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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 r � �' 76