03110003 CI'T'Y OF CUPERT[NO
BUILDING DIVISION PERMIT 'VCONTRACTOR INFORMATION ko
BUILDING ADDRESS: PERMIT NO
21020 HOMESTEAD RD
OWNER'S NAME: PERMIT Is UE DATE
YUE TUNG HING ENT. LTD. 11/03/2003
IRPINE: - SANITARY NO, CONTROL NO.
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MGCH
l000 LICENSED CONTRACTOR'S DECLARATION
F❑ I hereby affirm that I am licensed under provisions of Chapter 9(commencing Job Description
£zou with Section"Unn.r Division 3 of the Busumsand Pmfcalnns Cori my license is
m mBfntfe addelf I. pp Is REROOF (SINGLE-PLY/ NER-227)
;�? acnsc Cl ' 31 Lic.X eg r� CONTRACTOR: WEATHERSHIg ]';ROOF SYSTEMS
D
o ate�A Commcmr},a =tl�
f U ARCHITECTS DECWF.qATION
ajyS p■
J'Vundcrsnd my plans shall he used as pontic records
eu.G Liccroscd Professional APR
'OR A
S OWNER BUILDER DECLARATION PR 0 8 2004
sI 1 hereby affirm that I am exempt tram the Conlmcmr's License Law for the
00 following refund.(Section 703 1.5,Business and Professiuos Code:Any city or county
5 m ff which requires a permit of construct,alter,improve,demolish,or repair any structure DRAIN dial
�ZN prior to its issuance.also lrquireaahe applicant forsuch permit to File a signed statement
a< Rut hf pursuant is liccdacd pursuano the provisions or the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valu
kia
YI-$ (com fencing with Section 7000)of Division 3 of the Business and Professions Code)or
c — Nat he is attempt thcmrfom and the base for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penally of er Occupancy Type
not more than Fin hundred dollars($500).
1.as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the euuctum is not intended or offered for sale(Sec.7014,Businum
and Professors Code:The Conmcmr's License Law does not apply to an owner or Required Inspections
profanity who builds or harrows them...and who does such work himself or borough his
awn employees,provided that such improvements are not intended or offered for sale.IL
however,the building o,improvement Is sold within one year of completion,the owner
huildcr will brave the burden of proving that hf did not build or improve for purpose of
ale.).
1,as Awns,of the ropeny,am exclusively contracting with licensed cor mcwrs to
construct the project(Sec.7044,Business and Professions Code:)The Comuaator's Li
eve law does not apply to an owner of property who builds of Improves Immon,and
who contracts for such projects with a eonuaemr(s)licensed fursion,to Ute Conmetor's
License Law.
❑1 am exempt under Sea. B&P C for this reform
wne, Data
WORKER'S COMPENSATION DECLARATION
1 hereby efErm under penally of perjury one of the following declarations:
1 have and will maintain,Certificate of Conant to self--insure for Worker's Compel.
cation,asprovided for by Section 37110 or dte labor Code.for did performance of Ne
work for which This pe,mit is issued.
Q 1 banand will maintain Worku's Co plamax ion Ince anee,u mlud in by Section
31110 of the"hot Cafe,for the performanee of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
cr. FVaJt!> Policy] /r�-5G�33=z g
CERTIFICATE OF EXEMPTION FR MWORKERS'
COMPENSATION INSURANCE
(This section need not he completed if the Permit is for one hundred dollars($100)
or lfis.)
I cine ry that in the affirmance of the work for which this permit is issued,I shall not
employ any refund in any ma incr sit a m become subject 0 the Workers Comlismatlon
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Ccrificau of Exemption,you should
become subject so the Worker's Compensation provisions of the Labor Code,you must
�O forthwith comply with such provisions or this permit shall he deemed invoked,
Z CONSTRUCTION LENDING AGENCY
I hereby affirm that Nene is a mnamctinm lending agency ror the performance or
L' the work for which this permit is issued(Sec.3097.Civ.C.)
y Q Lender's Name
Y Lender's Address
',]J Q 1 certify that 1 ban read this application and sues that the above information is
P correct.1 agree 10 comply with all city and county ordinances and state laws relating to
�U building construction.and hereby auNorimrepresentatives of this city to fruit upon the
=C shove-fcmumcd property Be inspection Purposes.
