04100078 (2) CITY OF CUPER rINO
BUILDING DIVISION PERMIT GONTRAGTORINFORMATI'ON
BUILDING ADDRESS: O INC PERMIT N94100078
1518 ROCK SPRING CT
OWNER'S NAME: PERMITISSUEDATE
ah STEVE LIM 5554 HARVARD DR 10/13/2004
HONE: SANITARY NO. CONTROL NO.
(408) 269=2:02.5
ARCHITECT/ENGINEER: DING PERMIT INTO�,•' 1 BLDG E I PLUMB MECH
L 00 LICENSED CONTRACTOR'S DECLARATION s.✓ l s �"
inm I hereby affirm that I am licensed r ad limons of aborter 9(commencing 1 ,�^v,,{./,\\ JOb eseri�tl
with Semion7mBof Division Sof Jin BU; and Prufcssinna Code.and mylicenu is REROOF '?�L.VI'!t' .
^ah in full e it cffec m ,i
nJ'o Licen s Lic.N
F Dam d`:
— Ganlraer
RCHITECTS TION
Yq
YY 22 1 uym—l" d my s h Mud' is records
6
,.05; Licensed Pm saran
,] NER-BUIL RDECLARATION
i I hereby affirm that I am exempt from,be Contractors License Lew for the
O O following reason.(Section 703 1.5,Business and Profcainm Code:Any city or county
$ which requires a panni,to construct,altar,impnave,demolish,Or repair any structure $8876
priormits isamnce.alsoreyuires lheapplieanl for such permitm fill asigneJ nemmem
<
that Wislicensed pursuant othe provisions ofthe Contmcmr'sLima.Law(Chepscr9 Sq.Fl. Floor Area Valuation
e�D (commencing with Section 7")of Division 3 of the Business and Professions Code)or
y $ that he Is exempt therefram and the bussu fm the alleged exemption.Any violation or
Section 7031.5 by any applicant for a parenit subjects the applicant to a civil penally of b Occupancy Type
not more Nan five hundred dollar,(S501p.
1,as owner of the property,or my employees with wages As their role compensation,
will do she woh,and the structure is not imcndtd or offered for sale(Sec.7044.Busiass
and Prorcuions Code:The Convenors Liave Law doer not apply to an owwr or Required Inspections
property who builds or firm ovq memon,and who does uchwork himself or through his
own employees,provided that such Improvements are not intended or offered for sale.If,
however,she building or improvement is ecru within one year of completion,the owner
builder will have the burden of proving that he did not build or improve for purpose of
salt.).
❑ I,as owner of the property,em exclusively contracting with licensed contractors to
contract the project(Sec.7044,Business and Pro&ssions Cade:)The Contractor!Li.
cense Law docs not apply,o an owner of property who builds or improves,hemon,and,
who contracts for such projects with a contnnor(s)licensed pursuant to the Contractoh
License Law.
❑I am exempt under Site .B&P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the fallowing declarations:
1 haw and will maintain a Certificate of Consent to self-msum for Workcr'sCompem
setion,az provided for by Section 3700 of the labor Code,for the performance Of the
work for which this rennin is issued.
❑I have and will maintain Workers Compensation Insurance,as required by Section
3708 of the labor Code,for the performance of the work for Which mi,Permit is issued,
My Workers C,Un,AAA;a' I simsoceir. Poll
icumbc art:
Cprtiere Policy No.: TT
ER71FICATE OF EX• ON FROM WORKERY
COMPENSA IONINSURANCE
(This section sed nm bccamphacd if me perm!,is foranc hundred dollars($1011)
or Icss.)
1 certify that In the perfommnee of the work for which this permit is issued.l shall net
employ any Person in any manner an As to become subject o the Waders'Comptnsatinn
Laws of Cel ifornia.D.
Applicant
NOTICE TO APPLICANT:V,after making this Ctnifmam of Exemption,you should
become Subject to the Woher's Compensation provisions of the Labor Code,YOU mus,
.JO forthwith comply with such provisions or this perm i,shall W deemed revoked.
P"'• CONSTRUCTION LENDING AGENCY
(—ice I heathy affirm Nat there is a construction lending agency for the performance of
C4 the work for which me.permit is issued(Sec.3(N7.ON.C.)
W�Q Lender's Name
D z Lcnder's Address
U O 1 coolly that 1 have read this application and sum that me above lnfmmatkm Is �—
WT F coram.1 agree no comply with all city and county ordinances and tum laws relating to
Q U building convection,and hereby Antonin¢prcsemuites of this city to enter upon the
45l above-(We)Agree
an any for emnify An keepus.
gy
(We)agree,o sass,indemnify and keep harmless the City mC Against
againstliabil
N in
qunce or
mano of this Permit, may in any wayaccmo egeina said City
U 7 in consequence of me graining of Ihie permit.
•^+ APPLICANT UNDERSTANDS AND WILL COM LY WITH ALL NON-POINT Issued by: Date
SOURCE�EG LATI
91 /, -—�. /�/� /�/2.9� Re-roofs
S rat r a App yARDOJS 14iAT IAISDISCL URE Date Type of Roof -�
Will me applicant ser fmurc building occupant stere or handle havarduus material
as defined by the Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
,dgghLecce,sextan 3ssu(aYs
Yes r/a All roofs shall be inspected prior to any roofing material being installed.
❑ �"
Will the applicant or future builJingacupem use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hararduus air contamjnanu as defined by the Bay Area Air Quality Management all new materials for inspection.
Dislriafl
❑Yes
I have mad the hunn ms materials myWnments under Chapter 6.95 of the Califor.
nia Hui"SdalyCode,Sections 25505,35533 and 35534.1 undcrsund Nat ifth building I
dtrs not cuoen,ly haw a¢rank that it u my res siblU'y{ry m notify dm atopen,of me �/ _
rcyuircmc�whi s,bare riserm is'. :Cnifigte ofpcc9pancy Signature of p licant Date
nor uramho''. Sgt s I `Dau II roof coverings to be Class t"or better
Community Development
. O
0 Torre Avenue
Cupertino CA 9 014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEI�TINO
Building Department
JOB ADDRESS:
/ 57� PE CVV Mac, /z3
OWNER'S NAME: , PHONE #
GENERAL CONTRACTOR: FAX#
I am not using any subcontractors:
ignat 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
/ , Tile
-01rmer/g6nfractor Signature ate
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
��'�O 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.
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: rm-t
Job Site Address:
Roofing Company Name: L
A plicanYs Signature: Date:
• Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CU41TINO PERMIT APPLICATION FORM
APN# 3 � -a 1 Date: / C)
Building Address: I I
Owner's Name: Phone#:
Contractor: Vhone#: License#:
6
Contact: Phone : Cupertino-Business License#:
L
ype of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
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 CoNly With Cu ertino's Tear Off Policy:
J Job Description: S /,Q e S , 1f-/ IA o.<
Residential Commercial ❑ _ . U
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are anrestrictions: LJ
Cost of Proje t: W-1Type of Construction: Occupancy group:
i
Qty if
A is le 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
p
rS77.