05090184 (2) CITY OF CUPERTINO „z, -'✓�' r i
BUILDING DIVISION PERMIT kCONTRACTORiINF,ORMATION
BUILDING ADDRESS: T D ^ROOFING PERMITNO.05090184
1122 MILKY WY
O W HER'S NAME: PERMIT ISSUE DATE
CHEN, JASON 3540 MARGATE AVE. 09/27/2005
NE: SANITARY NO, CONTROL NO.
(408) 892-8872
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
u o o LICENSED CONTRACTOR'S DECLARATION
I hemey,affirm Thal I am licensed under provisions of Chapter 9(Commencing Job Description
w
iN Section)UIM))of D"vision3 fNC Busine orb Profcasinns Code en� lice is
+�„ mFullmmean errec REMOVE OD SHAKE, INSTALL LANDMARK TL COMPOSIT
;q= Linenm Gl ss 3 Le.g
-Fp Date Conuacar
ARCHITECTS DECLARATION
D� I unticrsund my plans shall Uc tied u public rcrnrd
a
is 0 G Liccnu0 Professional gip( ❑ I�
5 OWNER-BUILDER DECLARATION Cont ON r W,i t
i y I W rchy alEw that I am exempt from the eonwcmh License law for the 444111
O O following mason.(Section 701.5.Business and Prof ssuons Code:Any city or county %
m which require a Permit to construct.alter,improve.&mulish.or repair any structure n n $9500
_Zy prior tu its issuance,also mquims the applicant for such permit to Glc a signed statement
E�`o that he is licensed persuanttothe provisinnsofthe ConoaclursLicense Law(Chapter 9 Sq.Ft.Floor Area �I I O ��05 Valuation
a (commencing with Section 7")of Division 3 of the Business and Professions Code)or
y $ that he u exempt tortfmm and the buts for Ne alleged exemption.Any violation of n e;;
Section 7031.5 by a"appiirait for a permit subjects the applitanno a civil Penalty oft
r �1 Occu ane T
not mom thanfive hundred dollars(ISM � � :� � f •2{4 P Y YPe
❑I,as owner of the property,ar my cmployces wish wegeau their salt compensation, G'17
willdolhcworki andtheswctumis notintendedoroffarW forsale(See.?04d,11miruu
and Pmreasimu code:The Currencies Lt..law does not apply In ran owner of Required Inspections
property who Wilds orimpfnw demon,and who doossuch work himselforthrough his
own employees,provided that such improvements are not inanded ofoRacd fonale If.
however,the Wilding or improvement is sold within one year of completion,lie owner-
builder will have the burden of proving that W did rot Wild of improve for purpose of
sale.).
❑1,as owner of to pmpeny,am eaclueively convening wide licensed Contractors in
comwet the project(Sec.7044.Business and Professions Code:)The Comrumri CU-
ave Law does not apply to in owner of property who Wilds or improves Neuron,and
who convects for such projects with a contractor(s)licensed pursuant to she Contractor's
License law.
❑1 me exempt under Seo. B&P C for Nis masun
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I how and will maintain a Certifiou of Consent to sel6insure for wormer Compen.
talion,as provided for by Section 3700 of dee Inbar Coo,for the performance of the
oak for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Session
00 of the labor Code.for the performance of the work for which this permil is issued.
My WorkehC mK"�Gun ins can' and Polity number am: � (
Carrier. S A-U.• Polity No.: 1'4,2- 1 ±S
CERTIFlCATE F EKEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed if the Permit Is for one hundred dollars(sla)
in leas.)
I certify that in Ne perfonname of the work for which Nis Permit is issued,I Nall not
employ any person in any mannerso as to become subject in IM Workers'Compensation
Laws of Califomia.Date
Applicant
NOTICE TO APPLICANT:If.ager making this Certificate of Exemption,you should
become subject in the Wodrori Compensation innovations of Ne faWr Cede,you must
.JO faMwith comply with men provisions or this Permit shall tic deemed mwked.