(We)agree to ave,indemnify and keep harmless the City or Cupertino against
N in
costsandexpenses which may in any way accmc against said City
Z in consequence of the Braining of this permit.
APPLICANT UNDERSTAN D L CO Y WITH ALL N N-P INT Issued by: Date
SOURCE LATI
l� e Re-roofs
PhandE.=Idn" MATERIALS DISCLOSURE Doals—
Type of Roo(
Willuture building occupant store at handle haranhets mauifial
u defined by the Cupertino Municipal Code.Chapuir 9.13,and the Health and Safety
do.Section 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
rya Pjua
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an ins ection,I agree to remove
it hazardous air condominiums u defined by the Bay Arca Air Quality Management all new materials for inspection.
District
❑Yes �Nu
I have mad the houaldous materials lequirernents under Chapter 6.95 ofIM Glifor i
ria Heaftl Safety Code.Secdons255c15 533am2554.[an thmift, boildin / 3 Q3
docs not eo an a tens s my res flit too the Occup of
myuirtm men orn,ia oaf fmaiedr0.enpanf S e pplicaq Da[
Indria=d agent All roof coverings to be Class "B"or better
INSPECTIONS, Inc. DSA File•#
690 SUNOL STREET, BUILDING H • SAN JOSE, CA 95126 DSA Appl.#
(408) 288-8460 • FAX: (408) 271-0902 OSHPD#
SPECIAL INSPECTOR DAILY REPORT
Cityof: Cuy-7 zJc,' Date/Day: /i2- 30 -3 T�iur
Project Name: 7 / G Zd Allc-W'E' S-74eQ,.9'� A9�� Project No.:
Address: .SAN'/ e- Permit No.:
Inspection Coverage: ❑Concrete ❑ Post Tension Concrete ❑ Welding
❑Continuous ❑Masonry �❑�✓FFire Proofing ElShop
Q'Periodic E]Reinforcing Steel L�JOther ❑ Field SyS •�s.
Inspections Made: e/i1-1,{el �� �«G 5��� o� nlsa¢•bio r/
G$ fp//U�F/5
/ 7Ii.! /�`S7J7.C7�r� i s S v��C'i'✓..� � Sy9rs.h/ f13+E /r/'e�y.d�
3P
y
Tests Made: 5c4re `
e
Items Requiring Correction, Corrections of Previously Listed Items and PrevioLi t * AAs re
Changes to Approved Plans Authorized by Architect or Engineer:
Comments:
2 >3 3
To the best of my knowledge, work inspected was inccordanc with t e building department approved design drawings,
specifications and applicable workmanship provisions of the U. C.excep as no ed above:
Signed: Date:
Print Full Name: /f.Y HLf?� ��a/�i I.D. Number:
CITY OF CUPERTINO b 3 1 Io „„_3
REROOF
' CUPERTINO PERMIT APPLICATION FORM
APN # Date:
�Z,CoO70Zb /o z9 0
Building Address:
�! b ZA �oswE9r�tl D
Owner's Name: Phone#-
Jt
`/UC_ ru�v6 ti LT 9zo S - Z vC
Contractor: Phone#:
F S
Contact: Phone#:// Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
>q_. Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) 6( Other(Specify Siff.,LF,- �'y
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
• I Han Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
Residential ❑ Commercial
Fire Zone: Yes ❑ No ❑ Confirmed with PI tng De j if
there are anre tctions: LJ
Cost oje4t Type of C struc 'o . Occupancy g ups
Qty. if
A 1' a e 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
-2-36
�(f
,$,3Ud' , s�
CITY r7 CUPERTINO
c hsloN . Or�N',T.,m'_€,.._AC�+.T,'�®m RIzN�I�.OAt?•.MA."T' O. »N,i
DIV
W2NG ADDRESS: PERMIT NO
0 HOMESTEAD RD
OWNER'S NAME: PERMIT ISSUE DATE
�`rUE TUNG HING ENT. LTD. 11/03/2003
, SANITARY NO, CONTROL NO,
ARCHITECT/ENGINEER: A WA BUILDING PERMIT INFO
"2 BLDG ELECT PLUMB MECH
Op LICENSED CONTRACTOR'S DECLARATION
IO
m1bcrcby affirm that l am licensed under provisions of Chapter 9(commencing SCrIphO❑
iW❑ with SecOon')000)of Division 3o1 do Busineasand Profession,Cndc.And my license is
in rml mrta and err t. � /'Z REROOF (SINGLE-PLY/ NER-227)
�? Licenm Cla Lic.g
Date��/ Cantmeror eti'tf _ Y CONTRACTOR: WEATHERSHIELD ROOF SYSTEMS
a .J'lrundcrstand my plans shall usedaas public records
a0
Licensed Pmfcsxional
g
OWNER-BUILDER DECLARATION
in
I I hereby affirm that I am exempt from Ne Comranor's License law for the
00 following reason.(Section 7(D 1.5,Business and Professions Code:Any city err county
