03030007 (2) CITY OF CUPERTINO '^^^ f•,i��x '7L'T+ '� ^"" "¢ �•^
BUILDING DIVISION' PERMIT ,"ytV�L\.' 'CITD' Al Yl\ - RMA1rte10N fk
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BUILDING ADDRESS: ROOFING TECHNIQU BIRMITNO.
11509 ROCK SPRING CT 03030007
RS NAME: 1179. MYRTLE DR PERMITISSUBDATS
JANG YIHBAN AND YUAN-CHICH A 03/03/2003
NE: -4937 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
p 0 0 0 0
0p Z' LICENSED CONTRACTOR'S DECLARATION -
EY T Wmby afnrm wet 1 am licensed ander providers of chapter 9(commencing Job Description
with Section 7")of Divl&lon 3 of the Burins and Profession Cale,and my limse is REROOF
^� in I,.l fonx antic ecL
byLkenw Clue
Dam _ — `? Conus a 4 T O SHAKE, INSTALL 1 2 " 5 COMP
ARCHITECTS DEC RATION / / FRA Lkb1.
Ail I undcnund my plans Nall he used as public mccul, MAR 1 0 2003
.� Licensed Professional
OW NER•BUILDHR DECLARATION
m1 hcrchy&from that 1 am exempt from the Contractors License Law for the
HO O following ratan.(Section 7131.5,Business and Pm(esdotu Code:Any city m county .
$2 which requires a permit to construct,arm Impmw,demolish,or mpalr mY Structure Rim nING
1-��^ prior m its issuance.also requires the applicant forsuch permit to file A Signed statement
qqq <$
that heIslicensed pursuant mLaw Sq.Ft.Floor Area Valuation
(commencingwith Section 7000)of DiWion3oftheBualnssandProfession.Coca)or - $7500
-
11Nat he he emmpt therefrom and 0e bub for the alleged esemptlon,Any violWon of
Section 7031.5 by any applicant for a permit subjects the applicant in a civil penalty of 3 APLI[Q� bar 0 0 - Occupancy Type
not mom than fin hundred dollars(S500).
❑I,as owner of the pmpeny,a my employees with wage,as their sale eompenudon,
will do du work,and we structure Is not ntended or offered formic(Sec.7011.Business
and Profuse 11 code:no Contractor's License law dote not apply m an Owner or 305 — FRAME Required Inspections
property who builds or improves Women,and whodm.&mh workhlmself oywmugh his . 307 - INSULATION
Own employes,provided that Such Improvements am not Intended oro@red for Sale,If,
however,the building or Improvement Is Sold within one year of completion,the owner. 601 — ROOF TEAR OFF
Wilder will hen the burden of proving that he did not build or Woman for purpose of
tele'). 602 - ROOF PLYWOOD NALL
❑1.as owner of the progeny.am exclusively cormourng with licensed eontmcun to 603 — ROOF BATTENS
construct the project(Sec.70/4,Business and Profusions Code:)The Contractor's LI-
cemeLawdoesnotapplyuanowner of property who Wilds or Improved;Woman.no 604 — ROOF IN-PROGRESS
who contmets for uch projects with a conawmKU licensed pursuant to the Contnclor's -
License Low.
❑I am exempt under Sec. ,86:P C fm thin moon '
IMyor Data
WORKER'S COMPENSATION DECLARATION -
1 hereby&from under penalty of perjury mm of the following declarations. -
haw and will maintain ACenIncateof Consent macIf-Isom fo Worker's Compen. -
n,u provided for by Section 7700 of the Labor Code,for the performance of the -
forwhichthispermitisissued.
ban and will maintain Worker's Compensation Insurance,u required by Section
of the labor Code,for the performance of the work for which this permit is Issued.Workers Compensation Insurance caller and Policy number sm: -
Carrier. �.=.. - Q Policy No.: O —0
CERTIFICATE OF EXEM MON FROM WORKERS'
COMPENSATION INSURANCE
mut amfl m need not Wcomplemd if the permit is froom hundrcEdollms($100)
or leas.)
1 cattily that In the performance or the work for which this permit Is Issued.I shall not
employ any perm.In my manner an as In become subject to the Workerr'Compenaathm ,
Laws of Califeria.Dau
Applicant
NOTICE TO APPLICANT,If.afar making this cmuncam of Exemption,you should
become subject to we Workers Compensation provisions of the labor Code.you mutt -
.J O forNwprevisions or comply with such previsor this Permit shall le demN ranked.
rCONSTRUCTION LENDING AGENCY
[-i I Monday affirm that them its construction lending agency for we perform lice of
the ,it for which this permit it issued(Sec.3097,Civ.C.)
WA
Lender's Name
gl�r7 z lenders Address ,
U L7 I modify that 1 hon rand this application and mu that the.bon Information Is '
IS, F coneeL I Atte to Comply with all city and county Ordinances and auto IOM misting m
OU Wilding cau0uction.and hereby authatim repwsenutives of his city to enter upon we
W Wove-mentioned pmperty for inspection purposes.
gy - (We)agree n,Indcmni d keep harmless the City of Cupertino against
IZI liabilities ju ens,on sand es which may In my way oecmengalnst mid City
U 7 in ea oaf the Ging this omit.
Fry APPLI Nr UND STAN S D WILL COMPLY WITH ALL NON-POINT Issued by: Date
S U REGUL IONS.
G Re-roofs
It of ApplisnUCARDO Date HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
Will the applicant or future Wilding Occupant stare or handle hamolous material '
donned by th Cupertino Municipal Code,Chapter 9.11,and the Hcalth and Safety -
as%' ..
Ys 25532(69 All roofs shall be inspected prior to an roofing material bei. Installed.
t .� P P � Y g 8•
the applicant or future building cecupant Saw equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
om els conuminmu u dented by We Bay Am Air Quality Management all new Is for i e ion.
s7
Wthe Mvsrd,m rlala rcquiremcnu underChapter A.95 o(the Califor-Salct Ca@, 93505.2557 mW25341uWilding •.om haw a ,that It it my responsibility w notify the a�'"pant of the
�ichmu ctpriortoissuanceofaCcruOcamofOmup�l atureofApplicant X ate
3. 139thorivad agent Date All roof coverings to be Class „Bn or better
o . Community Development Department
a Building Division
h\ � 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 mi spection 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:
Job Site Address:
Roofing Com y Name:
A plic t'sSignature- Date:3—o3
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper