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07010179�OZZ ea o<uc nZ 3E"t�u � t>; �yUC4a U. f– :oa pC Kofi al—v FFG 3. O— CITY OF CUPERTIN7777 DIVISION PERMIT +cGTORI%�}RMT�©N' BUILDING BUILDING ADDRESS: PERMIT NO. c OWNER'S NAME: TE ROBERT TENG 1352 CIIPLAY DR. 01/30/2007 iONE: SANITARY NO. CONTROL NO. (408)929-7663 ARCHITECT/ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division3oftheBusinessandProfessionsCode,andmylicenseis REROOF- T/0 EXISTING SHAKES. INSTALL 30LB FELT. / in full force and effect Z%�O_ License Class Lic.I Sur INSTALL COMP SHINGLES. CLASS A. 32 SQUARES Date i –�B –G"7 contractor St ARCHITECT'S DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the 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 Contractor's License Law (Chapter 9 Sq. Ft. Floor Area Valuation that he is licensed pursuant to the provisions of the $19000 (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 ,QQ���7� Number 35922051 Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, Required fired Ins eC[lOI1 S will do the work and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of q P 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 will have the burden of proving that he did not build or improve for purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:) The Contractor's Li- 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 I have and will maintain a Certificate of Consent to self -insure for Worker's Compcn- sation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number are: Carrier. J%a TE %-6 s.1 Policy No.: 151 395 3 400 41 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for 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 Workers' 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 must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 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.) Lender's Name Lender's Address j I certify that I have read this application and state that the above information is 4 correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspcc ,on purposes. (We) agree to save, md= and keep harmless the City of Cupertino against j ts, costs an x nscs which may in any way accrue against said City the ti of is permit. DE D AND WILL COMPLY WITH ALL NON -POINT Issued b) : DateA-lo�-O-7 "APPL4ANDE Re-roofscant/Ca Type of I:Oof for Date HAZARDOUS MATERIALS DISCLOSURE Will the applicant 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)? No ❑Yes [:]If All roofs shall be inspected prior to any roofing material being installed. /— a roof .s 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 contaminants as defined by the Bay Area Air Quality Management all new r iaterials for inspection. District? Yes ❑ ,EJNo I have read the hazardousjjQQatenals requirements under Chapter 6.95 of the Califor- i 25505, 25533 and 25534.1 understated that if the building nia Health & Safety Coq1. does not cu n havThat it is my respansihilily to noUl'y the occupant of the reqs c ich t prior to issuance of a Certificate of Occupancy. S ignaturc of Applicant Date ` All roof coverings to be Class "B" or better wncr or authorized ag Date CITY OF `-UPEkTINO Community Development 10300 Torre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax (408) 777-3333 Building Department JOB ADDRESS - 5-5- ke%?,- dl-_ PERMIT # 6 --7 0 (0 l ",;ZY OWNER'S NAME: go ens PHONE # 9029= 7&(, . GENERAL CONTRACTOR: FAX # I am not using any subcontractors: 1, ' Si tore 47 Date Please check avnlicable subcontractors and com-:)lete the following information: Owner/ Contractor Signature Date 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 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 buildinE inspector. A final inspection and approval shall be obtained from the bu lding 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 f irst 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 vispection 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 abov(- stated policy on re -roofing. r Homeowner's Name: job Site Address: �/ �✓� �' J g n/ Roofin Company Name: P ; Applicant's Signature: % — Date: / _ 3o f. Greg Casteel Building Official Revised 11/2/04 orloin►iq CITY OF C'UPERTINO RE11OOF CUPEkTINO PERMIT APPLICATION FORM APN # Bldg Permit Fees Date: Building Address: C/ SS v -p— C Energy Owner' ame: Phone #: 3 q3- Contractor: `, 0 S�- � �..i e� � �-0� License. D v�-oC �o Contact: BUILDING Cupertino Business License #: ' 1 ,I� BUILDING BUSLIC Business License Type of F:oof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof , Asphalt Shingles ❑ Asphalt Shingles Wood Shakes ❑ Wood Shakes ❑ Wood Shingles ❑ Wood Shingles ❑ Other (Specify) Number of existing coverings ❑ Other (Specify) ❑ Provide I.C.B.O. Report # ❑ To be Removed ❑ Provide Mfgr. Installation Specs. I Have Read, Understand and Will Com 1 With CL ertino's Tear Off Policy: Job Description: 3©� i=e���- Residential Commercial ❑ C" S A Z A7 Fire Zone: Yes ❑ No Confirmed with Planning Dfft. if LJ there are any restrictions: Cost of Project: Type of Construction: Occupancy group: 1�2_v kz — ,V Qty. if 4'2,VIII&I Fee Descrition Fee Group Applicable 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