05080198 (2) CITY OF CUPERTINO = x
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:'
BUILDING ADDRESS: CUPERTINO ROOF, INC PERMIT NOO 5080198
10581 JOHN WY
W NER'S NAME: PERMrr ISSUE DATE
MING TSANG 1052 KELLY DR. 0.8/22/2005
ONE: SANITARY NO. CONTROL NO.
(408) 973-9427
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
+O+Op LICENSED CONTRACTOR'S DECLARATION =1O O O
y P I hereby affirm Nat I am licensed under provisions of Chapter 9(commencing Job Description
- i with Section 70M)of Division 3 of the Business and Professions Code.and my license is ,a
inrwlrorceaneerfea.C3 `1 S 6S 43 REROOF-T/O SHAKES, INSTAliL 3_/2!x}, @DX,®
,4 4 License Q�tuos Lic.M_ H (}_
nF❑ DOW Com- Jam'- C'Conaacmr s^a � I?JY`yG� kMju`w"
ARCHITECTS DECLARATION al ?•
I understand my plans shall W used as public records
;w� Licensed Professional c,.= �y Z005
`'Dg OWNER-BUILDER DECLARATION
4<Z 1 hereby affirm that I am exempt from the Contractors Licenm Law for the ^7
O O following mason.(Section 7031.5,Business and Professions Code:Any city or county fP-''044o,8000
i t V.
K m which requires a permit to construct,alter,improve,demolish.or repair any structure J,] fy� %I re4 4 o,8,0 O 0
_ ly�poor as its issuance.also inquires the applicant for such permit to file a signed statement — ems. sid
< that he is licensed pursuant to the provisions of the Contractors License Law(Chapter9 Sq.FC Floor Area �dGva-IuaHiod
ad (commencing with Section 7")of Division 3 of the Business and Professions Code)or a
C.�3 Nat he is asempt therefrom and the basis for the alleged exemption.Any violation of
Section 7831.5 by any applicant far a permit subjects the applicant to a civil penalty or Cr Occupancy Type
not mom than five hundred dollars($500).
I,as owner of Ne property,or my employees with wages az their sole compensation,
will do the work and the swctuin is not intended or offered forsale(See 7044,Business
and Professions Code:The Co motor's License law dors not apply in an owner of Required Inspections
property who builds or improves thereon,and who doessuchwork himaelfor through his
own employees,provided that such improvements are not intended or offered for sale.If.
however,the building or improvement is sold within one year of completion,do owner,
builder will have the burden of proving Nat he did not Wild at improve for purpose of
it L
❑1.as owner of the progeny,am exclusively contracting with licensed contractors to
Conswct the project(Sec.7044,Business and Professions Code:)no Contracmr's Li
cense Law data not apply m an owner of progeny who Wilds or improves demon,and
who contracts for such projecta wit a contractor(s)licensed pursuanuo the Convatio s
License Law.
0 1 am excmpr under Sec. B&P C for Nis reazon -
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby af0rrn under penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self-insure for Workers Compen-
sation,as provided for by Section 3700 of the Labor Code,for the perfmmance of Ne
walk for which this permit is issued.
I have and will maintain Workers Compensation Insurance,az required by Section
3700.f on Labor Code,for the performance of the work for which this permit is issued
My Worker's Cnm nsati nlnsun cecarticr and Policy number am:
Canter: S Q Q^ 0 Policy No.: Z-
C RTIFICATEOFEXEMPI'ION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed if the permit is(moot hundred dollars(SIM)
or less.)
1 certify Out in the performance of the work for which this permit is issued.1 shall not
employ any person in any mannerso a to become subject 0 tW Workers'Compensation
Laws of California.Dam
Applicant '
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation previsions of the Labor Cade,you must
.,O foMwith Comply with such previsions or this permit shall be deemed invoked.
CONSTRUCTION LENDING AGENCY
[r rte. I hereby affirm Nat there is a construction lending agency for the performance of
CL .�. the work for which this permit is issued(Sec.3097,Co.C.)
6Wi Q Lender's Name
a Z Lenders Address
U O 1 certify Nat 1 have read this application and sine Nat the above information is
II. COMCt 1 agree to comply with all city and county ordinances and sole laws slating to
0U building Construction,and hereby authmise representatives Of Nis city tin enter upon the
above-mentioned property for inspection purposes.
6. (We)agree to Save,indemnify and keep hassical the City of Certain.against
F'y
liabilities,judgment,costs and expenses which may in any way acme against said City
U Z in eon¢equcncc of the granting of this permit.
'-' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINTsued by: Date
S OREGULA NS.
�M�' S'- 2- Z Re-roofs
Signa o Applican Contrazmr Dan
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building Occupant slow or handle hazardous material
az defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
otic,Section 25532(a)7
Yes ONO All roofs shall be inspected prior to any roofing material being installed.
❑
Will the applicant or future building occupant ase equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hazardous air contaminants n defined by the Bay Arca Air Quality Managementnew materials for inspection.
Dino,'i
❑Yes 0 N I 4
I have read hazardous hardous materials requiremene,under Chapter 6.95 of the Caller- 1 �j)� -0
nice &Safety COM.Sccu..25505.25533and25534.1undorsmndthmifNC Wilding \ b J\
docs not curly haw �p ant Nat it is my responsibility w nicely the Occupant Of the
Tey ' :men rich m t 6nme,prior w issuance of a Ccoodcare of Occupancy.
i Signature of Applicant Dale
Ownet or aamaa.<d agent Datc I All roof coverings to be Class "B"or better
! Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E kT I I O 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.
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.
Homeowner's Name: `� n
Job Site Address: it
b )( J I� nl 1 �1 Q
Roofing Company Name:--,c U r< - i.
I �
Applicant's Signature: 1�� t Date: Op_z Z — O
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO
C REROOF
CUPERTINO PERMIT APPLICATION FORM
APN # Y15716 Date: g—Z
Building Address: �-
Owner's Name: Phone#:
\ r, �
Contractor: U Phone #: icense#:
Contact: Phone#' Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ 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 Polic
Job Description: S ACC - 0
1 `-'�
Residential-g Commercitd ❑ `
Fire Zone: Yes-E] No ❑ Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
4
Qty. if
Applicable 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
3
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