04040166 (2)CITY OF CUPER'TINO
art' jp n '�y�� [ a
"CON,TI"G RIND ORMA.TION
BUILDING DIVISION PERMIT
"
BUILDING ADDRESS:
110260 HAR TAP DR
_
WESTSHORE ROOFING CO
PERMIT N004040166
OW NER'S NAME:
PERMIT ISSUE DATE
YU FANG CHUNG
5869 WINFIELD BT.17
04/2C/2004
NE:
SANITARY NO. CONTROL NO.
(408)629-2100
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
:RCHITECTIENGINEER:
LICENSEDCONTRACTORSDECLARATION
I hereby affirm that I am licensed under provisions of Chapmr, 9 (commencing
mide,S
Job Descrl IJ O� .E(ya
P ai—gEGa[{� '
Division Sof the Business antl Professions Cndc, end my license is
Score
and effect
LimnsClaanderre t
in fu
License Glma a =a ti Lic. M __ase �' r z
REROOF
MAY 26' 2004
Date U— 4=jLY Cumove or ✓L -awL
ARCHITECTS DECLARATION
1 understand my plans shall W oma ns public reeoods
I
�UILD'NG
Licensed Professional
OWNER-BUILD ER DECLARATION
I heady affirm I am exempt from the Law for the
on f mbuistCu a: Any c
following reason. (Section ]1)31.5, Business and Professions Cuba: Any city or county
which requires permit ua improve, demolish, or repair any structure
poor bs its issuance, also reyuirce the applicant for such permit In Gln License signed stammcnt
n tures the aalter,pplicant t
thathe (Chapter
puuuam mrgB
Sq. Ft. Floor Area
Valuation
mencinglicewit the Business andon. Code)
(commencing with Section Division3
of Divinnn3 oftContsinessanProfessions
Nat he is exempt therefrom and the basis for Ne alleged exemption. Any vinlatimn of
and the Any violmi
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of
3 W]SI2tuh'$er0 0
Occupancy Type
P Y YP
not more than five hundred dollars ($500).
❑ Las owner Of the wlthwred
compcnaades
the stn blummycmntended for saleBusiness
will Pr Newark, ands: he Contractor's
and Pmfcssions Code: The License Law docs not apply to an owner of
Licensoroffereds, not apply to
RegU1CCd IDSpeCt1OH5
progeny who builds orimpmvcu thenar,and who does himselfor
improves daemon, his
own edthrough
own employees, intended
that such improvements are not immnde If.
am not for able.
octl
buildingt mpledo ,
however, Be building or improvement is sed within one year of completion, the owner
rte
builder will have the burden of proving Nat he did not Wild or improve for propose of
sdC,).
❑ 1, as owner of the pmpeny, am exclusively contracting with licensed contractors to
construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li
cenm Law does not apply to an owner of property who Wilds or improves thereon, and
who contracts for such projects with a ombacmr(s) I cenmd pursuanno the Contractor's
License Law.
❑ 1 am exempt antler Sec. , B S, P C far his reason
Owner Dale
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a CeniGcam of Consent to self-insum for Worker's emoted-
_
radon, as provided for by Section 379 of the Labor Code, for Ne performance of the
work for which this permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance, as mgmmd by Section
3700 of the Labor Cn e, for the performance of the work for which this permit is issued.
My Winp otcamran lPolcyoumberare
/p
Ok
O
CaRe
D`FftEXEMPnON
C ROM WORKERS '
COMPENSATION INSURANCE
.
(This section need not W completed if the permil is Arron hundred dollars (SIM)
Irm.)
1 cenify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as In become subject to the Workers' Compensation
Laws of California. Dam
Applicant
NOTICE TO APPLICANT. Ir, after making Ibis Ceni Bodo of Excm ption, you should
become subject to the Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this Permit hall M deemed mvnked.
