05090042 (2) CITY OF CUPERTINO *'�
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BUILD]NGADORESS: SOM
YING LIU PERMIT NO.05090042
OWNER'S NAME: PERMIT ISSUE DATE
YING LIU 18971 NEWSOM0
ONE: SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
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to
LICENSED CONTRACTOR'S DECLARATION lob Description
U I hereby affirm Jul 1 am f licensed Bd under and
Profess of Chapter 9(commencing p
with Section 70g)ce Division3of the Busines and Professions Cole.and my license is
a imm�mree, derreel REROOF--T/O (E) ROOF INSTALL SHr NGLES
Liensc Clasa Lie.. ,
n r o Dam C.r uumr
�nj ARCHITECTS DECLARATION �B J✓�N ReP
w 1 understand my plans shall W Coed as public records
;LLQ Licensed Professional OCT 2005
❑O OWNER-BUILDER DECLARATION
d i P 1 hereby affirm shat 1 am aempt from the Contmcmr's License law for the
i
00 following mason.(Section 703 I.S.Business and Pmfesdmns Code:Any city or county
ymLL which requires a construct. co
1In construct.after.Imports.demolids.Or m itN structure
hyo 4 s Z riff
prior m its issuanc also require tW,ppliunt far such permit m file e4iigneJ smtemcm •' "x! �`^1 C 2 0 0 0
p=�'<
that he is licensed pursuant o the previsions of the Contncter's License Law(Cheper 9 Sq. Ft. Floor Area ftV 12:17 7li5m2a9' LI a vt
£�C V816atiOn
(commencing with Section 7000)of Division 3 of the Business and Professions Cout)or
fey $
that he is exempt thuefrom and Ju basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects be applicant to a civil penalty of
net more ban fiw hundred dollars($500L -3AINMWerou Occupancy Type
0 1,u owner of the pmperty,or my employes with wages u Noir sole compensation,
will dote work,and be structure is notintended oraRered for sale(Sec.7044,Business
and Professions Code:The Contractors Liaise Law does not apply to an owmer of Required Inspections
property who builds tar improve thereon,and who does such work himml f m through his
own employes,provided that such improvements are no,inundcd OroRcred forsdo.If.
however.be building or improvement is sold within one year of completion,be owner-
builder will haw the burden of proving thea he did not dtiid or improw for purpose of
tale.).
Las u owner of the property,am exclusively contracting with littnud contractorsw
tNeI tM projem(Sec.7044,Business and Profusions Code:)The Contractor's Li-
cense taw does not apply to an owner of property who Wilds or improves Hereon.and
who convects for such projects with a convumKs)limmed pursuant o the Conwctals
Lim.law,
0 I me exempt under Sec. B&P C for Nis reason
Owner V;%4i9 COMPENSATION DCARAOeN�"1�
1 hereby arfmmm under puulty,of perjury,one of she following declarations: .
I haw and will maintain a Certificate of Consent to self-insure for Worker'sCompcn-
moon,as provided for by Section 3700 of the tabor Code,for be perfmma m of the
work for which this permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,u required by Section
3100 of be labor Code,for the petfmrmmce of be work for which this permit is issued. -
My Worker's Computution Insurance urtica and Policy number arc:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thisseninn ucd not hecompleted if the permit Is Andre hundred 4.11.(SIM)
or Mss)
I certify that in the performance of be work for which this permit is issued,i shall no,
employ any paean in any manner so u On become subject o tW Workef Comp recolon
Laws of California.Dao:�1 nI11 VT
Applicant `
NOTICE TO APPL CA If,after making this Cenifieate of Exemption,you should
become smbkcl to be Workui Compensation previsions of the Labor Cade,you most
.,,Z forthwith comply wish such provisions or but Permit shall W deemed moked.
z Q CONSTRUCTION LENDING AGENCY
(-+ IMmby afrime that there is a Construction trading agency for be performance of
be work for which this Permit is issued(See 3097,Civ.C.)
