05080266 CITY OF CUPERTINO f t `• ' "°"' i�""•
w BUILDING DIVISION PERMIT C01 'TYtAC 'OR W—IMATTIO
BUILDING ADDRESS: T D ROOFING PERMIT No.05080266
OWNER'S NAME: PERMIT ISSUE DATE
WEN LING CHEN 3540 MARGATE .08/30/2005
NE: SANITARY NO. CONTROL NO.
(408) 892-8872
ARCHI'IECTMNOINEEW BUIIDINO PERMIT INFO
BLDG O PLUMB
MECH
�
'j OO LICENSED CONTRACTORS DECLARATION lb Description
I hereby affirm that 1 am licenseo
d under prevision of Chapter 9(commencing
with Sutton 7M)of DivWan 3 of the Business and Professions Code,and my license u
^� n(ull(am" eff 45 j G I REROOF-REMOVE SHAKE/REPLACE W/30YR. COMP.
514 License Cl I
e 4 Dale Conlrulur
0 ARCHTfECI-S DECLARATIO
i understand my plana"l be used u public
3=lY� Lurnsed Pmfcuional
G OWNER-BUILDER DECLARATION
0 I hcrtby affirm m 1 am exempt from the essm..Conummor'sChuLicense: .y.law far IM
S O o following mason.(Section 9 construct,
Business and nae,dcaom Code:Any city or coumy Iryy �j
u�9 which mqurma a permit to cnnaweL aloe Improve,demolish.or repair any ed statement
RNA tr !t � $6700
Fly pdwtasliamadpalso tequime the powisilicant for such uddicComaatefl ccrilessUw(uspou9 d -
� < Wlheiningwipanuammlhcpmvivom ofof Conuito lic<mc Won Chepear9 Sq.Ft.Floor Area „,q r�z Valuation
$ (comm is exemhh Seclian7 and
n3 oraeBed exemption.
Ayvi Ction of -
Net io 4 u1.5 b therefrem and the burs for de,alleged exemption.Any l parabn of pp[
Section 7031.5 by uryapplkantfor a permit mbjau Ne applkanuoadvil penalty of r All Occupancy Type
OCT-
An,mart than five hundred dollars($5001. OU
❑Luawner .tae prepmy,ar is ctnpleyeu wlNwaguaslhei(ale Com.Bmine s
will Pr the work.endo: he Comusnot e,Lkintended e Law it=
not
70 N,Botnar
And PoreWau Cade:The vas ductofa Llceme{caw uc a not apply to An owner of QI ire I
propauny that such
Arsesauhwded or usellonArmed forage his
, atm..
awn employees,provided Nal such improvements Area ml ear of d m effmrd fuck,r..
however,Nebft ft carimprevementissaid within oeeyear ofimproe for the purpose
ofbuilder will have the buNcn of proving Nn he did Out Mold or improve Iw puryou of
ak,l.
❑1.as owner of the property.am exclusively contracting with licelued conuectoa to
construct the project(See.7044.Business and Profession Code:)The Contractor's LI-
Come Law dose not apply to an owner of property who builN or improve thereon.and.
whoconuacu for such projects with a conuamm(s)Hemostat pursunt to Ne Contractors
Lkunse law.
❑lamexemptunder Su. ,BkPC(w Niamnon
Owner Dau
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of Ne fallowing declarations:
I haw and will m.W.•Cerafscam o(Caasent to self-insure fa WoacelCompcn-
ution,As provided fm by Section 3700 of tie labor Code.for the performance of the
y]ro[rk for which this permit is issued.
til s have and will muni.Workers Compenaidon Inurua.As required by section
3700 of tare labor Code,fm tae perfawanee of tale wok fm white thk permit u issued.
