05080056 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT 1�3CON'CRACTCIRINO,(0) .T9 ;
;.d my: ,tf, noose
BUILDING ADDRESS: R E• ROOFING & CONSTRUCTIO PP'f"NUO05080056
1024
OWNER'S NAME: PERMIT ISSUE DATE
JENNY SUNG & JON IKEGAMI 15230 CLYDE
NE: SANITARY NO. CONTROL NO.
(408) 626-9320
ARCHITECTIENOMMER: BUILDING PERMIT INFO
BLDG 0 PLUn MOECH
309 LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affirm that 1 am Ikmned under provisions of Chapter 9(commencing
wmgallon 7070) D i' n fee Bualauaod�r fetal..Code. myliceoseis
4� in f.1 ands d IZ r REROOF-T/O 1 LAYER TILE/ INSTALL 30#
Am ucenro Llag ASTM FELT & NEW STEEL TILE
3 F Dau Contractor
` AR HI'IEC1'S OECL/� 10
! 1 uodereand y rune all be used u pis 1 sever
g Licensed Professional
G
5OWNER-BUILDER DECLARATION
M1 hereby strum Nm 1 em exempt from the Contractors License law for im
O O following mason.(sentiou 7(1313,Business and Profeatio.Code:Any city or county
$lei which requires a permit in construct,alcor.Imprrve,demolish,or repair any swctum
_Zen priorm I%issuance,also require lW applicant farsuchpermiva rile deigned st,umcia
p < Met he is licensed promotion MMeprovisionoftheContractor',Umose,law,(Chapur9 Sq.Ft.Floor Area Valu$00000
i 8 (commencing with Section 7 0)or Division 3 of lie Busi...d Proposals.Code)a
Mat be t,
- mexempt therefrom and tit basis for Ne alleged evmptiou.Any violation of
Seddon 7031.5 by any applicant fora permit wbjecu me applicant in a civil penally of APN Number Occupancy Type
not mom Nen Rw hundred dollen($500). 32639049 . 0 0
❑1,aaw.r of Me property.or my employees who waged a heir sale compewlion,
will do the ,it.Nd ise,met..4 not Intended earaReRd interim(Sec.70M,Business Required Inspections
and Pnefesdon Code:The Germicides License law dads at apply to an oweer of q P
property who builds ofimproves Noreen,andwhodoeaeech work humidifier through his
own employed,provided that such Improvement,aro nalineoded aaffered for We.If.
however.the building a Improvement 4sold within one year of completion,Ne owner,
Wilder M0 have me Wrden of proving Unit he did not huiW or Improve fee purpose of ^
sale.). i
4
co I,as=war of she property,am704 .Business reclusively contracting wtm I)dneed come im's i.
mass a d project(Sec.n an anonofand ProfedUaos Code:)The Canuaemes Lid .• /.• //V
ante law doss net appy b an awn.of property who Wilds re Improved;eNorton.and All % '
whocontractsLa uf.r ash projects wiNecontracmr(s)liecosed Punumtto the Contfxmots `Iw
License law. vin
❑Ism mempl under Sea ,B&P C for Nb moon
Owner Dam i" '9: 4el s
WORKERS COMPENSATION DEC"RATION
I therebyeRl m under pe.lty of perjury centurion following dalantion: �ti•��;'s i
Ibawandwill maintains CeNOesu of Cane.molt-I.un fa Worker'sCampen Fd s f.N-i,
utinn,u provided for by Some.3700 of the lab.Code,for We performuse e of the
for which this permit is issued. to
1 base and will mambo.Worker's Compematlon l.unnm,u exceed by Section
3 of the labor Cade.for Na performance of Ne work for which Nis permilt,Luueit.
My Works Compen e. lasunnm cannot and Policyn her em:
Cdrier. I Polly No.: ^ U
C RTIFICATE OF XEMPITON FROM WORKERS'
COMP LI SATION INSURANCE
(Tlmu secUm ad atbe<omPleed If Ne permit t,(m a.hundred dollar(5100)
or less)
I certify that In the performance of Ne work for which this permll is leaved,I Mall not
employ any pecan In any modest an u but become subject o Ne Workere Compensation
Laws of California Dau
Applicant
NOTICE TO APPLICANT.If,after making this C=nllicau of Exemption,you should
become subject in Ne Worker's Compensation previsions of me Labor Code,you must
.,O forAwttb comply with such provision or this permil Mail W deemed nvnkad.
r y CONSTRUCTION LENDING AGENCY
't-m I Wmby affirm N .
