06100128 77777:7 777777=77777=i
CITY OF CUPERTINO
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RUILDING`DIvISION PERMIT
BUILDING ADDRESS: WING' S ROOFING INC PERMIT No. 06100128
PERMIT ISSUE DATE
OWNER'S NAME:
LYNN SING TSAI SANITARY NO. CONTROL NO.
ZONE:
510 889—
. BUILDING PERMIT INFO
ARCH]TECT/ENGINEER: BLDG ELECT PLUMB MECH
0
cz
o p LICENSED CONTRACTOR'S DECLARATION Job Description
U I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z with Section 70(10)of Division 3 of the Business and Professions ,and my license is
y in full force a eft e� L1C 'C' k1( REROOF-T/O WOOD SHAKE INSTALL 7/16" O. S .B .
z DaConti
en c1 s & 30 YR ASPHALT SHINGLE CLASS A-30 SQUARES
H actor
ap Date CHITBCTs DECLAMWR
a< I understand my plans shall be used as public records
ryU
to y Licensed Professional
H OWNER-BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors License Law for the
3 p o following reason.(Section 7031.5,Business and Professions Code:Any city or county
which requires a permit to construct,alter,improve.demolish,or repair any structure
prior to its issuance,also requires the applicant for such permit to file a signed statement Ft.Floor Area Valuati
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 $q• "8 5 0
(commencing with Section 7000)of Division 3 of the Business and Professions Code)or
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more than five hundred dollars($5W). 32643024 . 00
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered forsalc(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder wiB have the burden of proving that he did not build or improve for purpose of
sale.).
O 1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:) rac
The Conttor's Ui
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sec. B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
�I 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the pcifor ance of the work for which this permit is issued.
My Wo r ria Co pensa od Insuranc carticr and Polity number are:
Cartier. - Policy No.: L �L�
ERTI TE O EMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is far one hundred dollars($100)
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workcrs'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you mast
,J Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
Fr r�-i I hereby affirm that there is a construction lending agency for the performance of
> the work for which this permit is issued(Sec.3097,Civ.C.)
W Q Lender's Name
2 Lender's Address
U C) 1 certify that I have read this application and state that the above information is
L>+►� correct.I agree to comply with all city and county ordinances and state laws relating to
O Ubuilding construction.and hereby authorize representatives of this city to enter upon the
Uabove-mentioned property for inspection purposes.
W (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City /,Z-
U Z in consequence of the granting of this permit. Data
►� APPLICANT UNDERSTANDS AND WILL COMPLY WITH LL NO -P NT Issued by:
SOU CE RE� ATIONS.
U i Re-roofs
Sign pplicant/ ntractor Da1e Type of Roof
H RDOUS MATERIALS DISCLO URE
Will the appli t or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Code,Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
If a roof is installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
mit hazardous air contaminan as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes Nu
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safely Code,Sections 25505.25533 and 25534.I understand that if the building
does not c ndy have a tenant,that it is my responsibility to notify the occupant of the
mqu' men which must et pnorto issuance of a Certifr to or ap Signature of Applicant Date
All roof coverings to be Class"B"or better
Ow uthorizcd gc Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
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: �i V)
Vv� L�t4)_*
Job Site Address: -
Roofing Company Name: s ` ' tS 1 A -
Applicant's Signature: Date: J I /1
Greg Casteel
Building Official
Revised 11/2/04
S� Li
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
CUPERTINO
Bu4din De artment
JOB ADDRESS= PERMIT #
OWNER'S NAME: S i'✓�G —S G PHONE # - 27
GENERAL CONTRACTOR f Sjo, ,✓ FAX #
I am not using any
in subcontractors: 'p
Si ature 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
�0 x7
�uj 9 -Z�
r/C ntractor Signature Date
CITY OF CUPERTINO
0!1� _ REROOF
CUPOw CW
ERTINO PERMIT APPLICATION FORM 00/o?
APN# - _ Date:
0,2?
Building Address: �
z� uC.e
Owner's Name: / C �- - Phone#:4S2
ontractor: License#:
Vi'41'
Contact: Cupertino Business License#:
L�(2 C,,-
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles X Asphalt Shingles
0 Wood Shakes C] Wood Shakes
Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
l� To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read,Ud ndersta and Will Comply With Cu ertino's Tear Off Policy:
Job Description: ( 0 CA],'196 -7/, it p s , C3 3
Residential 11 Commercial ❑
Fire Zone: Yes ❑ No E7r— Confirmed with Planning Dept. if
there are any restrictions: El
Cost of Project: �}�y�-V Type of Co�ns��ction: Occu ancy�g{ou .
r J
Qty. if
Applicable Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEIS UCOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING