05060183 (2) CITY OF CUPERTINO ^x
BUILDING DIVISION PERMIT rCONTRACT,OR, INP,ORM TION:,"
BUILDING ADDRESS: SUM' S CONSTRUCTION PERMIT NOO 5 O 60183
IS2e POPPY WY
OWNER'S NAME: PERMITISSUBDATS
lahl YANN-MING WA
ONE: SANRARY NO, CONTROL NO.
(408) 202-6501
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BO EO PLO MEOCH
Sop
LICENSED CONTRACTOR'S DECLARATION Job Description
I Wroby affirm Net I am n licensed under provisions of Chapter 9(commencing
with Section 700)of Division 3 of Ne Business and Professions Cade,and my]icon=is
I.full fora and.ffam
�z Lieeruea Lia, REROOF W/SHINGLES RNA
f1]t7 E9 D
Dam Cantrsew L
A CHITEC'DECLARATION /1
��O Ion ,stand my Prom still he usedaspublic=coma ,_/Q/�/_ 11 �j
;CCCo
Licensed Professional
S OWNER.BUILDER DECLARATION
I hereh afhres Nei i sec exempt from the Contractors License Law for the III I(�nI1� �j n
3O O following mason.(Section 703 1.5,Business and Professions Cade:My city m aunty \V/11 II �� I�\'1
8$ which requires a permit m consumer,after,improve,demolish,or repair any structure ` ) 'L 1 r,
�Sn prior m its iouace.abo requires the applicant for such permit m file sulmodmtemem
<
Man heulicensed pursuant=Mepmvisimuofuse Contr=mfsLccn=Law(Chapter 9 Sq,Ft.Floor Area Valuation'
S (commencing with Sedan 7000)of Division 3 of the Business and Profaiom Crude)Or
Hat he is soca t themfmm and Me basis far He alleged exemption.Any violadon of
Section
e tioars 0. bw AMdApplicant
dlic Iles(SS permit subjects the appliwn m a civil penalty of 3 WV13 fflacrO 0 Occupancy Type
❑1,as owner of the property.or my employees with wages as titer sole compensation,
will do the mL and the structure a rmtinundod mortertd forWe(Sec.70M.BusiMr.
and Profeeso es Cade:The Commrors License law dm rot apply m in owner of Required Inspections
property who bui Ids or im panes Hereon.and who does such work himmi f or Mhmush his
own employees,provided Hat such improvements are notimended oronemd image.if.
however,Ne building or improvement is mid Whin am year of completion.the owner.
Wilder will have Me human of proving Mut he did not bold w improve for pugnae of
tela.). -
C3 1,as owner of Me property san exclusively contncMng with licensed anuanon u
construct the project(See.7044,Business and Prefraslom Cade)The Conumurs Li-
came Law don not apply to an owner of property.who builds or haprom Memon.and,
who com ecu for meh projects with a sona=r()licensed pursuant m Um Comracmrs
License Law.
❑I am esempt undo Sec. .B k P C for this moon
owns, Data
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of Me following decimations:
1 have and will maintain a CrNlcam of Consent to self-insure fm Workers Compcn-
ast
ion,as provided for by Section]700 0of Me labor Cede,fm the Performance of Ne
work for which Nb permit it issued.
❑I have and will maintain Workers Compensation Insurance.u required by Section
370(t of the labor Cade,for the performance of Me some fmwhich this permit u issued,
My Workers Ca pen Man Insunnc.artier and Policy number are:
Carrier, A Policy No.: _
CERTIFICA ^OF EXEMPTION FROM WORKERS
CO 1PENSATION INSURANCE
This section need not be completed if[he permit Is for one hundred dollars 1$100)
or loss)
I certify Not in the performance of the wark for which this Permit Is loved,]shall not
employ any person in any manner an as m became subject=Me Workers'Compenwion
Laws of Califomia.Dam
Appli.l.
