02050103 CI BUILDING DIVISION ° PERMIT CONTRACTOR INFORMATION:
• ByIq,Dlf4grsDDR)w55:ENVIEW AV MAXIMUM ROOF CARE CORP PERMIT NO. 02050103
�Mli EIAiNN-RU AND WANG YA-CHUN 423 QUEENS LN 161'nl° '2H"2
PHONE: (408) 441-0933 SANITARY NO. CONTROL NO.
O O ARCHITEC(ENGINEER: BUILDING PERMIT INFO
w BLDG ELECT PLUMB MECH
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F LICENSED CONTRACTOR'S DECLARATION
'DNS I hereby affirm that l am licensed under provinicnsof Chapter 9 lcommencing Job Description
;yt� widt Scctinn]U(0) fD' ision 3ofthe Business and Professions Cale,and my license REROOF
in can Tome dnaer t. INSTALL 30 YR. ELK SHINGLE 1�21OSB
< Liccntt Cla! — — L Lia.tl fS o,� / r
Dam_ Contractor I
a O la CHITNLTS DECLARATION
1 undersand my plans shall be used as public rtcods
NALED
°o Licensed Pmf",`nmol JUN 0 5 2002
a OWNERcelandBUILDER DECLARATION
y
1 hereby,(fens this I am eBusin from the Contsaaor's LiAny c taw fertile
CS?<
following teres (Section TDns 5 Business and Professions h,oc Any city structure county
N D wh ch q armit t c wet aper mprrsu demolish,or repair any ewment
Pn t t issuance els y theapplicant for such Permitofleongnc0 statement - .7-0.0,0
m,hei licered palsomatt6ilas provisions oftn Contractors LicenLw(enpt 9 Sq:F',t..F,loorArea t lir Valuation
(commencingwth0 do 70(0) fDivision' J f the Business and Professions Cod) { ra n
or than he s exempt th 7rom and the basis f the allegedopt ei s n Any violation 3'691:103 2'. 0 0
..of section 7031.5 by any applicant fare Permit subjects the mapplicant to a civil Penalty �'P
of ton oremam five handled dollars ta5o0). APN Number ".ai: Occupancye
❑1,as owner of the emperlr.(it my employees with wages as their sole compensation 305 - FRAME
will do the work and the structure is not intended or offered for sale'sec:7044,'
Ba.iaesa rad Profession.Code:The Contractor's License law does a.,apply m am 307 - uired Inspections` " f
caner of propcny Who builds or improves thereon,and who docs such work himself 601 - ROOF TEAR OFF
0
_:c. through his own employees.provided that such' promems are not intended or
offered fur sale w however- thesoimprovement n sold with n one ehd of building '-
r _" � " ""-' _--- -ROOF' PLYWOOD NAIli;,', :_ v •,. ,7
impose an the owner bit Wer will have the harden of proving this he did net build ar
imPrnve for ppspnse nr sde.l. 603 - ROOF BATTENS
_. 604 ----ROOF IN-PROGRESS
construct 1 s owner of jec p(Sec.7 am B usi a sly c Prefer'g it th all The mracmrs to
- - icenseLathew
Prodoes
no(Sec. to a Business and property
who ills or improves
Contractor's
License Law docs not apply man owner of properly who wilds seimprover thereon, -
ii}i .vnd.wctim" kens for such projects with a.contmctor(s)liccnud,purtuant.m the ._.__ .. _ _..... .. ..... .._-____—.... ..... .... ..... ....__._.__... ..........___...-
r .
C 1 m a License law.
slam exempt under Sac. -'° " .BRPCfanhis rcazon
• -- .. - .
-_ Owner' 'Date
" 'WORKER'S COMPENSATION DECLARATION
• I hereby affirm under pcnd!y of perjury one irTithe following detitiouinns:
❑ 1 have and will maintain n Ccnibemc of Commis m selGinsome for Workers
�p• Compensation, as provided for by Section 37W of the labor Code, for the
Pcrm
oance of the work for which this Permit is issued.
:rfhave end will maintain Worker's Compenoatimi Intomoce.es required by Section
3701 of the Labor Code,for the performance of Ne work for which this Permit is
-" issued.My itt1la�keppr'.�Compe^pensation lnsuuaace caior,and%Policy mumherme:
t W:4l/e R. _k FPolcy No.:..LY I)'ZL A�'o7 __ -.._ _. . _....
