04070150 CITY OF CUPERTINO
BUILDING DIVISION PERMIT k 0NTRXCT0R �TL\Cg�O M T OIA
BUILDING ADDRESS: WING' S ROOFING INC PERMIT NEO 4070150
a OWNER'S NAME: - PERMIT ISUEDATE
KUO HWA CHEN '124 ; qYnNFY WAY
ONE: SANITARY NO. CONTROL NO.
510 889-9068
ARCIIITECUENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
=oo LICENSED CONTRACTOR'S DECLARATION
Job Description
5 u C 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing P
ez U, with Scction7M)of Division3of Om Businesaard Profcssi sCodcautdmyliceneeis
gmfnnforce a reran. 6 �t REROOF W/PLYWOOD /ASPHALT SHINGLE
i Licenm C Lic.is
F Da¢ Conhactor
ARCHITECT'S DECLARATION
a 1 urukrst and my plans shall Mused as public records
JWU
u G Loculed Professional
OWNER-BUILDER DECLARATION
S 1 hereby affirm that I am exempt from dm Correctors License law for the
20 following mason.(Section 7031.5,Business and Profeaxions Code:Any city are county
x m which requires a Permit to construct,aline improve,demolish.or repair any structure
poor,,its issuance.alsurer,mor theit,licant Rocucb perniuo file a signed suument
�< thathe Maimed purecomm the pmim
viseof Nor
CCrmum,U..Lsw CWNcl9 Sq.F[. Floor Area Valuation
�Ire-Q (commencing with Section?(Xiof Division 3 or the Business and Professions Cooc)or
that Inc I,exempt therefrom and the baso for the alleged emmpood.Any violation of
Section 7031.5 by emyapplicantfar.pe.it subj.m the applicant to a civil penalty of3-'k?XaQift6er00 Occupancy Type
not mart Nan five hundred do1Ws($50(y.
❑1,as owner of the property,or my employees with wages as their sale compensation.
will do the work and the structure is not inundcd orcfferW fortele(Sae.7W.Business; Required Inspections
and Professions Calc:The Contractors License Lew docs e ns not apply to an owner of q P
property who Wilds of improve themo ,and who doesst¢hwork himselforduough his
awn employees,provided that such improvements me not intended araRered funs ale.If,
however,the building or improvement is sold within one year of complNan,the owner
builder will have the burden of proving that he did net Wild or improve for purpose of
sale.).
❑1,as comer of me property,am a mimelvely comreming with licensed contractors to
construct Ne project(Sec.3Oba,Business and Professions Cade:)The Comeamor's Li.
come,Law docs not apply to an owner of pmpeny who Wilds or improves;themom,and
who contracts for each pmjeeu with a eantracmr(s)licensed pursuant to dm Contractors
Liver.Law.
❑I an exempt under Sim, ,B A,P C for this maAson c O
Owner Date - 4 2004
WORKER'S COMPENSATION DECLARATION
I Wmby affirm under perelty of perjury one of the following declantians:
tt
1 have and will maintain a Certificate of Consent self-insure for Worker's Camper.
tenon,as provided No by Section 3]00 of the Labor Code.for IW perfotmana of the
wora
k for which this permit is issued.
1 have and will maintain Worker's Compensation lnsurar ,as required by Second
3T0o of the Labor Code.for the perfmrrime.of Ne work far which Inde permit is issued.
My Workers Cnmperei nlnsu warier and Polity number are:
Cartier. Policy Na.:
CER'DFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Qbis.mien'recd our W compklN sides permit is form.hundred dollars($101)
less.)
I anify that in the performance or the work far which this permit is issued.I shall not
employ any person in any manner an as to Wcome subject o the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption.you should
become subject to Ne Worker's Condonation previsions of dm la Wr Code.you most
�Z roMwith comply with men provisions or Nis permilshall W deemed revoked.
ZO CONSTRUCTION LENDING AGENCY
Er 4 I hereby alfrm Nat there is a construction lending agency for the pmfurmana of
Ci> Ne work for which this p.it is issued(Sec.3D97,Co.C.)
Ira Q Underi Name
D+ Lender's Address
U O 1 certify that I hart read this application and sum met the above information Is
f' correct.1 agree to comply with all city and county ordinances and stere laws labeling to
0U Wilding convection,and hereby ambmrae repraunmives of this city m enter upon the
.hove-mentioned property for ins,etion,comms.
(We)agree to save,indemnify and keep hurries,Inc City of Cupertino against `
F'fad liabilities.judgments.costs and expenses which may in any way acme midCity `Jar
U? APPLICAof th,pemait.
NT UNth RSTANDS AIND WILL COMPLY WITH LL NON-POINT Issued by: Dat
SOURCE G L 0 5.
-b Re-roofs
Signamreof
HAZARDOUS
ZARDOUS MATERIALS DISCLOSURE Type of Roof
ed th,t e Colombo,
o,forum iplu Cg a Chapter
stem or handle hazardous .,.,y
u defined by Inc Cupeninn Municipal Code,.Chapter 9.13,and the Hcaal
hh>n Safety
Bade. No
Sac❑tieYesa i55325532(.)' - All roofs shall be inspected prior to any roofing material being installed.
Will the applicam are future building occupant use equipment or devices which IN If a roof is installed without first obtaining an inspection,I agree to remove
41,11h.zardous air conal his az dcit it by the Bay Area Air Quality Managenu m all new mat rials for inspection.
District?
Q Ycs Nu
lhavc real the hazardnusmaterials requirements; W
underCpur6.95 of the Calder- I3
rlalialth Safety Coo.�d.M505.35533.dn534.lunMrs ftifdtc Wilding (/ V
does note locally have a amara that his my responsibility m nobly the occupant of the
which a=Wmet prior missuance dfac face., y. Signature ofAppicant Date
ca d: 4 Owr. m o dagem o e All roof coverings to be Class "B"or better
.� Community Development
� f 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
WUPERTINO
Building Department
JOB ADDRESS: P IT #
56 PR,LA_ Y eq-o 0 (5-0
OWNER'S N U PHO . #
GENERAL CONTRACTOR FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
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
t 2
"__C c9arr¢i•/Con actor Signature Date
Community Development Department
Building Division
iF 1 „1 City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
OUPEkTINO
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.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4 " per foot slope and demonstrate
that there is no ponding.
2. An LC.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.
V
Homeowner's Name:
Job Site Address: t^ (� lam/, [[
Roofing Company Name:
A plicant's Signature: Dater/�
UV
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
On OF
® CUPEkTINO PERMIT APPLICATION FORM
APN #. ? G 2 / 0 3 6 Date: 23 4)
/
Building Address: C"7, /[ Q� c�/ L.a / e p,/
Owner's Name: 'l tav GI Phone#:
cN c-�I , Kyo
Contractor: r Phone#: License#:
W�tJC t I NL Sio - _ c • 6c 91/
Contact: Phone #: Cupertino Busi ess License #:
oG D
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ted Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino'�_Tear Off Policy: ❑ /
Iob T -a W f,j S , Z1^ � 2 y 16ZJ S / l
Residential K Commercial
Fire Zone: Yes ❑ No ❑ Confir with Planning t. if
t e are restrictions:
Cost of Project: / (- Type of Con Occupan up-
Qty
A i le Fee lD 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
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