C Worker Cmpewtion ksurenceca car and Policy number are:
carrim: �i�" PolicyNa.: 14 a' 15 s0
CERTISCA OF EXEMPTION FROM WORK ERS'
COMPENSATION INSURANCE
(This weaken need not Ie completed lithe permit Isforwc hundred dolixra(SIMM
or less)
I unify that in the performance of the work far which this permit is issued,l shall nm
employ any person in toy mannerso as to become subject to the Workers'Compensation
Lewy of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Excmpaan,you should
become subject m the Worker's Compcmadon provisions of Ne labor Code,you most
.J z forthwith comply with such provisions or this permit shall he deemed revoked.
zsn CONSTRUCTION LENDING AGENCY
[-+ I hoary affirm that Nem is a Construction lending agency for the performance of
Ci the work for which tha permit is issmtl sea.3097,Civ.C.)
W�Q Leader's None
Z)z Lenders Addmaa
U0 I ceni(y that I have mad this application and ma that Ne above infomaaun is
{L correct.I agra to comply with all city and county on inareu and sue laws relating to
O Wilding comuuction,and thereby authadre representatives of this city in enter upon tK
fS.l above-mentioned Property far Wpectien purports
P. me)agree to save,indemnify and keep harmless Ne City of Cupertino against
fn liabilities,judgments,corn and expenses which may In any way ecru against aid City
in consequence of the jointing of this permit.
APPLICANTiU D RSTANDS AND WILL COMPLY WITH LL NON-POINT Issued by: Date
SOURCE R U ON p O
O Re-roofs
Signature of AppliciesX nlnclar Data
HAZARDOUS MATERI SCLosuae Type of Roof
WIII the applicant car future buildinf; r— nlmure or handle huardous material
As defined by the Cupertino Municipal Cade, pear 9.13.and the Health and Safely
ld.ms
k.Section Yea )AN.`I All roofs shall be inspected prior to any roofing material being installed.
❑Yca IL No
WIII the applicant or future building Occupant use equipment or devicm which If a roof is installed without first obtaining an inspection,I agree to remove
It Inium is air conuminanu u defined by de Bay Arta Air Quality Matugcmcni all new materials for inspection.
uictT❑Yrs �Na
Ihaveaad Nehmasdonmate05,re33 And 5534.1 rChaPearb95 of Ne Glding � � /7r�not afI! A Susam2et it my respoI.533/.1 unders�ndandeOccup buildingj /q[�C/ p t� O not c mH h a eanank Net it u my rcspomlhllity w noa(y IM ucupant n(tie in na hi nal mel prior avance ofa Ccrifteato of Occupancy. Signature of Applicant Date
owner ar.atherized agent Dow All roof coverings to be Class"B" or better
I`
3 Community Development
10300 Torre Avenue
aTY0114
Cupertino CA 95014
Telephone(408) 777-3228
Fax(408)777-3333
,�UPEkTINO
Building De artment
JOB ADDRESS: �� PERMIT# OTO p26
X,z � 8 3 S.wl n. s e
OWNER'S NAME: 'UQ L, Y) C aY\ PHO q%39 3 19, 8 f'o IQ
GENERAL CONTRACTOR: T D n oo " v1 FAX#
I am not using any subcontractors: 30
Signature Date
Please check applicable subcontractors and complete the owin rmation:
21 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
Owner/Contractor Signature Date
f
f Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
CUPEkTINO 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: w ,� r a (',fn z 1,\
1 —
Job Site Address: a p 6 g a� s
Roofing Company Name: 7 n n z,Q 4 '
Applicant's Signature: � n Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
r CITY OF CUPERTINO
alRE ROOF O
CUP&JINO PERMIT APPLICATION FORM
APN# 3 d , Date:
8 30 ( oS
Building Address:
,20683 S.�>1n� se Dtr
Owner's Name: Phone#:
NN eve Qk e) yog 31 g 8 6 I O
Contractor: Phone #: License#:
-r. D noofIN SCiA 88 a- SA- SS91
Contact: Phone #: Cupertino Business License#:
646 % S so
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles '* Asphalt Shingles
' ( Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
XTo be Removed ❑ Provide Mfgr. Installation Specs.
90�1 Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: ff y y
h-Q-.0� of 2 W Oop SAA Ck L Q ,xR Gl CA
Residential A Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Constructi Occupancy group:
6 00 — rvL �:
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