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BUILDING DIVISION PERMIT
BUIL>io ��p 2 E HANFORD DR
OWNER'S NAME:
LEE WINGHUNG
SNE:
ARCHITECT/ENGINEER:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and my license is
in full force and FL
License Class Lic-
Date Con1w.
ARCHITECTS DEC
I understand my plans shall be used as public records
Licensed Professional
OWNER -BUILDER DECLARATION
1 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 rile a signed statement
that he is licensed pursuant to the provisions of the Contractor's Liccnsc Law (Chapter 9
(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
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (5500)_
❑ I, 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. 7044, Business
and Professions Code: The Contractor's License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through 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, 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 docs 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 Contractoes
License Law.
❑ I am exempt under Sec. B & P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
L] 1 have and will maintain a Certificate of Consent to self-insurc for Worker's Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Workcr'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 Co pensation 1pturancc carrier and Policy number are:
Carrier: PolicyNo.;
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.
z , CONSTRUCTION LENDING AGENCY
E -t ham. 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.)
W A Lender's Name
a, Lender's Address
U 0 1 certify that 1 have read this application and state that the above information is
LL
Co CL I agree to comply with all city and county ordinances and state laws relating to
rJ J building construction. and hereby authorize representatives of this city to enter upon the
W above-mentioned property for inspection purposes.
L1. (We) agree to save, indemnify and keep harmless the City of Cupertino against
E" to liabilities, judgmen osis and expenses which may in any way accrue against said City
U Z in consequen granting of this permit.
►+ APPLI U ERSTANDS AND WILL COMPLY WITH AL NON -POINT
SO E R LATIONS. G7
Signatu onuactor 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)?
❑ YesNo
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management
District?
❑ Yes
1 have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health &Safeode, Sections 25505, 25533 and 25534.1 understand that if the building
docs not c have a tenant, that it is my responsibility to notify thy occ pant of the
require
n hich must be met prior to issu a of a Certificate ^f Oytupafcy.
Date
KEITH ROOFING CO INC
920 LINCOLN AVE
(408)29-D-8616
PERMIT NO.
07020002
PERMIT ISSUE DATE
02/01/2007
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Job Description
tear off existing roof
Issued b -
Re -roofs
Type of Zoof
Sq. Ft. Floor Area
umber
Required Inspections
type
All roof.,; shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant
All roof coverings to be Class "B" or better
Date
\� Building Division
\ 10300 Torre Avenue
Cupertino, CA 95014-3255
\ Telephone: (408) 777-3228
Cl OF Fax: (408) 777-3333
CUPEkTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
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 th= 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.
(P To receive a final sign off from the City the following steps are required.
rIP Preinspection and/or tear off approval.
In progress inspection approval.
Final inspection approval.
a) Spark arrester installation.
5. If plywood is installed, a plywood nail inspection is required.
b. 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 I" 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.
,!5 q ly
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: 9.
Address: ;20 2) —
Reroofing Company Name: �
Applicants Signature: c61 Date. —
c •
.i
Joe Antonucci
(Chief Building Official)
. We
CITY OF
CUPEkTINO
CITY OF CUPERTINO
F EROOF
PERMIT APPLICATION FORM
07D,� DDDR
APN # 3,26 — 30 , D
Date:
BENERGY
Energy
BUILDING
Building Address:
Seismic Fee Res
A/
BSEISMICOM
Owner's Name:
BUILDING
Phone #: Seo -
_
BUILDING
BUSLIC
Contractor: Phone #:
1�l�
License #:
Contact: Phone #:
Cupertino Business License #:
Type (of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
❑ Built -Up roof �) l
Asphalt Shingles
❑ Asphalt Shingles
)q
A— Wood Shakes
❑ Wood Shakes
❑ Wood Shingles
❑ Wood Shingles
❑ Other (Specify)
Number of existing coverings /
❑ Other (Specify)
19 Provide I.C.B.O. Report # Ig S g—e.5 1
qr To be Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu
ertino's Tear Off Policy:
Job Description- V+T. i0c = S1ti:,,�� 7 GESS —
Resi ential Commercial []
� c
Fire Zone: Yes ❑ No
Confirmed with Planning Deft. if
there are any restrictions: Lf
Cost of Project: Type of Construction: Occupancy roup:
F. lob, bo t,�L
Qg;�, rLakcs
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