m which requires a permit to consumer.ale,improve,demolish,or repair any structure
Zapoor to its issuance also requires the applicant for such Permit to file a signed statement
that he is licensed pursuant a the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valu
r� (commencing with Section 7")of Division J ONIM 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 rot a permit subjccu the applicant to a civil penalty of Occupancy Type
not marc roan Five hundred dollars($500).
❑h as owner of the property.or my employees with wages u their sole compensation,
will do the work,and Ne atoccone is not intended or offered far sale(Sec.7044,Business
and Professions Code:The Contractors License Law does not apply to an owner or Required Inspections
property who builds or improves thereon,and who does such work himselforNmugh his
own employees provided that such improvements arc not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion.Ne owner-
full let
wnerfuiller will base cue burden of proving that he did not Wild or improve for purpose or
.in).
❑ 1,as an,of 0m pormart,em cxcluxively contracting with licensed convenors m
construct Ne project(Sec.9014.Business and Professions Code:)The Contractor's Li. -
cenm law does not apply to an owner ofpmperty who Wilds or improves current,and -- — "
nacu for such projects with n
J pursuant the Contractor's
Law.
;37W
c erupt under Sec. ,B k P C for this reazon
DueWORKERS COMPENSATION DECLARATIONt hereby efrml under penalty of perjury one or Ne following declarations:ve and will maintain a Cmificate of Consent m self-insure for Workers Cumpcmu provided for by Scaion 37W of the tabor Code,for cue performance of theofft ab ]Carlo fo the Pe f ve and will maintain Worker's Compensation Insurance,u required by SectionMytil ke Labor Code,for In urance Cance ofd work for which this permit is issued.
My Warkcls Compensation Insurance carrier and Policy number are: _
cr. �irre, )-VOA Policy ORKERS' t✓�3—zG
CERTI. C OMPE SATIONINN FROM WORKERS'
COMPENSATIONINSURANCE /0 -) -aj='
of less.)
(Tris section need not W completed if person is No on hundred dinars($lat) r
I Cali ry But in the performance of the work for which this permit is issued,1 shall not
employ any list in any manner ser As Or become subject o the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IT,after making this Certificate of Exemption,you should
become subject y the wash pr Compensation provisions of the Laborued evokeCroxyou must
)z forthwith comply with even provisions or this permit shall Wdccmcd motca.
. O
4 Di CON STRUCf1ONLENDING AGENCY
I hereby aRthi for mit i is sued(Sea 30 tending agency ler the Performance of
But work for which this permit is issued(Sec.JU97.Civ.C.) t
0 Lender'sName
�z LcndcrAdds Address
Q 1 certify that 1 have read this application And SUM that the above information ii
Hcorrect.1 agree to comply wit all city and county ordinances and sure laws relating to
V building construction,and hereby authorise representatives of this city to enter upon the
Lkl shove-mentioned pmperty for inspection puWassz
(We)agree to save,indemnify and keep harmleu the City of Cupertino against
h judgments.corm and expenses which mryin any wry ecrncegamst saitl City
7 AcPLICANTc NDERSTAN of this permit 1/
^ APPLICANT UNDERSTAN D L CO Y WITH ALL N N-P INT Issued by: Date
SOURCE BLATIpNJs. _
l� Re-roofs
no
H ARDOUS MATERIALS DISCLOSURE DOMType of Roof
Will sec applica t or furore building Occupant store or handle hazardous material
red by the Cupenina Municipal,Code.Chapter 9.12.and the Health and Safety
Code.Section25532(0)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes PINa
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
eamnus air contaminants az defined by the Bay Arca Air Quality Management all new materials for inspection.