Z� CONSTRUCTION LENDING AGENCY
[•+ I hereby affirm that there is a consuectinn lending agency lm NC Performance of
C > the work for which tha parmh 4 issued(See.Som.Cm,C.)
WI<nder's Name
a z lenders Add.
U Q 1 certify that I have read this application and sate that Ne move information is
U. F correct.1 agree to comply with all city and county oNinanses and sate laws relating a
DU building construction,and hereby authonee mprescnmiva of this city to enter upon dre
Haove-menuoned pnopeny Tor inspection Purpnsea C (We)agree to Sane,Indemnify and keep hamdeas the City or Capef40n against
fA IiabiliGa.JuddDTAN
and cspcnscs which may in any way accrue againslsaid City
U z in ing of this Permit.
AND L COMPLY WITH ALL NON OINT Issued by: Date
17 Re-roofs
Signature of AiihmmUConwcmr pa
HAZARDOUS MATERI(7ASCLOSURE Type of Roof
Will thwpplicant in future building occupsut atum.,handle havaadow material
u defined by she Cupertiw Municipal Code.Chapter 9.13,and the Health and Safety
ak.Section 3ss3z(a)? � All roofs shall be inspected prior to any roofing material being installed.
❑Yn
Will the applicant or Future building occupant the equipment If a roof is installed without first obtaining an inspection,I agree to remove
pP 6 0 y proem or devices which g
h hazardous air conamin cfned by the Bay Area Air Quality Management all new materials for inspection.
Inialicalob&
svl(?
❑Yea
(have ad the ha ar wsmamrialsmquimmcnuundcrChaptcr&95oflhc Califon
sty bed Sccucm355a5.75533md35534.lun Icreand thuifNe Wilding
csooleu ml aM tensnL Natitismyrppnnsibililywnoulydoeaeupantofthe
u;mmcn vel or s cenfacmGrteateororo palmy. Signature of pl cant Date
Owner.,authornudagcnt Dace All roof covering [o a Class"B"or better
Community Development
x 10300 Torre Avenue
✓' Cupertino CA 95014
Telephone(408)777-3228
CITY Of Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS:asPERMIT #
4I l, I fz` W y b S O 9 0 g' /
OWNER'S NAME: —`C. son CA, PHONE # •t4-,;2
GENERAL CONTRACTOR FAX #
I am not using any subcontractors: 4 t14 �i '2 0 S�
Signature Date
Please check applicable subcontractors and complete the following information:
66 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
Q
Owner/ ontractor Signatu'6 Date
j Community Development Department
it ./rte Building Division
11 t: City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
Fax: (408)777-3333
U P T'N O
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 LC.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: TIN S o n (211 e r)
Job Site Address: 1 1 'i 2 (1/) ',fin,/
Roofing Company Name: i D n o 0 fill)
) G
Aplicant's Signature: 1' /' Date: g 3 o j
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
10's- 0I 8�
CITY OF CUPERTINO
REROOF
• CITY OF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
.302 ZrJ ^ OOZ 9
Building Address:
Owner's Name: Phone #:
TcNso o el•i e. yo3 ) 34 A 6 .�
Contractor: Phone#: License#:
T n noo p $9 .3 8B , 84- 5501 I
Contact: JPhone#: Cupertino Business License #:
� cw 1 d C 4-G 0, 550
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles )j' Asphalt Shingles
A Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O. Report#
XI To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
i e Il)J42 \v"Oj skccfax „) S.4-cn V , ,oA e)ic.cfa l L eam,
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are an restrictions: LJ
Cost of Project: Type of Constru ion: Occupancy group:
Cl — cc 0
Qty. if
A licable Fee ID Fee Description Fee Group
MBSEISMICOM
Bld Permit Fees BUILDING
Ener BUILDING
Seismic Fee Res BUILDING
Seismic Commercial BUILDING
Plan Check Fee BUILDING
Business License BUILDING
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