04070133 (4) 1 CITY OF CUPERTINO
BUILDING DIVISION PERMIT kCONTRACTQR I40 A'TI(JN.
, BUILDINGADDRESS: T D ROOFING PE ""'04070133
10692 P
OWNER'S NAME: PERMIT ISSUEDATE
Alk SHUO HAO CHEN 3540 MARGATE AVE- n7 /22 /2nn4
ONE: SANITARY NO. CONTROL NO.
(408) 892-8872
ARCHITECT/ENGINEER: - BUILDING PERMIT INFO
BLOCELECT PLUMB MECH
p 0 0 0 0
+app LICENSED CONTRACTOR'S DECLARATION
I bcnby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
withllfor n]01 of Division 3af the Buvnasand Profession Cade,and mylicenuia MALE
D
r � in mummeanderet. as REROO LA
j Z Lke u.Cas Ln.g
at Fg p Dala Contractor f
a< ARCHITECTS DECLARATION
Z I understand my plans shall he used as public recede
ao� Licensed Professional SEP t 2004
3OWNER-BUILDER DECLARATION
1 herchy nfOrm Nat I am exempt Irons the Commcmrs License Law for the
p
ZEEfollowing mune.(ScxMn 7031.5,Business and Professions Code:Any city or county
$tai which mquirm a permit to convect.alley,improve,demolish,or repur any structure
FZa priono iesu
isenec,alw requires lheapplicant forsuch permitto Ole a tigned.ulemnnt
p C that he is licensed pursuant to the prevision ofMeContractaraLicense Law(Chapter 9 Sq. t. Dor Are Valuation
(commencing with Section 7")of Division 3 of rhe Business and Propessinna Code)or
..
that he Is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant,o a civil penalty of gr0 Occupancy Type
not mom Nan five hundred dollen(5500).
❑I,as owner of the property,or my employees with wages m their sole compensation.
will do the work and the structure isnot intended or offered for sale(Sm.7044,Business - Required Inspections
and Professions Code:The Contractor's License Law dean not apply to as owner of q p
property who builds or i mproves thereon,and who does a uch work hpmsel f or through his
own employees,provided Net such improvements are not intended motioned for sale.IL
however.the building or improvement is sold within one year of completion,the Owner.
builder will have the burden of proving that he did net build or improve for purpose of
.ole.).
❑h as owner of the property.am exclusively contracting with limmed commeran to
convect the project(Sec.7(44,Busineu and Profaasioos Code:)The Convecmrs Li.
cense paw does not apply to an owner of property who Wilds or improves Nereus,and
who contracts for such projects with a moranor(s)licensed pursuant to the Convectors
License taw.
❑1 me exempt under Sm. .B&P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby rufhm under penalty of perjury one of to following declara0mu:
I have and will maintain a Cenifiam of Consent to self-insure for Warkere Campers
retire,m provided for by Section 37011 of Ma labor Cade,for the perfam once of the
work for which this permit is issued.
3/1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the labor Code,for Ne performance of Ne work for which this permit is issued.
My Worker's tC`omppeensation Insurance carrier and Policy number am:
Cartier. Slr\ lY .J i t ry o1 Policy No.:
CERTIFITCAT OF EXEMP770NFROMWORKERS'
COMPENSATION INSURANCE ..
(Thu section need not be completed B set,permit is forane hundred d.tlars(EIW)
nr leu.)
1 certify that in the performance of the work for which this Perrot is issued.I shall not
employ any person in any manner an as e become subject to the Workers'Comincre len
Laws of California.Dee
Applicant
NOTICE TO APPLICANT:If.after making this CendicaM of Exemption.you should
become subject Io Ne Worker's Compensation provisions of the Labor Code,you mat
O forthwith comply with such provisions or this permit shall he deemed revalued.
„z,I CONSTRUCTION LENDING AGENCY '
Ihereby all.Our there is a convection lending agency for the performance of
6i > Ne work for which Nis permit Is issued(Sec.309'1,Civ.C.)
Q Lenders
�z Land eexAddress
U I certify that I have road this application and sum that Me above information is
N conccL I agree to comply with all city and county ordinances and solve laws relating to
pU building construction,and hereby authorise npresenutiva of this city to enter upon the
W .hove-mentioned Progeny for inspection Purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
wy,,i liabilities,judgments,coats and expenses which may in anyway accroc against said City /J'
U z in consequence of Ne granting of this permit.
,•^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:34toD e
SOURCE R U IONS.
.w rias )0* Re-roofs
signa�Applicaro Commetor
HAZARDOUS MAARIALS DISCLOSURE Type of Roof
Will the applicant or future building mcupantstore or handle haymdous material
az defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and safety
ode.secaon 25532(a)? y a All roofs shall be inspected prior to any roofing material being installed.
❑Yes ,
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
m11 bayardous air contaminants as defined by see Bay Area Air Quality Management all new materials for inspection.
Diavict?
❑Yes ��j No
I have mad Ne hcespouematedalsmquircments under Chaperti.95 clone Califon Get
nia Hcalm&Safety Code,Scetions25505,25533 and 25534.1 understand that iflhe building �� ,l ys�j( '�
does not curter I h ve a mount.Iha1 it u my msporuibihly m redly the occupant of the {'_111 UUU I
requimmamspbib ustbcmetprioruissuanccofeCeniOcateaOccu r. Signature of Applicant Date
dL ZLI� x1aa�04
Owner or authorised agent Date All roof coverings to be Class"B"or better
Community Development
4 `E 10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building Department
JOB ADDRESS: PERMIT #
P !n/ o /33
� o6ga- ehh�e � ,.,7' a
OWNER'S NAME: S R ckQ CCA¢n PHONE # 0 8 9 54- a.1-
GENERAL
Q- a.a✓GENERAL CONTRACTOR: T . D Too , n I FAX #
I am not using any subcontractors: I SIHBaam C T
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
-JAff 77114
�a O
Owner/Contractor Signatu6 Date
Community Development Department
Building Division
City of Cupertino
MR.
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U P E IST I N 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.
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: SV%" o K aA
Job Site Address: fD`)
Roofing Company Name: 1 R o o Y1 q
A phcant's Signature: Date:-+—� o
• Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
73 � � g � �
r �n �
SU r) �G��
t CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# Date:
Building Address:
f6 S 11 \N -f C',
Owner's Name O) Phone#:
Slflf � �.« (yo8) 9 3 q 4 So
Contractor: /� Phone#: License#:
i D Roof'; y) KoB) .249 Io4-a- COT 66a29-
Cont : hone#: Cupertino Business License#:
ctres�; � 1E00%" hone
S9A 88T�0-
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles '( 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#
XTo be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: ' (� ELK J c-0 m
Ire-move v400d S�nc�Pa,a I «'1' CL LQ- w. So y P
Residential Commercial ❑ it O S(3 30 # f""' 30
I�
Fire Zone: Yes ❑ No E5 Confirmed with Planning Dept. if
there are any restrictions: LI
Cost of Project: Type of Construction: Occupancy group:
$ S 300 -- TI,le- - wo f
Qty If
ApplicolDe 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
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