Cam S _r, .+ i.t, , f` t,•'A 1 . . 1.\ C1 1 e
+ "CERTIFICATIONOP.ATION IIONFOMWORKERS' '
COMPENSATION NSURANCFt + _} : a ...... . ___...._._
_
" iIThis union need no,be cdmPlemJ if the Permit is for one hundred dollars
($10H or less.)
mloyan intrson in any ma ftp rtobecobch thspctmu Worker( -
shallCum-act em to nim an minner,m as to become mb en to the Workers'
Coplicasation employ
Celifomie.Date )
-Applicant
-g is .. .. - .- . .-- ._..._ _ ..__ ...-__ .._.. - __ ..._.. ....... .._ ._.
NOTICE TO APPLICANTheWork rst.a0ermaktngthis visio s6f of Labor Cade,you
mind, ' .. .
tidwmeI compo the Workers Cdions or t his provisions
ermiti shall theLaborCode,you must
Q 0 morrow III with such provisions or this permit shall be deemed revoked.
r
I .
t'v✓+ CONSTRUCTION LENDING AGENCY t '
' 1 h by which
this there is s commotion I ntlinp ug cy f rhe perform ice
Lethe k f which iM1 permit s lamed(Sec.3097 Civ.C) .,_ -
L (� Lards Name..._, -...,..+.
Lender's ABdress ... .. .... .... .. .•r .... _. _ ._._ ..
U:0
W;Z ']certify that 1 have d this city
and
and sate that Ina above fo tion is ,
ks�[r .67
n greet comply with II¢ry and county ad and state laws rtlasing
0'V nob ,2 g o st- ti n andh by authrepresentatives fthiscity toe ter upon - /
,W the abs a me fi n d properly f pet purposes. 4 1
0e (We)agato se ndeda,fy vddk keep the of Nperlmo against 'V-
y
Habit'ti judgments.costsand a Pernes I ch yin any yseemsagainst sand
City n y ice of he gr t of p ii n
'Al 1 LICANT l U RSTANT i \ND LY WITH ALL ON: NT 7
souucERP n Issued by: Date
Signamico A plieatNCont r "'. ate, 'f' Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
Will Neappliwmoform building aapantstore orbandlehawdouslimened
Type of.Roof.. ..:- _._ ._. .._..._ ..
as defin d!by the Cupertmo Mumapal Cone,Cha ma!).12,and the Health and Safety a „ .- >• ' 1�r, r _. .. ..� f
Cod 5 ; ;2553'( 1 _ r' r : . ',
OYe 5 o t7N ', y .,Atall t .+
r ;_.,T„ All roofs shall be inspected poor to_any,.roofing material being installed._. _
Will theapplicom or fof..building occupant Liu equipment or devices which If a roof is installed without first obtainingan ins ection;I agree.to remove
con hazardous air conmminans as defined by Ne Boy Area Air Quality Management P
n.t tet' far inspection Applicant understands and will comply with
0 Noa ne\ materials
all
no ,int source regulations
1 h Health
the ely Codes ccifod l requirements its under Chapter a 6r93 ,f the.
if,California H',des, S f ry Code Sections 25505 t it
and 25534J undemmnd this 0�
dihe bit Id ng tlaes not curtcmly have hot Nes l s my re pro ib bry m notify the '" -"-"' :"' -
ce pa The eq Pira
s heli mus be met e -to inti` C nifcg's of '
a` •2/v Signature of_Applicant Dae
?;
Uwasse Or authorized agent Dart All roof coverings to be Class"B" or better
_ ... .. - ,
. . ... OFFICE'-'- '
y ;
Building Division
• 10300 Torre Avenue
Cupertino,CA 95014-3255
r' Telephone: (408)777-3228
CITY 0 Fax: (408)777-3333
CUPEkTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
K 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.
• W 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 minimum of Y"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:� �t Y`pp^�
�
Address: 4 S S Cs L� a[44''J vd�- i
Reroofing Company Name: kA :C I-,- t. CA�
Applicants Signature: A 7(-i —Date:
Joe Antonucci
(Chief Building Official)
6/25/01