n7 `u
0Ycs �j1J
I have real the hamWt)usmauriais mquim=nu unJ rChapmr6.95 of the Califon
is HcaWgr SalnyCodc,Sccuom25505 533 and 255 d,lunJ Off if Wildin
Jtra not cu a.0 a senary.Na t s m res ills ul tW ecu f - 1/
C requirtmf wniCh�usats� norwissy ofaC �lcalo of Q:cupa^< n S onpRtHai 11 A I1niI err ✓ T�Rt
INSPECTIONS, IIIc. DSA Appl.DSAppl.
#
690 SUNOL STREET, BUILDING H • SAN JOSE, CA 9$126 ``-`•.
(408) 288-8460 • FAx: (408) 271-0902 OSHPD# \
•� SPECIAL INSPECTOR DAILY REPORT
City of: Date/Day:1n- 30 ',3 rAyr
• /
Project Name: 2 XV Project No.: CCPD - �,/U
Address: Permit No.:
I
Inspection Coverage: ❑Concrete ❑ Post Tension Concrete ❑ Welding
❑Continuous ❑Masonry ❑ Fire Proofing El Shop G1/ U7Ps`�5>% r.y% cf
OPeriodic ❑Reinforcing Steel IJOther Aoof7' ❑ Field j:>>> �*>S•
Inspections Made: ,� �-���� ��! �' rcr�6 it/9 . S�c�rJ c%lam. ✓fin r ��
cis ✓-a/•Gk/5
/ 7hr xJ 57i L7Ur s
I .r � �-�r:�t � c%(e'e.��✓ lv e�e� G„�� la tTJ-t.<J �e-er� �..� Ll5
,z -T�,- rrxr� .;✓r,• � %� .sem-.-u-��r�-ley s��;.v�:/
5 , �`/f route i/raiia/S ure gulf'^ �. /Y /Yrii tr: �Y -% o?ri/Z
�/"; X t�i�.lG /lid l'� �%.;�✓�� ✓ 5 .� -f.:t%iy."f,>r� �i'7a°S'cc � *:.G✓. !✓.. ,�r., r� „A X.r..
r-• !/�//> •C �i t%' x..1.7 :2%Li'�"/� c�s�'u-1•=/�"l �� G
{✓.. T//�, y^e.:�„�(.j�iw✓� !/�'.K:•:� G✓ �! /3>"ter, +;mid/ .�,!✓'! 'C {%
JX17^_• i r �r.��Ic...
6G ✓ %iyzGr✓!J// 5 % D�w /iG /%�ii /1ra'l�iv�✓; IIJL%O /.,• iL
3 W
Tests Made: /
Items Requiring Correction, Corrections of Previously Listed Items and Previo re BPI
Z b
z�
�I
Changes to Approved Plans Authorized by Architect or Engineer:
N
Comments: .-7� 9•-�Y' ;, L� C D� `L'itrr�- 4✓ (✓Yun!r-<T J `•,...us� r:,n/ /Si
�.....Y /, i:-r c ;• '%r•/ J�n/.i/fi f.�r2c� •i/!�s �l,j - � 9.3 .
To the best of my knowledge, work inspected was in accordance+with fhe building department approved design dra
specificationsshand applicable workmanship provisions of the U.e:C. e�t as noted above: j,
Signed: %L>r/h�'tir �nGz1 Date: ':•>onr
i
Print Full Name: .b�'�l/ ��>-���✓�� I.D. Number: 0%=cr)0��i_!r_