04090255 (2) 777
CITY OF CUP
'� m 7
BUILDING'DIVISION' PERMIT 1• NIT "'�y 'U .�.T� al :
BUILDING ADDRESS: _ - MAXIMUM ROOF •CARE CORP PERMIT No04090255
20109 TAS QhTT)AR WY
OWNER'S NAME: PERMIT ISSUE DATE
Alk TONG-MING LEE _423 QUEENS IN
ONE: "- SANITARY NO._. ..:.,_�CONTROL NO.,
(4Q8) 441-093'_;
ARCHITECT/ENGINEER:. BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
nee o LICENSED CONTRACTOR'S DECLARATION -
rd I bcmby afifrm That 1 em licensed under provisions of Chapter 9(commencing Job Descriptio tII�
with Secy'op]IXIU)ofDivixion 3 of the Bus�mmpaand Profemionn Code,and my license is ���
mfmlRKeaneeq t. Q, REROOF W�PRESIDENTIAL SHING
j Licfnx'C`lam--(, Cun p
nQF Oalc�-i GAS— cYsu� AT10 �s
if hind/erstand my plim.riCha111TE"d a public records - OCT 2004
Edd
it Licensed Pmfessionel -
OWNER-BUILDER DECLARATION BUILD
■ ■IS D
I hereby.(Siem rhes I rum exempt from tie Contractor's License law for the U L
0 0 following moon.(Section 7r131.4 Business and Profess moll Code;My city stcounty
$ which its isu a permit re consumer,a@6 improve,h pereash,or repair any tI uelum
t-Zir thtrmslissuance,ahumquims the applicantfor ouchpermiuoice ssignedatskmnm
£F� Nalhe me licensed pSectio700the ofprevisions sionf NeConwnessnd Proflaon&Cod(Chapter Sq.Et.Floor Area Valuation
(coW 'at he is exempt
Section and the
thastson3 of the al Business exa and Professiooslation of
Nn io u exempl any cep li and the buts for the alleged exemption.Any violation of -_
Section than
LS five
any applicant for a permit subjects Ne applicant to a civil Penalty of 3 "diber0 0 - Occupancy Type
not mom Nan five 6undmd dollars(SSW).
❑I.as owner ofthe property,or my employees with wages as their solecompensation, -
willdothework,and the auucture is nolintendedorofered fonshe(S.C.7044,Business Required Inspections
and Profusions Code:The Contractor's License Law docs not apply In an owner of q P
property who builds or improves thereon.and who drum such work himselfor through his
own employers,provided that uch improvements w not intended or offered for ale.If,
however,the building or Improvement is mid within one year of completion,the Owner.
builder
will have than burden of proving that he did not Wild or Improve for purpose of
.ale.).
❑1,as Owner of the property,am exclusively conoaaing with licensed contrecNrs to
construct the pmjcct(Sea 7054,Business and Profusions Cade:)The COnVutork Lt.
Cause law does nor apply to an owner of property who Wilda or improves Neeson.and,
who contracts for such projects with a contractor(s)licensed pursuant o the Conamoes
License Law, s
❑1 un...of..do,Sec. B&P C for this mann
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury,one of de fallowing decimations: -
1 have and will munuin a CeNBcam of Camm.l m m1f4asum far Wagner,Compen-
7(3D7.00
on,m provided for by Section 3700 of the labor Code,for the performance of the
k for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,u required by Section
of the Labor Code,for the perfosmanu of mW work for which Nis permit is issued,
Workers Co pensation lour ce artier endP�)icy number am:
rtier. try No.: O r
TIFICATE MOF 70N FROM WORK
COMPENSATION INSURANCE
(This section need not W completed title,permit Isforonc hundred dollars($100)
loss.)
I certify that in the performance of The work for which this permit is issued,I shall not
employ any person in any m rt neran as to become subject to the Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Canificam of Exemption,you should
become subject to the Worker's Compensation previsions or the Latom Cnde,you moat
.,O forthwith Comply with such provisions"is permit shall W deemed revoked.
„Z,a'-" - CONSTRUCTION LENDING AGENCY
!-+ 1hemhy affirm that Nem is aconstmction lending agency for the performance of
[rte> the work for which this pemnit is imam!(Sec.3W7.CO,C.)
W�Q
LC dc Namc
0.Z Lender'Address
U Q 1 cdnify that I have mad this application and sate that the above Information is
W F Cartmel.I agree to comply with all city and county ordinances and auu laws relating to
0 building conswcttion,and hereby aurhurim representatives of this city or enter upon Ne
W above-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
fA liabilities,judgments,costs and expenses which may in any way we=against mid City
inconsequen99'
ng ru(th Permit. _ _ _ _
s-^ APPLICANN AND WILL COMPLY WITH ALL NON-POINT Issued by; - Dale
SOURC ,
' ` ,� Re-roofs
Signature A plian,Conweor me
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will due applicant or future building uccupanlstore orhandle huom us mamrial
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 25532(a)?
E]Yes No
All roofs shall be inspected prior to any roofing material being installed. '
a
Will the applicant or room,building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it havardoua air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
C]Yes Nu
lhavc mad the harakmms maurialsmquimmentsunder Chepur6.95oflhe Calif.,
nice HcolN&SderyCode,Secdou25505.25533ud Z5534.lundnwdthaifNc Wilding
dos n�Cnhd.;
enol.that it is my responsibility m notify the occupant Of the //YYY LLL------till ��/VVVreyM/r/sd{I,'ak��{ Jsv sssuancc ofa Ccrtifiuu o(Occ anry. Ignatu—Applicant Date
ownsdl - All roof coverings fo be Class"B" or better
Community Development
T
10300 Torre Avenue
9 MY Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building De artment
JOB ADDRESS: PERMIT #6 O
OWNER'S PHONE #
GENERAL CONTRACTOR: 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
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
' 10300 Torre Avenue
Telephone: (408)777-3228
CITY OF
SUPEkTINO
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.
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: IM
� 1,y^t\� 7
Job Site Address:
Roofing Company Name:
A plicant's Signature:. Date:
qZ/Y"a`(
• Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEI�TINO PERMIT APPLICATION FORM
APN# 3 (—1 3)�- O 33
Date:
Building Add ress: 1�
Owner's Name: KXW
Phone
Contractor: ' 1 Phone#:\ License#: V
Contact: Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
I Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report# 23
(Y To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: [L]
Job Description:
• Cer off' S'fe,/�, ��1 71�y 3 f�h't-s�et�w+at �
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are an restrictions:
Cost of Project: d� Type of Construction: Occupancy group:
I
Qt . 'f
O"e
ID Fee Description *BUILDING
Bld Permit Fees Ener Seismic Fee Res Seismic Commercial Plan Check Fee Business License
6