Net mere I. mmustctinn mm
lending agency for e purformco of
ai> the work for which role permit is Issued(Sec.3097,Civ.C.)
Lender's Name
7 z Lene.Address
U0 1 aaify that I haw reed this application and mu Nu tW above Information is
4L correct.I agme to=amply with all city end county ordinenceund some laws misting to
0 rU' building convection,and hereby auborim representatives of this city to env upon lM
fbl ahovwmrnuonod properly for inspection purposes
G (We)agree in an.indemnify and keep mention the City of Cupertino against
w�rag. is " enjodgm=nu.eau andexpenes which may in any my s=ane against said City
LVZ
APPLICA nccUNDE-_TAmixiNDSIAIND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE
Re-roofs
anUCantrulor Dau
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
WIII Me aPpli..ta fretum building t wore a luodle heufdous material
u defend by the Corsair.Municipal ,CWpur 9.13,add the Health and Safety
asolecome,Section 3553x4)7 All roofs shall be inspected prior to any roofing material being installed.
❑Y. u
Will the apps t or future buildingoaupam um equipment ar de w31ich f a roof is installed without first obtaining an inspection,I agree to remove
Il ha'raMnn air couuminanu u dcfi y Ue Bey Arta Air Quality anagement all w mated for inspection.
Dim m7 /
❑Yea u
Ihavemad Ne ardo.mwriat,mqulremenuunder Chapur&95o Califon
nu HeslN&SafatyCodc,Seetiau25505,23533md35534.1undersondmelf Wilding J
city haw a un mat II u my Nilily m nodfy mo occ an
myuirtmcnu tprior i ni0cauafOccy ig tureofAppli ant Date
ori P ret eJ ,e All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228 .
OCF Fax(408)777-3333
IfUPEkTINO
Building De artment
JOB ADDRESS: �d�`T PERMIT��a��
OWNER'S NAME: J, 5LA NfCh E4 AM ( 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
' e
�-�a�
• v�
Gontr or Signature Date
Community Development Department
Building Division
City of Cupertino
�( 10300 Torre Avenue
CITY<)F Telephone: (408)777-3228
CUPERTINO Fax: (408)777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1: Prior to permit issuances 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 withtheabove stated policy on re-roofing. q
Homeowner's Name:�-./o�`lt.�{ 1 f(J(/111(f r' �o� I h�kAA
Job Site Address: I U 2`T � 'N ffS L V
Roof' gCompan ame: Ci ♦f
A plicant's Signa re: Date: U
Greg Casteel
Building Official
Revised 11/2/04
CITY OF CUPERTINO
C REROOF
OCUPEkTINO PERMIT APPLICATION FORM
APN # Date: n Q U L
2� 3 `' v U
Building Address: 0 n 4 I TOP,Owner's Name: c7v1 ' Phone#: 'l lC
<,Tl � ' S 0 Q \ ' Ivo
Contractor. Phone#: License#:
"ham,
Phone#: Cupertino Business Licen #:
Contact:` J qq� � � !"[1��. 610 2 (0 L
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
C1Asphalt Shingles ❑ Asphalt Shingles
❑ C3 Wood Shakes
Wood Shakes
_❑ Wood Shingles A ICA [3OW ed hingles
Other(Specify) CAL A (Spec fy)
Number of existing coverings 1 ❑ ' Provide I.C.B.O.Report# 31 l
To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ASfM
Job Description: CWVU Y�IS' wI 1 L—V Om t'ti JWSTkO, 1��1J
a tfLJ 15iLil L
Residential I Commercial ❑
Fire Zone: Yes El No Confirmed with Planning Det. if
there are anrestrictions: IJ
Cost of Project. . Type of Construction: Occupancy group:
2 0 o0U
Qty. if Fee Grou
A licable Fee ID Fee Description
BPERMFEE Bld Permit Fees BUILDING
BENERGY Enerav BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
3601 -b