NOTICE TO APPLICANT:IL after making this C.NRcate of ExcmPtian,you should
become subject=He Worker's Comix n=Jon provWom of Me Labor Code,you most
.J O foMwith comply with such provision or ed this permit Nall be deemrevoked.
CONSTRUCTION LENDING AGENCY
rrr I for whifhthi Hct Mesetssed(Mucunn len ding ageneyfmr Ne perfarmaria of
aE Hework Ina which this s=tirhstead(Sec.]09'i,Co.C.)
;L.Q Lendcr'e Name
.7. z Ianderi Address
U O 1 certify that 1 Tuve read do.application sand sum that the show information b
!'. correct.1 agree m comply with all city and county ordinances and lute laws relating to
Q rU^ building construction,and hereby author=representatives of this city to enter upon the
W ebovo-Io uaad property for inspect an purp=L
gL (We)agree=ow.tndcmnify and kap harmless Me City of Cupertino against
VJ liabilities,judgmams,costs and expenses which may in my way&=me against aid City
U'2,' In c(vamattr c of the treating of this Permit. `iy Or ng r
r-" APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date 6/ SCC -I, Jin
SOUR R GrTIONS.
�r' 2 /rr te /!� LRe-roofs
SitnourtbSTAppli ^
HAZARDOUS
�
US MATERIALS DISCLOSURE Type of Roof
Will the applicant ert or(mum Wading Occupant Chapter
a=rt or handle hoamaus mammal
u dented by Me Cupertino Municipal Code.Chepmr 9.12,and He Health and Safety
Inia
e,Section 25532()1 All roofs shall be inspected prior to any roofing material being installed.
❑Yea eta Nu
Will the applicant or future building Occupant me equipment m devices,which If a roof is installed without first obtaining an inspection,I agree to remove
It ha,andon air contaminants as dchned by the Bay Area Air Quality Management all new materials for inspection.
mlct7
❑Yes No
I haw mW the hvardo is materials mquimmcnts under Chapter 6.95 of Me Califon
Health&Safety Code.Sectio=73515.25533 and 25534.1 understand this if the bolding
o not currently haw a wom Nat It u my responsibility m notify the occupant of Me
Wremenis wh'chm met primmiswanaefa Cc"'e"'l up=.Y. Signature of Applicant Date
6 b
Ownm amhaM>ed res ,te All roof coverings to be Class r'B"or better
Community Development
10300 Torre Avenue
1 Cupertino CA 95014
Telephone(408)777-3228
C OF Fax(408)777-3333
#MkTINO
Building De artment
JOB ADDRESS:/S26 DoPp PERMIT#
pS6Ga l d-3
OWNER'S NAME: Ginn — i+ PHONE# o Q Z o
GENERAL CONTRA OR: -5-c4nj Lf FAX#
I am not using any subcontractors:
Signature Dat
Please check applicable subcontractors and complete the following information
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
l • 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
Own /Contractt Signature Da e
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U PE IST I NO 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 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: YA/VN 7— �2�� L✓/9 /
lob Site Address: S 2 6 pO
Roofing Company Name: C 14 ru 5 h Sfr-u 4MIn CA .
Applicant's Signature: Date: a�/os
Greg Casteel
Building Official
Revised 11/2%04
Printed on Recycled Paper
CITY OF CUPERTINO oS G l , -
REROOF Q z> V
CUPERTINO PERMIT APPLICATION FORM
APN# 6 G o l \ v Date:
G 2� oS
Building Address:
/.52 9 �DPja bVA "
Owner's Name: V ,4 r . PW#J OPP^ A/�
Contractor: Phone#: License #:
SN�js �o�,s(r�Pw ¢o9,
Contact: Phone#: Cupertino Business License #:
u M °B) 0 2 —{So
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
ElAsphalt ShinglesAsphalt Shingles
ya 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 Will Comply With Cu ertino's Tear Off Policy:
Job Description: P /_
/I'ara a5 xja.&I SMV -Qe
Residential VCommercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning D�t. if
there are anrestrictions:
Cost of Project: Type of Construction: Occupancy group:
Qty. if
Applicable 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