05060170 (2) CITY OF CUPERTINO 774--
BUILDING DIVISION PERACT C®�iTittlCTOR TNNG? I1�TI(J1Y -�
iUILDINGADDRES3: CORNERSTONE ROOFING PERMITNIbs060170
07
OWNER'S NAME: PERMIT ISSUE DATE
Adh MABEL YUEN 1605 MONTELLANQ CT 06/27/2005
10 ONE: SANITARY NO. CONTROL NO.
(408) 997-9788
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG 0 EI-EcrO PLUMB MISCH
O 0
�Cp LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm unit 1 am licensed under Provisions of Chapter 9(commencing , ,
with llfOMO ndcufeCt. on 3Ofue 0udnras and PrefessiaNCode.and mylicense b q /y toy
^ in fullforeeendanect,�•-O� 6 2.Z?/� REROOF W/SHINGLES
? Z License am J7 - Lic.• 44(J
"p Dau E'^1.7-aT Conlrular GG see 00 NG
e 700700 ARCHnECTS DECLARATION
y F<• I understand my plan shall be used as,public recordsis
L fM rye
L Ol^ Licensed Professional
q OWNER-BUILDER DECLARATION 1
y 0 1 bombe.(Sect on I nm exempt s i NL Conlrlmala Llttntl IJW for the �`
Sy o O following mama.(Sevum RD L3,Business from
m he Con UN Cade:mm Any,ily or forme D I IL,{)/Y,1 1\
which requires a permit w construct,alter.hnprow,dernalbh,or repair my structure - 1
prior in its issuance,else requires On applicant for such permit to file a signed canonical
�<
that he is licensed pursuant o the previsions of the Conuecunes License Law(Chapter 9 Sq.Ft.Floor Area ". Valuation
$ (eosernaint with Section 7000)M Division 3 of the Busiam and Prereselons Cotla)ur
est that he u eumpt thertfmm and On bub for rix alleged eumptk n.My vi.latbm of
Sudan 7031.5 by story applicant fu a Permit subjects the applicant to•civil penalty of
.at mart Nan five hundred dollars L 0). erO O Occupancy Type
❑1,u awour of be Property,or my employee with wages a their sole compensation,
wnidalhewark.sadthesweNa lanatimm�dedaronemdrmaale(Sec.70a4.Businiss Inspections
and PI0IC4,ION Cade:The Co. uses Lt..law dW art apply bl an owMr of RequiredP
property w ho builds m i mpmves datum,and who doss ausb work himself ser through his
awn employ=.provided thotsuch Improvements tee natinuMed deo(ferW fearsome.IL
however,the building or Improvement is mid within am year ofcompletim,the owoer-
builder .will barn the human of proving that he did not Mid or improve for purpose of ,
❑1,as owner of the property,am uclu inly contracting with Inomued ronuectma to
convect On pmject(Sec.7044.Bolton and Profession Code:)The Contractors Li-
cense Law does not apply to an owner of property who Wilds or improves thereon,and -
who convects for such projects with a conumwr(s)licensed parents,in the Contractor's
fLiLiSII am Law.
lam exempt under Sm. ,Bk PC for this reran
Owner Data
WORKER'S COMPENSATION DECLARATION
1 toothy&film under penalty of perjury am of On following declensions:
I have and will maintain a Certificate of Consent In self-inure far WnM1eftCooper.
sation,as pmvided for by Section 3700 of the labor Code,fm tete Performance of nix
work far which this Permit is issued
❑I have and will maintain Wmkf(a Compensation lawream,as;required by Serum
37110 of the labor Coda,for the peerammo of ga wart for which suis permit it tuned.
My Workels Compensation Insurance,carrier and Policy number am:
Carrier. Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE
(rhhsmdmneadnotbecm plcmdifwepemubfmonchundmddolim($100)
m leu)
1 certify,that in to performance of the work for which this permit Is banned.I shall nm
employ anyperson in any manner an as to becomawbjact to On Worse",compensation
Laws of Calif a.Da
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Eaemp,ion,you should
become Subject to On Worker's Compensation provisions of the Labra Cade,you must
.J O forthwith comply with such provisions or this permit shall be demand revoked.
Z CONSTRUCTION LENDING AGENCY
1-i^ Iheroby.M.Nat there It a fonauunim lending agency for the performance of
N.> the murk fa which this pemil is imed(Sec.3097.Civ.C.)
lLQ Lender's Name
D,Z Lealces Addwas
U Q 1 cerdfy that I have reed this application and sum that Ne shove information b
U, come,.I agree,o comply with 41 city and county ordinances and state laws miming to
O building crosuunian,and hereby mutation representatives of this city to tour upon the
{T7 above-mentioned property For inspection pugmsea
gL (We)agree to save,indemnify and keep burolep the City of Cupertino against
VI Ilabllines.judgments,come,and expenses which may in my way amao against said City
U z In consequence of tie trandng Of Im Permit.
r-t APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SQWE REGULATIONS ,� '
/ / 6`27`S' Re-roofs
Signature of ApplientaConuactor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant porn mhaldle hwrdous material
n defined by tino Cupertino Municipal Code.Chapter 9.12.and the Health and Safetyarta,Sefton 25$32(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yea R�
Will the applicant or future building Occupant use equipment or dcvim which If a roof is installed without first obtaining an inspection,I agree to remove
It haerdaus air conuminane,u dclined by the Bay Area Air Quality Management all new materials for inspection.
District? '
❑sen
I have mad the hazardous materials mquimmenu under Chapter ei.95 or the Cali for
nia Health d SaretyCode ScetaN 21305,25533 and 25534.1 understand llutifthe building �,.2 / —C>3—
does ant currently ban a tenant Na,it is my responsibility in notify the occupant of the l�
re
nuwhi me arwianrmmofaCerufmaaa(ampmfy. Signature of Applicant Date
Owner or mthorimd agent Dam All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
aCOF Fax(408)777-3333
�UPEI�TINO
Building Department .
JOB ADDRESS: PERMIT#
40- 51-e il, o
OWNER'S NAME: M'6, Vuej PHONE #
GENERAL CONTRACTOR FAX#
I am not using any subcontractors:
Signature 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
Heai*
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing �'o2Hc46 �one � � �9�o1(P
Septic Tank
Sheet Metal
Sheet Rock
Tile
Ate° p% G 27•oS-
Owner/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF
U����'�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.
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: m 5. / {u ✓l
Job Site Address: C 0_7 54-'—t(41 cr
Roofing Company Name: CDQ H eA 'S o n e F✓OA;�
Applicant's Signature: /l. A sic f' Date: `2?"a 5
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
CITY OF CUPERTINO a .
a
ar REROOF
CUPEI�TINO PERMIT APPLICATION FORM
APN# , Date-
Building
Building Address:
C/O-? 54&_1( ;H
Owner's Name: V Phone #:
m,CS. L4 L10.51 �JfS _428
Contractor: Phone #: License#:
In eR 64.0 e. l�ioo�N 170Y 997. 97 S' -
Con act: Phone#: Cupertino Business License #:
No Fs 3/s-9a 8
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles a Asphalt Shingles
d' Wood Shakes ❑ Wood Shakes
O 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:
Residential 0— Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:
/ 0, 6,00
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
D � � y
27 2 ' s