02080033 (2) CITY OF CUPERTINO
a+oAt DING nwtsiON PERMIT CONTRACTOR INFORMATION:
d BUILDINOADDRESS: PERMIT NO.
10'4;6.4; SCENIC CT WESTSHORE ROOFING CO 02080033
W A APPLICATION SUB DATE
4ISA M1TEI-KWEI AND LI-HUA 5869 WINFIELD BLV 08/07/2002
/ PHONE: - - SANITARY NO. CONTROL NO.
(408) 629-2100
RO OF ARCHITECTJENGINEER: . BUILDING PERMIT INFO
oc u,b BLDG ELECT PLUMB MECH
f _I O LJ C7
FF i , LICENSED CONTRACTOR'S DECLARATION
Z-_G •';- t'1 Eereby aRrm Nal l am licensed under provisions of Chapter 9(commencing Job Description
O,L whhsioabm 7000)Pf Division 3 of the Basin ss dPm�f7cssyinm Cale,and my license REROOF
m L in fu a and eRect.`�G .C
m 6 license -11 Lic.
c a V Dm _ Contractor
HITECI'S D����,/t[+A 92
tnudeistmud my pians shall he uudhrllf,blic rtcoN.s Roo h�l w`e
�u i p p Liccnud Rvfessiowl
o _ Oat I am eU rept front
DECLARATION
1 hereby affirm that 1 am esemq from the Contractor's License Law for The
E?a fallowing mason.(Section 903 L5.Buttress and Pm@ssiom Cade:Any city or county' $17800
I O which iequio' a permit to conxtmn,mees improve,demolish,or repair arty nmcturt
�is.3m pdarm
mints
u issuuxe.dw requ.,"Ne apphcam(or such permit m fleasignJ statement,
W.1
Abe isfan¢ed poll t9rhe pm Niton of
L'OreavZ,License lsw(CM1ager9 ^�s,,,�.a FI rpz.�.a'r ' Valuation
(dommcour.-wnti Secden)0001 of0ivisian 3 ofthe arts _.ad RofcasionsSe'AOk �Fl,
Pr th.1 he fired rpt therefrom'aM the huts farts
alleged ea o akin AnY violation i
of Secdon 9W IS by any applicant fore pentyl subjects to
epphrion to a civil penehy p y yp
of aot mare they five huuered not.ISSWI. 3 0 55AeN Mt � OCcll ane T e
1 ,
111.as..or of the property.or my employtts wish wages as'Ihcir sole eompor ration. 307 - INS )LATION
--will do the work,and the structure is'not"intended or offered for sale(See 90iJ;' - "' - - - - "---'---_---_-----'-""'"""
Buiineis and Professions Cade:The Corrector's License Low des net apply to an 601 - ROOF TEA bgQRU Inspections' "•I`
ownc
r of property Who W ilds m improves thereon,and who docs such work himself 602 _-_ROOF . PLYWOOD NAI L
or through his own employees.Provided that such improvements ax not intended nr'
'offend for[dll:If:Fowcvef,the Wilding oFlinum;cment is i ild within one ycmi of' "--" - - --- - -- - '_. ...-.__ ____
completion,the owncrWilder will Wve Ne WNen of proving Nm he did not Wild or 603 - 'ROOF BATTENS , •-
improveforPurposeofxleh 604 - ROOF IN-PROGRESS
s�. Glnasownr fth-e-pin . l- --' - --c'o-nr-ctou'I
o
ronett(S..7( Brinitiit d rwtion,CW,:)Th COa - -.. ._ _.._. ._
S_G.•.._HYV.'fi
License eoes no apply to an owner of p ety who Wilds improves thereon,
-ii
i contracts such.PoJas wit,
commaco-s(s)licensed pursuant bribe, __.-
C uae, rs LicenseLow. :•. f
. .- ._.
-
❑lamei,enip,under Sec _er ` :' B&P Cfor thus reasonT. '
b ner r .f Dole
W� ORKER 5 COMPENSATION DECLARATION /
Ili reby firm under penalty of perjury ime of chefollowing dlarmtons:
zl h oence d'willmnumn7'a'
Certificate f Consent self-insure
l6 nsute for Worker's
/Ri a
O
Cpen m o s p idcd for by-Seeti n 3W I the-Labor for he
of thew k for which Nis perm usissued.rm
,r,+
C I have and will ma nmin WPdw's Compensation In trance;m regmrcd by secuun
.3100 of the Labor Code for the funfdrinuorce of the work far h h'd is'perann is
is uN My Worker's Cmpens ton insurance a mer and Policy Ire _- ......�. ..,.,.,,_.,.,,„,
x
mar
ol¢yN : ' OO.4N1�1 -\V p,
1h , PIC No o 7 EXPMPTION H WORKBR4 j. !: t. 0 ;1 4,. i' [ Y ;,o
r COMPENSA710NINSUR NCE } 4
- n .i_.. . 11 ., ._-....._...,..._ ..,....v .. _., . .. .. ......... -.
(ThLeseeinn need not be cmmylctdf the permit is for one hundred dollars `•iy '[!t :'.\I 1 i „I_!'!�I r, it
Ithat cKnooa a fth kf wh h'Ih
certify P pc mus¢issued,I t+ r - .
'th ll t employ any person any mana o ds'Ih Wcome su jcel to the Workers _,L Il 't L -•
Compensation Lows of C I f m Dote '
"NOTICE Applicant
TO APPLICANT if a urmmi u p Cenifc ofth Exmpthode,y u n u t
becamesubjectm the Worh pr ... or to ties permit shall Is,deemed rtvaked
2 wy ._.- .... ._ ... ..... ..__.... .. .... .... .... ....... .. _ ... ...._...
+'fk'C CONSTRUCTION Fi L clen AGENCY ”them by off rte th t th con wen n I ding agency for the performance L.i
,
.W..� of sh rk for rich N' pe i t 'tisued(Sec 2097one C) '
'Lentl sAed e - .. . . .
t..7 C ° 1 art fy'Ih t 1 h mail'Itis appl t and',one that the ols�)ve utornat' is j
ki•f'+ correct i agree to comply,vth all city and counts.ordinances and state laws rcin'Iing
'C' ;fo building construction,and hereby authorize representatives of this city m enter upon
,,, 0. ;the eW a of red Property flyandinspection purposes
/T
Lu 0. (We)agree tdss d keep which
ince wayacruertino3gmnm
en fn Cliabilities,tycJseq nes see and a genu wh h m y n any y gal t said
C„> City in consequence of the Starting �fth N t
AP ICANTUND,ERSTANDSAf'D WILLCONPL4'WMHALLIJO a YT r vV
RCE REGULATIONS,fy [t(�la_k g sued by: Date
46ignature fAppicamoConttract, oror'I"...- t ,Dine Re-roofs /
HAZARDOUS MATERIALS DISCLOSURE
W II thea 1 cmt f t m Wlldin meas nt tore a handle hazanl6m uwmnal _
ppi, g q .,_.Type.of Roof_...__-. ._-. _.. _ .__.._..._,_,_., w...,._is defined by,the CupertS Municipal Cade Chapter'9 13 and the Health and Safety f ac's j y?, '
Crde Secton25532�a) n 4 .3.
❑Ye f •,� s No, g SP pi's i � l_V.• s
1 �, All roofs shall be inspected poor to,any roofing_matenal being installed.�_„_r
Will clicePPhc nt roti_ Wilq g e p eq Pm ten a e n n If a roof is installed'without first obtaining W an`inspection I'agree to.
remove
cm t aN s a tma Say co as defined by the BAAir Qualuy Manegcmcm
District,
all new materials for inspection _Applicant understands and will comply with
• `all'non-point source regulations..
] pi h e ieae'Ne hairdo p mammals q menu and r Chapter 6 95 of the
Cabfrm Health,&safety Code Sections M05.25533 and 25534 1 uncle om d that _
if Ne 6u ldmgdoes not eurrtedY ha atenant that ws my rcspr bll ey tin aufYthe '( _ -y^ry. 11{�'y�.. ..,. .' '-- .__. - ._ ._Q _._. __.-
acupan'I of the requiremcna xM1mh must W met pnono isuenc ofa Cenif<ue of \�I'•`A/1yWl� -�
ta1rL✓ 8 ?�2.' - Sig azure.of Applicant _ Date
aamWgrce get , ;r, oa'Iec All roof coverings to be Class 'B”of better- '
.. . . .
-------- OFFICE
.
Building Division
10300 Torn Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Pax: (408)777-3333
CUPS TING
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a**+i*+i**+um of 1/a"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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: J u£l KW Gi I S OLc
Address: Orb S CeytlC C6-f pb of V L "V
Reroofing Company Name:
Applicants Signature: V tT A!t�lM i Date• 1 2-
�Joe Antonucci
(Chief Building Official)
6/25/01