04040150 MR p
CITY 01'CUPER"1'190 it w ss I . rte sN, -
BUILDING DIVISION PERMIT CO,N1=12'A OR�N QRMA O
BUILDING ADDRESS: DRAEGER CONSTRUCTION INC PERMIT NO04 04 0 15 0
1 642 BRID
OWNER'S NAME: PERMIT ISSUE DAIS
DAVID Se SUSAN CHIU 605 COMMERCIAL Q4 /22 /2004
ONE: SANITARY NO. CONTROL NO.
(408) 536-0420
ARCHMECIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMO MECtI
G� 0
unese, e LICENSED CONrRAC1'OR'S DECLARATION
E1 heron,affirm that I am licensed undo,revisions of Chapter 9(cnmmcmcimg Job Description
Sa6 wit,Section7=)),,fDivision Ser the Basimea.nd Profession,Code,and my license i. f� l't�� t1
AL
in full force andeffcct. REROOF ll Utl EM
j n K. License Class Lie,a
am Dom Common,
jCU ARCl11TECTSDECLARAT10ts JUL 26, 2004
5s 1 understand my pl ARC]1ll E-TS as public records DECLARATION
Licensed Professional BUILDING
y�ga
='mg OWNER-BUILDER DECLARATION
Contractor's
ON B ABL DI G
z a p I hereby,(le that 1 1. exempt from me Canons Co License law co,lite �1 CYC YI�VLII ni
<00 following moon.(Section]1131.5,Business um n,dem li Code:Any city s county �fl
m which myuires a pertnit m cnnsuucL alter,improve,demolish,n,mrair any mmmumSpono
prions itsmaanm,also requires the applicant for such Permit u file a signedsmtemem
that he is licensed Po to tile Imvisions of Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
x_m (commencing will,Scoff,]IMX))of Division 3 onhe Businass and Professions Code)or
i (hoe he is exempt therefrom and the basis for the alleged exemption.Any violwinn of
Section 7031.5 by any applicant for a permit subject,the U,plicamm.eivil pem.ltyaf 363W-Q Gr00 Occupancy Type
not mere than rive hundred dollars S500). P Y YP
❑ L 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 for sale(Sec.7844,Business
and Profession:Code:The Contractor's License Law does not apply a an owner of Required Inspections
property who Zola o,improves thereon,and who does such work himself anhrough his
own employe.provided that such improvements arc not intended or offered for sale.IL
however,the building or improvement is sold within one year of completion,the owner
huildcr will have the burden of proving that he did not bel If or ire prove for purpose of
sale.).
❑1,as owner of the properly,am exclusively contracting with licensed contractors to
cons WCL the project(Sec.7044.Business and Professions Code:)no Contractor's Li
cons,law docs not apply to an owner of properly who builds or improves thereon,and
who contracts for such projects with a contractor($)licensed pursuant to the Contractor's
License law,
El I am exempt under Sec. .B h P C for this rex on
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby of rra under penalty of perjury one of the following declarations:
1 have and will maintain a Ccnifiealc of Consent to self-insure for Worker'sCompcn-
aillen,as provided for by Section 37Ik1 of,he,lahor Code,for the rerforman r m the
A, for which this permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,as required by Section
37 W of the Labor Code.for the Performance of the work for which this remat is issued.
My Worker's Compensation Insu anw carrier and Policy number am:
Cartier: Policy No.:
CERTIFICATE OF EX FM MON FROM WORKERS'
COMPENSATION INSURANCE
[TTI$section need not be completed if the Permit is foram,hundred dollars(51IXp
m loss]
1 cenify that in the pfrom arm of the work for which this permit is issued.1 shall not
employ any person in any manner.sa as in hccomc sudecuo the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this CmnlEca r of Exemption,you should
become subject to the worker's Compensation provisions of the labor Cmle.you must
.J 7, forthwith comply with such provisions of this permit shall be deemed revoked
OCONSTRUCTION LENDING AGENCY
j. 1 hereby affirm that there is a construction lending agency for the perfurmamm of
x me work for which this Permit is issued sec.3097,Ci,C.)
W O Lender's Name
z Under's Address
V C 1 cenify that l have read this application and state that the above information is
W H Cartmel.1 agree to comply with all city and county ordinances and state laws relating to
�U building contraction.and hereby lulbmim representatives of this city to enter upon the
> abov-facruoned prorerty for inspection purposes.
(We,)agree a save,iefemnify and keep harmless the City of Cupertino against
L.
rq liabilities.judgments,costs and expenses which may in any way accrue against said City
U z his loperrit.
in
STANDS
eUNDERof role graming Of IAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
RC-TOOTS
sigmmor,ornnNicaDam
HAZARDOUS
US MATERIALS DISCLO ad) TypC Of ROOF
Will ac applicant Lir(wore building eccupre am stonr mM1andlc ha'rarduus material
ai dcrned by.the Cunino Municipal Code.Chapter 9.12,and the Health and Safety
Code.Section 25532(apo)? Y roofing Dyes ❑Nu p All roofs shall be inspected prior to an fin material beim Installed.
�' g
Will the 2PPFcam or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
,it havardnus air contaminants x defined by the Bay Area Air Quality Management all new materials for inspection.
strict?
[3Yea ONO
I have read the hmardaus materials requirements under Chapter 6.95 of the Cali for
iia I iia 111,X Safety Carle,Seehnns 255115,25533 and 25534.1 mak send mot if ac building
acs not currently have,a tenant drat it is my r,apunsi bihty to nouty the MCupant of the
requirements wh,,hm.,f bemmtrdorm issuance oft,Cenlficam of Qcupancy Signature of Applicant Date
Owner Lir aulhorimed agent Date All roof coverings to be Class "B" or better
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF
Telephone: (408)777-3228
4UPEkl I N® 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: C, n, r,� 'a" , .. �_ ,� SQ, n v
Job Site Address: //,--q2— �v.�or �a, �� C11 t
Roofing Company Name: J l o �m� ,« F tc✓ �ya c.
ApeelHcant's Signature: <<� Date:��J� /
7"
Greg t
Building Official
Revised 1/30/03
Printed on Recycled Paper
t
CITY OF CUPERTINO
' RERooF 6-
CUPEkTINO PERMIT APPLICATION FORM
APN # Date:
3s� z� ,,_Z3-�<�
Building Address:
Owner's Name: Phone#:
u \ vzw� o� 97''— z U�
Contractor: Phone #: License#:
�� 36-64 z 17 6' i CD
Contact: Phone #: Cupertino Business License#:
6105 j -1 9 4//
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Asphalt Shingles
�
❑ Wood Shakes ❑ Wood Shakes
/— Wood Shingles ❑ Wood Shingles
❑7 Other(Specify) ❑ Other(Specify)
Number of existing coverings I ❑ Provide I.C.B.O.Report#
54�' To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu/// erti`no's Tear Off Policy: ❑
Job Description:. ro�� 2v � rcQ� ceGUoed �4 acs WA\, 6AY- 6',C �r1 1
Residential Commercial ❑
Fire Zone: Yes ❑ No/9P Confirmed with Planning Dept. if
there are anv restrictions: LJ
Cost of Project: o 0o Type of Construe tioq: Occupancy group:
RG 1(0 0�
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
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