04060103 (2) CITY OF CUPERTINO 17777 77
BUILDING DIVISION PERMIT � TR XI6AI(
•BUILDINGADDRESS: _ BAKER ROOFING 11MITND04060103
1625 PERMIT ISSUE DATE
OWNERS NAME:
Id1hKING K HUANG 20r�7 T-A CON CT
ONE: SANITARY NO. CONTROL NO.
(408) 559-5105
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDO ELECT PLUMB MECH
+,a00 LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm tel I am Ilcmnxed under provisions of Chapter 9(commencing Job
with Smile.7)(0)of Division Sof Ne Business and Pru(cuiou Code,and my license is FUNALE[t
^ y In lbnfmm.pdcrfcet. a ZZ �.f,32 REROOF r�k RC'iB(fbsa6
j Z License Class ✓� Lic.# r p
nt- Dam . (d n es n 6 Comoro
^� ARCHITECTS OECLARATI N JUN 21 2004
I understand my plans shall he wed as public records
0-U
3 G t Licensed Pnr(essi...I mmm���
:21 OWNER-BUILDER DECLARATION BUILDING
aI hromo .(firm mm 11. exempt from d r Contractors :Any c Law for me BUILDING
E:e 2 following mom..(Section]1131.5,Business and improve,
d moll Code:Any city or county
a�q which requires a permit m rnnsnrceL aIle[improve.demolish,or repair any awcwre
Fly prior In its iuuance.also mquiros me applicanl for such permit to File a signed nammant
FG that he is licensed palmemtothe pmvistomofthe Common.License U.(Chapter 9
Sq.Ft.Floor Area Valuation
repa (commencing with Section]000)of Division 3 of the Business and Professions Code)or
mat he is exempt thamfrom and the basis for the alleged c a mpti.a.Any violation of
Section 7031.5 by any applicant for a permit subjects me applicant to a civil penally of 3 Skplm QL3dBe10 0 Occupancy Type
not mom than fin hundred dollars(1500).
I,as ownerofthe property,armycmploy es with"gum theirmle compensation,
.tilde the work,end me mucture is norimendcd or offered tousle(Sec.7041,Business
and Product.,Code:The Contractors License Law does not apply to in owner of - Required Inspections
property who Wildsor improves daemon.and who do ssuch work hfmulf orthrough his
own employees.provided matsuch improvements are not butene ed or opened formic.If. ,
however,me building or improvement is sold within one year of completion,me owner.
builder will have OR burden of proving that he did not build or tmprow for purpose of
sane.).
❑L as Owner of the property,am exclusively contracting with licensed contlattom W
consumer to project(Sec.7004,Business and Professions Cade:)The Connector's Li.
cense Lew docs not apply to in owner of property who builds or improves memon.and,
who contracts for such pmjecu with a conttador(s)licensed pursuant W the Contractors
License Law.
❑I sen exempt under Sec. .B&P C(art this mason
1037�'ffl
ner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Faulty of perjury one of the following oscillations:
I have and will maintain a Certificate,of Consent to self-insure for WorkelsCompce-
ton,as prevtdcd for by Section 3]00 of to Eton Code,for me performance of me
rk for which this Permit is issued
I have and will maintain Workers Compensation Insurance,as required by Section
of the Leber Code.for the Performance of the work for which this permit is issued.
y Workers C�oompeJnsation Insurance carter and Policy nummber amrtier. S r* #� f b� Policy No.:1Z[L.Q_(
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(Thusectfon need notbecompleted If the Permit is pounce hundooddollars($I00)
or leas.)
I anify that in me performance of the work for which this permit is issued.L shell not
employ any person in any mannerm as to become subject to the Workeri Compensation
Laws of Calif amia.Data
Applicun
NOTICE TO APPLICANT:If,afar making lilts Certthcam of Exemption,you should
become subject W the Worker's Compensation provisions of the L dWr Code,you must
O O forthwith comply with such prmvfstens or this permit sell M des med revoked.
iy CONSTRUCTION LENDING AGENCY
[—i I hereby apnm that mem is a c...auction lending agency for me performance of
ai me work for which this permit is issued(See.3037,Civ.C.)
W�Q lenders Name
z Lenders Addreu
U O 1 unify met I have read this application and ams mat the above Information is
IL F coned 1 agree W comply with all city and county ordinances and Rude laws minting m
C) building construction,and hereby mthorfxe representatives of this city to enter upon me
W
allow-mentioned properly for impaction purposes.
(We)agree to save,indemnify and keep harmleu me City of Cupertino against
h liabilities,judgmenu,cosuandexpcn3M which may in anyway acemeageimsloid Cfly
U,'� fn consequence offs ung of this Permit.
ti APPL ANT ND STANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: 4 Date
SOU ER L ONS.
1� 6 //i16 Re-roofs
Sign re of Applium/C.muctor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle evsrdous material
as defined by me Cupenino Municipal Code.Chapter 9.12,and the Health and Safely
Ali�cxm'sectiYoean 25532m)7 e All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building acupam use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
not hazardous it contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District,
Oyu RN.
I evereel thehmardmsmamtaisre33and55 under Chrearal eafdW building
/t3z
nice Health&Safety Cadc,tumSectm,in.,iti my pund75634,1 to Won, he
of Me % (� // ` I V
dos not curtenlly ho tenenq mal it is my respoasihility m nntil'y the oaupant of the
mquimm nu with a�l is mel prior W issuance of a Ccnifcam ofc kncy. SI natuie of Applicant Date
!%
owner ramneri,edsaem r Dam All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF IFax(408)777-3333
UPEkTINO
Building Department
JOB ADDRES PERMIT
IMP I wp
OWNER'S NAME: 41- 6/v ✓C PHONE S X05
GENERAL CONTRACTOR: FAX #
i
I am not using any subcontractors: � �_A
U Signature Date
Please check applicable subcontractors and com Tete the followin 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 (�,��✓ �y
Septic Tank
Sheet Metal
Sheet Rock
Tile
ial')e�p
e;/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
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 uriderstand and will comply with the above stated policy on re-roofing.
Homeowner's Name: 4 r /V adol b
job Site Address: )-sr roffzn
Roofing Company Name: 6 n ka,
A "cant s Signature: J 4 Date:
ee
Greg tl
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO v v
REROOF
CUPERFINO PERMIT APPLICATION FORM
APN# / / ' O 3 Date:
Building Address: IS' PWfo AM
Owner's Name:L( -w Phone#:
Contractor: Phone#: License#:
Contact: Phone65' Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑, Asphalt Shingles ❑ Asphalt Shingles
4 Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles w�
❑ Other(Specify) ❑ Other(Specify) /V AI/ dV
Number of existing coverings 4 ❑ Provide I.C.B.O.Report#
JD, To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: 0a
Job Description: ,_,
4/1 V ; S JA ' ! v_54'{ki- 000 4 /U 3'v tet Chi k
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De
there are any restrictions:
Cost of Project: yp of n ctioo�n: Occupancy group:
X00 JL-
Qty.�if
A lic b 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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