CONSTRUCCI ON LENDING AGENCY
I hereby airrm Nat there is a conswctinn lending agency I'or the arl'urmanom of
the work for which this permit is issued (Sec. 3097, Civ. C.)
Lenders Name
Lender's Address
I terrify that I have read this application and sum that the above information is
correct. I agree to comply with all city and county ordinances and state laws rclming to
building construction, and hereby authorise representatives of this city to enter Open he
ahnvcmeminned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilities, judgments, costs and expenses which may in any way accrue against said City
in amnxyucnee of the gmadi ng of this pandit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
Issued by: - - Date
SOURCE pEGi1LATI0N5. /j
Re-roofs
Type Of Roof
q—,26-0
/t/rac/mr ',_ —,2 `—�
Signator/r/--��gppGcanucnna/'
Date
HAZAR
HAZARDOUS MA ERIALS DISCLOSURE
`ERIALOccupant
Will the applicant turebuilding stnrcO handle hararduus material
' v
as dermad by the Cupertino Muniui pd Code, Chapter 9.12, and the Health and Safety
ode, Nation 25532(a)?
❑ Ycs
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applirmtm future bwldin occupant am equipment. devices which
it harartlnua air comeminanu as J N by the Bay Arca Air Quality Management
all new materials for inspection.
strierl
❑ Year
I have read he h rsamousmarorla irorciremenu under Chapmf 6.95 of Ne Calif.,
dy
nia Health &Safety Code, Sections 75505.25533 and 25534.1 undcrsund Not iforc building
docs not currency haw a tenant, Nm it is my responsibility m nnGly the cecupml of the
equips h stbc mprio omuace or a GcrdfiWm of Occupancy.
�
Signature of Applicant Dale
�//.._�y G
/or
All roof coverings to be Class "B" or better
g
x
wncr or auti�ri'r'cd ugcn�2/ "�
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
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 e "
approval shall be obtained from the btulding 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.
IWORTANT
1. Flat roofs must have a minimum of Y4 " 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 complywiththe above stated policy on re -roofing.
Homeowner's Name: �✓ I q� C�✓n7
Job Site Address:
RoofingCompanyName InkStilns ^C Rn4r�n "`� Co In,;.
IG
icant's Signature: '� Date -
Building Official
Revised 1/30/03
CITY OF cuPERTIN0 6.6
REROOF'
PERMIT APPLICATION FORM
APN # ,Z C
0 7
Date:' y Z6 y
Building Andress. ('oLba PInw IaP Dv
Owner's Name: W C
BUILDING
Phone #t �o g yyb - Yyd f
Contractor. (
�CS�Jka✓t(Lo�l
Phone #:
Llof•6t1"Zlao
License #
7872L(•
Contact:
Phone # Yo p 62 y Ll o c
Cupertino Business License #
Plan Check Fee
BUILDING
BUSLIC
Business License
Type of Roof Covering:
Eydsting:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof
❑ Asphalt Shingles
'�,d Asphalt Shingles
.,e Wood Shakes
❑ Wood Shakes
❑ Wood Shingles❑
,. other (specify)%ar ✓'a✓t
Wood Shingles L C
❑ other (Specify) '
Number of existing coverings Z
(3Provide I.C.B.O. Report #
/d To be Removed
❑ Provide b fgr. Installation Specs.
I Have Read, Understand and Will Com 1
With Cu rtino.s Tear Off Polic :
job Descti tion: R c. k Swed rd,rt
&4 tbL t I �T•t.11
f"Verf pge* o gLt ij sae, ( (w / tX I
t•7i 5Adv k4. t ('tt 'fni/ O. C .
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑
Confirmed with PlanningDept. if
there are an restrictions: LLJJ
Cost of Project:/q G / Type of Consttuctiomp Occupancy group: S1cR
l
( DDo
Qty. if
Y •TRi, �l
Frio Tloa,A"tinn
Fee Groun
BPERMFEE v
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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