot such permit File a signed statemmnl Valuation x< NaI he is licensed pure rml so Ik previsions of ftComrsetafs License law(Chapter 9 . .Sol-Ft. as (commencing with Section IDA) Division J of lk Business and Professinm Cnde)m a. do he u exempt IMmfmm and the basis for He alleged exemption.Any violation of Section 7031.5 by any applicant for a Knoll lobjecu be applkaIof-civil 1-111 Of 3er00 Occupancy Type not mart Nan five hundred dollars($500). - t]1.u awn,of tk PrmP'ssY•m mY unploy,s with wgu ss Ikir sole eompernsatlon, will do the week.and the swcwrt is no,intended oroffered foradc(Sec.loan,Business Required Inspections and Prefer ions Code:The Contactor',License law dos not apply to in owner of - - 9 P properly who bui Ids or improves Hereon,and who does such work himself or through his own employees,pmviok4 that such impmsememe,art not intended or offered for tile.If. however.He building or improvement is said within one year of Impletion.the no, builder will have the burden of proving that he did not build or improve for purpose of sok.). ZI 1,as aw a r of the progeny,am exclusively commending with licensed contractors to construct the project(Sec.70an.Business and Professions Code:)The Conuacwr's Li- ce.law docs nos apply to am owner of property,who builds ac improves thereon,and who conuacut for such pmjccu with a comrseter(s)licensed pursuant in the Conuacmes - License Law. ❑1 stn exempt under Sec. B A P C for this recon Owner Dam WORKER'S COMPENSATION DECLARATION I hereby affirm under proudly of perjury ane of the following draboauolu: 1 have and will maintains Ccnlfmota of Consent to self-insum fm Workers CumPcm sation,as provided for by Seedan 3700 of the labor Code.fm He pedormsma of the work for which this permit is issued. 1 have and will maintain Workcri Compensstion Insurance.as tcquired by Section 37W of the labra Cade.for He peAoor.or the wok for which this perch is tamed. Myy�br is Compensation lmm�na arms,and Policy nnuumberr are' Carney- Policy No: � ` ✓ CERTIFICATE OF EXEMPDON FROM WORKERS' _ COMPENSATION INSURANCE ' (ndS reeriM need not kcompleted if He Permit is fmanclomd dollvs($100) or kis.) -- 1 certify Net in de Performance of the work for which this Permit u issued.l shall not - employ any person in any manscr he as m become subject to tk Workers'Compcentaion Laws of California.Data Applicant NOTICE TO APPLICANT:if,after making this Cenifate of Exemption,you should become subject to the Worker's Compcwuun provisions of the lakf Code.You mew Qforthwith comply with such Previsions or His pore it shall be deemed mvaked. 72 CONSTRUCTION LENDING AGENCY 1-.�n I hemby affon Nat Hcre is a comuuctinn lending agency fm the Performance of !� ? the,work fur which this permit is issued(sec.304/,Civ,C.) H] A Lender's Name =,Z Lcndcr's Address [)Q1 certify that I have read this application and state that the above Information is (-' conte,.I agree In comply with dl city and county ordinances and state laws misting an nd 0 building construction, soave.mdeyamhandkee hadentiss the Hiscity menter upon ga lk r IT7 shove-mentioned property for inspection purpoics. \ (we)agree m save.indemnify and tecp harmless He City of Cupcnino against •scs (A Iiabil4ml,judgments,cos.and eapic whichmayinanywayaccrucagdnatild Cily fJ Z in consixmrace of He granting of this permit. Dalt: V '-' APPLICANr UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: SG�fRCE RE�IfLATIOrs. IN yo GLS Re-roofs Signmurt of Applian AZARDOUS MATERIALS DISCLOSUREarector / Date Type of Roof Will the applicant or future building Occupant store of bandit h liamons materiel as deOlmd by the Cupertino Municipal Code.Chapter 9.12,and dic Health and Safely Imd.ode.Simon.255324)7 All roofs shall be inspected prior to any roofing material being installed. 0Ya 6Na Will the applicant or fnuI 'If a roof is installed without first obtaining an inspection,I agree to remove uture Wilding mit hmards air contaminants as the B me equipment or device which as definedby He Bay Area Air Quality Management all new materials for inspection. istrict? ./s❑Yes o I have read the haardousmaterials requirements under Chapter695 ofthe Califore ikalth&Sde,Cade,Sass,.25505.25533 and 25534.1 toolmaumd lhatifNe Wilding not cancolly have•tenant Na flouryat it my responsibility to ury de oecupant of the quimmen.which muslbe mel prior in issuance of a CcNfcate ofcy. S' ature of Applicant —Date apamV_oy All roof coverings to be Class "B" or better Owner arm homed agent Dam afTY01F Community Development 1030 Torre Avenue Cpertino CA 95014 Telephone(408)777-3228 Fax(408)777-3333 UPEkTINO Building Department JOB ADDRES PERMIT 2 OWNER'S NAME J IPHONE # GENERAL CONT CTOR: a,-Il-a,7 Con FAX # ted' _/87 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 lambing Roofing Septic Tank Sheet Metal Sheet Rock Tile _ �`� Owner/Contractor Signature Date i ;a1 Community Development 10300 Torre Avenue t y, CuO"noj'PL J5014 *� 'eleRhone(408) 777-3228 CITY OF Fax(408) 777-3333 �UPEkTINO `7j Bvii At --De artment JOB ADDRES S:i M 6� ` PERMIT !!.,,D OWNER'S NAME: PHONE # GENERAL CONTRACTOR: !/i,C;77 Cow Yi— fico-7 FAX # 4�a,d 7,'1-7 _ IS J 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 1' Electrical Excavation ' _4 Fencing / ('" ) Flooring:.CarpetingZ 7 7` _ 6 " 7c 3 Linoleum Wood Glass / Glazing ^' Heating Insulation - Landscaping Lathing Masonry Ornamental Sheet Metal Painting/ Wallpaper f Paving (Plastering 'Plumbing. 11,,,„Ie e r �r" AZ Roofing ' Sep •tic Tank r ' Lrn i ;✓ / y Sheet Metal ��, /f/�,, /o%el oc i Sheet Rock Tile , Owner/Contractor Signature Date Y Community Development Department Building Division City of Cupertino s I 10300 Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408)777-3333 OUPER,TINO 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. 3. 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. a 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: Cir/i/ /Lli'dc�; />t/ job Site Address: /,097 >n7�,es7tt`>7 ,�L Roofing Company Name: S i 1A!,r ! 67w Y�g71 erl A plicant's Signature: C/ii;I/ Date: �JVo✓�" • Greg teel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOFCITY �CUPEI�TINO PERMIT APPLICATION FORM APN# Z �� Date: Building Address: 10,97 1 oas— Owner's Name: Phone#: CH1H Mi,JCT HU Contractor: S,r1&aA) 5Z v7zz� -I0 /Phone #:(7409 fX72zV13 License#: 1879/8 Contact: ra M P one : (f OK) Cupertino Business License #: 9�i_ z/zy Type of Roof Covering: Existing: Proposed: ❑ uilt-Up Roof EI Built-Up roof 6Y Asphalt Shingles & -Asphalt Shingles ❑ Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ./ ❑ Other(Specify) Nu ber of existing coverings�/� !4z (3 Provide I.C.B.O. Report# Nu be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑ Job Description: !ze"As, Residential P., Commercial ❑ Fire Zone: Yes ❑ No p Confirmed with Planni -De t. if there are any restri ons: Costo r jec : Type of Con ton: Occupancy grou Y y. if /ApRl'lqable 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 MW X27367 2- 26"'. 7,bl'