lLlO Lender's Name
Undes's Address
U C)
CJ Q 1 certify that I haw mad this application and stem that ffic and
information u
ji�0 Ur. building I agree m comply with 11 city and cowry Ordinances sdsor and state lava r upong e
�U mewc-gcrlimmdion,and for
represcnuuws of the city mentervpnn the
r W above-(We)A ed pmpcny fm inspection pump W
F gy m.judgments,
agree to eve,indemnify and lump hayiinm the City of Cupertinoagainst said
against
N ince Wes.jnum or be
and expeue which may in any way accrue againstuid City
Uz in eonscqueue of the gaming of Nis permit.
^' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 67a Dale
,..6 f—
SOURCE RE ULATIONS.` �—
L gf9/g71 Re-roofs
Signature Appincan onbectur Date
HAZARDOUS MATERIALS DISCLOSUREType of Roof
Will be applicant Or future building occupant store orbandlc haurdoe material
cdefined by Nc Cupertino Municipal Code.Chapter 9.13,and tW Health tad Safety
Code,Sec tion 2553'1(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes AI No
Will the applicant or f'utture Wilding Occupant use equipment If a roof is installed without first obtaining an inspection,I agree to remove
It haummus air contaminants u defined h Ne Ba Area p neva or devices which g
Y Y Quality Management all new materials for inspection.
706"w'.cr
umt7 P
Dyes
�Nu
I hove mad she huvardousma trials requirements under Chapmr6.95 of be Califor.
Hulth&SafctyCOdc.Sudmu 25505.15533 am125534.1 understand Nm ifthe Wilding
a not cumemly haw a temnl that;a u my reponsibility m notify Nc occ.....f the
uirementa which must be met pnono issuance ora Certificate orOccupancy. Signature Of Applicant Date
ur,mmmrtvc gent Dare All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
10, Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
9)-711 GVvwsc�- /AT,e 0j-0Ivot-Cz
OWNER'S NAME: ? PHONE #
GENERAL CONTRACTOR. p FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinginformation:
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
CITY OF Telephone: (408)777-3228
UPEkTINO 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 i/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: \I t tlrl Li N
Job Site Address: 1 �q1 f�jesorr, �
Roofing Company Name: Own p i
Applicant's Signature: '�,
Date: �pf
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent, spouse or child) will perform
A. the work authorized by this permit
B. / portion of the work
C. None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. — All of the work
B. — A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
✓C C[2 Viii3G4
• 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer(see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
erformed
......................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information(reverse side .
c
Property Owner's Signature: Date:
Job Address: �Aa Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
City of Cupertino Building Department
CITY OF 10300 Torre Avenu
C U PE kT I NO Phone: (408)777-3
Dear Property Owner.
An application for a building permit has been submitted in your name listing yourself as the builder of
the property improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself,you
may protect vourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work
(including materials and other costs) is$200 or more for the entire project,and such persons are not licensed as
contractors or subcontractors,then you may be an employer.
If you are an employer,you must register with the state and federal government as an employer and
you are subject to several obligations including state and federal income tax withholding,federal social
security taxes,workers compensation insurance,disability insurance costs,and unemployment compensatio*
contributions.
There may be financial risks for you if you do not carry out these obligations,and these risks are
especially serious with respect to workers compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your
obligations under state law,contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor,only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit,erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors'State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department,
City of Cupertino
Panted on Recycled Paper
CITY OF CUPERTINO
,gtc --F.)
REROOF
OF
CUPERTINO PERMIT APPLICATION FORM
APN # 37S^ 3 Z c� Date: 9/7/OS_
Building Address: 1 �Cr7 ��SQm �ye X-0
Owner's Name: / Ph ne#:
to
La 2
Contractor: IPhone#: License #:
Contact: Phone#: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shinglesj� Asphalt Shingles
El 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 WiJI.Comply With Cu ertino's Tear Off Policy: ❑
VF Job Description: t
a
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Det. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
Zbrro._
Qty. if
A licable 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
W07
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