04070134 CITY OF CUPERTINO
BUILDING DIVISION PERMIT �tONTRAGTORANFORMATION
BUILDINGADDRESS: ROOF ROOFING PERMITN904070134
10160 MHANSON AVE.
OWNER'S NAME: PERMIT ISSUE DATE
JUNG J KIM
ONE: SANITARY NO. CONTROL NO.
408 265-9270
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u00 LICENSED CONnRACnOR'SDEConsOfCON IObDe$CTIp{�pilIIVALE®
0u C 1 hereby affirm ion I am licensedCONTRACTOR'S
under S DECLARATION
RATION r 9(commencing �''
t2 with Sait..7000)uf Division floe Businus Prefcssivas Codc.and.1 he...is
-caan inmuf �anej!feet p SG y REROOF W/TAR & GRAVEL
tgZ License Olps /`� Lk.
Damesf Gan — DEC W 2004
ARCHI'IELTS OEC 'ION
w
I undtisal my plans shall W used a per menrtls
Diu,
;o Licensed Professional BUILDING
OW NER-BUILDER DECLARATION
+� 1 hereby afro that 1 am exempt from the Comracmfs License Law for the
in o following mason.(Section 71B 1.5,Business and Professor.Code:Any cosy or county
se a E� which requires a permit in construct,allot,impmve,demolish,or repair any structure
priorm itsissuance.also require the applicant for such permit to rile a signed suument
2. ...art then he is licensedp...anothenowulaunitheContracmcla
Contractor's w(chapter 9 Sq. FL Floor Area Valuation
¢t–$ (commencing with Section 70BB)of Division 3 of she Businevsrnd Profession.Code)or '
_ Wt he is comp,therefrom and IN Buis for the allegeA ascription.Any violation of
Section 7031.5 by any applicant fora permit eubjects the applicant to a civil penalty of er0 0 Occupancy Type
nos more than f hundred Jolla.(5500).
❑1.as owner of the property a my employees with wage as their sole compensation,
will do the werk.and am swnu.is ws intended or offered for aah:(Se.7044,Buick. Required Inspections
and Profession Code:The Commences Liam law does not apply to an owner of 9 P
property who builds or improve thereon,and who docs such work himself or through his
awn employees,provided Nat such improvements..at intended or offered for In.IL
however,the building or improvement is mid within one year of completion,the owner-
builder will have the burden of proving that W did eros Wild or improve for purpose of
aril.
❑1,as owner of she property,am exclusively convecting with licensed commitment to
consumes the project(Sec.7046.Business and Profeaiou Code:)The Contractor's Li
came law does not apply to an owner of property who Wilds or improm thernan,and
who contracts for such pmjees with acom esu r(s)Iiceued pursuant to the Conmactoh
License law.
I am exempt under Sm. .B k P C for this retie.
137M
wner Dam
WORKER'S COMPENSATION DECLAP ATION
1 hereby all under penalty of perjusy arc of the following declanfan:
1 have and will maintain accniriente of Carriers to self-intim for Worker'sCompcn-
ion,u provided for by Section 3700 of the labor Code,for the pada mance of the
rk for which this Normal is issued.
1 have and will maintain worker's Compensation Insurance,u acquired by Section
of the labor Code,for the performance of the work for which the permit is issued.
yW 's Qnm1)emation lnsumntt enicr and Polity numhc�ttier. �t -t e,` Poli,N..:C&:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This ucsion need nos W completed if the permit is far ooa hundred dollars(SIM)
or loss.)
I es.ofy that in the performance of the work for which this permit is issued,l shall nos
employ any person in any manncrae its in Wcome subject to this Workeri Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Ccnifcam of Exemption,you should
become subject no the Workers Compensation previsions of the Labor Code,you must
wJZ foMwith comply with such provisions or thin Permit shall W Named revoked.
ZO CONSTRUCTION LENDING AGENCY
(rant Iherebyoffrm soar them isaeomtonedmi lending agency,for thma
e perfors. of
Ger 7 the work fur which Nis permit is usued(See.3097.Civ.C.)
W Q Lenders Name
C Lenders Addrsa
U Q I certify Nat I have read this application and sou that the salve information Is
W f~ correct.1 agree 1.capply with all city and county ordinances and sum laws¢lasing to
0U building convection,and hereby addition,mpmptiouim of this city to enter upon thc
W above-mentioned property for inspection purposes.
(We)agree to save.indemnify and keep harmless the City of Cupertino against
F'N liabilities.judgment.cos.and expense which may in any way acmuc againt and City
U Z in consequence of the granting of this permit.
^ APPLICANT UNDERSTANQS AND WILL I:QbdPLY WITH ALL NON-POINT Issued by: Date'
SOURCEREG LATIO
C �2 2 x9r Re-roofs
SgNou of ApplimNu Comsamor —Une—
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will IN applicant or futum Wilding Occupant store or handle haadous mav:nal
as;defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
We,Section 25533(e)?
❑Ye All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future Wilding occupant tau equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit horardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
Dyes Nu
1 have mad the harp dnus materials requirements under Chapter 6.95 of the Calirm-
niaHcalu6SdctyCodc.Sacdom] 505.15533and2 534.lund mwdthmifthc Wilding
duet not curtcnlly by .,!:,al,a Nat it u y msponsihilily m notily dm ecu t of Nc
reyuirtmcnu womb met prior canfahla,mo of the ryry. nature of Applicant Date
/ � - 7— 2'-LO f' o
�cr or authorind agent Dare All roof coverings to be Class"' or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Buildin De art ent
JOB�lA^DDR\ES� qE /
5.
OWNER'S NAME: ; s . PHO YC.e,' 23-,)-
GENERAL CONTRACTOR: f FAX # S.---—
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
Contractor Signature Date
Community Development Department
Building Division
aM
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
OUPEkTINO
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 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'sName-
job Site Address'.
Roofing Company N6,1e:
A plicant's Signa#ure: / Dater' 'L `F
\�l/r61vAD�XI �
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF CITY OF
u 7 �� ��
CUPERTINO PERMIT APPLICATION FORM
APN# z-"-3--) !T-2 S-0�O Date -Z� -01
Building Addr
Owner's Nre: Phone#:
:ScNt1rCcpa
Contractor: Phone#: Lic nse#:
4I%-265--V-)'096756
Con act: Phone#: Cupertino Business License#:
o 40r- 60%0- 33((b`-
Type of Roof Covering:
Existing: Proposed:
Built-Up Roof wilt-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#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
• I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description:
Residential Commercial ❑
Fire Zone: Yes ❑ No Confirmed with Planning De t. if
there are any restrictions: LJ
Cost of Project: , Type of Construction: Occupancy group:
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