04070191 CITY OF CUPERTINO '^'";
BUILDING DIVISION PERMIT ' CUN'PR[ilGTUR INEfU�A'.'� Ni
C,,T-O r! ♦` 3 x'32 %., re
BUILDINGADDRESS: PERMITNO04070191
� � nga Noypm RR ng
OWNER'S NAME: PERMIT ISSUE DATE
CHOKUN CHANG ONE: SANITARY O. 0 OL N0.
ARCHITECr/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
] 0 0 0 0
±,t OMZ' LICENSED CONTRACTOR'S DECLARATION
1 settle,IM.Nal I am licensed under pmnsvtaloof Chapter 9(rommeacine lob Description
n, with Section]0110)of Dlviaimn3of the Bmeineuend Pr fcuirns Code.andmylicensois
InmRfmWeJercen REROOF
j g Z LkeneeQ(ur Lk.g
zl- DIM Contractor CONTRACTOR: ARMASS INSTALLATION
ARCHITECTS DECLAR TI
Ni `I undcn and my plana shall be mead u public, ,
Liecomd Protected...I
3� OWNER-BUILDER DECLARATION
ConuION
o S 1 hcrcby affirm that 11. exempt from the Canons Cod :Any c law for tk
O O whip Tat Ryon,permit I,,
con.S,BYSblc.Improve,
Pm(ceJPN demolish.or Ally Clly ar taaar,
$(v which reyuilns a e.Its.re quina O 1,alter.improv, ermit1m mpoh any sticustmt t
r Z r prior M its tensed F rstm nn to the Ne vision o thefor IncCo its' Lice s Law(Chkmcnl �Ty�
that he is licensed punuaml0the of Delons of the Conuacmr'and Prolusions
odc)or Sq.Ft.Floor Area Value gY000
6$ Mat ncinj and of Dlvumn3 the
museeption.my
Crock)of yT'3
a Nu he Ice esemPt Nem(mm and the buts fm Ne JIt�W esempdan.M,vlalstian of
Section 7031.5 by any applicant for.permit subjeau On Applicant o.Civil penalty of fl, mber Occupancy Type
not more than rev hundred dollen(S5001.
01,uownerof Nepmpany,MMy=Plmyaawithmg UteiTMICm penution, /521 3 00
will do the work and the suucmre isnot Intended"offered f...In(Sec.70u,BuJneaa a squired Inspections
and Pm(e19'aN Code:The CommusteL
r s kfAY Law dead an awilQ e IMI apply of
Property who builds orimpmvad¢reamaMWho doeamchwerk himselforNmu(h his \
own emFloyeu.provided that Inch impmvments art not intended aroRan d(orsae.If.
however.Ne buildin3or Impmwmem isanld wMmane year of cmnpledon.the owner- \
builder will have the thrift.of proving that he did not build or Improv for purpose of
sok.).
❑I,as owner of the property,w esclmeivcly contracting with licensed conuacton to
construct the pmjcct(Sec.7044,Business and ProfeWan,Cade:)The Contnctor's LI- > ��
cetie law fou not apply to an owner ofpropertywho builds ormvu lissome,and,
who acufor such Pmjeem with acontractot(q licensed pursuant to the Cou
nacM1
ta
License 4w. t
❑lson exempt undo See .Bk PCfor this reason
Owner Data
WORKERS COMPENSATION DECLARATION
I hereby of um under penalty of perjury oro of the fallowing d scluatiana:
❑1 hev and will maintain a Certificate of Consent to self-ineum fm WOIkeYaCompen-
noon,as pmvlded for by Section 3700 of the labor Code,for the performance of the
work for which this permit is issued.
rl 1 New and will maintain Workers Compensation Insurance,u required by Section
37M of Rha Labor Code.for dM pedatmanm of the mete for which this permit Ice Issued.
My WoheYs Compensation Insurance carrier and Polity number tie:
Carrier: Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thisseclion need Out becomplated if tie permit Is(armee hundred dmllata($100)
orlcu.)
1 certify ll,tyafarm.of the work for which this Fermi,us Issued.I"I am
employ any ' Ir any manner an as M become mbjact to the Worlems Cmmpenla on
Laws o(CJi( e. ��I ppp
A hunt .s OIL,
N C PPL A ding thCen an, �i+ mption,you Notal 1/
bec A j a m the Worker's pcuuuon 'lou of Labor Code,you muse
.7,ZO to with ply withsuch p//myyII mu or Nu pesmll NJI sc timed revoked.,
q ti CONSTRUCTION LENDING AGENCY
[.. 1 thereby al'torten there is.constmNnn lending agency for Ne scrforreance of
a> the work for which this permit Is issued(Sec.3097,Civ.C.)
QIandce.Name
=z Lender's Add.
()Q I comfy Nat I have mad this application and state that the show information is
E correct.I apse to comply with JI city and county orsnumre(e
dinces and sIlating m
QV' buildingconswetlon,andherebyAuthorizerepmsenmivuofthiscitymenwuponOM
f17 shove-mentioned property for inspection purposes.
LL
(We).,me to cave.too...ify and keep harmless the City of Cupertino against
IA liabilities,judgmenn,core and expenses which may in any way secrue against said City
U•z in CmnegrmMe Of thUndolini,of this permit
., APPLICANT UNAOSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: DatfeW;97"*
SO R E ON
Re-roofs
m ml oCanoacmr
HAZARDOUS MA ISCL SURE Type of Roof
WIII the applinm ar furore soil ocrMpaoN(orc or handle he'raNam makdJ
ss defined by the Cupertino'un
al ode,Chapter 9.12.and the Health and Safety
C.
det.Section 25532(J] All roofs shall be inspected nor to an roofing material bei. installed.
[31 Year No P P Y g g
Will the applicant or future build"' Want sex cqutpment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mall haurdnus air comma" ant as d by the Bay Area Air Quality Management all new materials for inspection.
Di uict7
❑Yes No
Ihawludthe hu us lnatcrulrmquimmemrunderChapmr6.95aftheCalifor-
ntaFkal0 Sof yCtxk, 'ons 25505,25533em125534.1mu mead Nrtl(the Wilding
docs not c y hev e_ that it u my responsibility M notify ft occupant of thc
RgriRme melprior Mi rota Tea ofoct ignatureofApplicant Date
owner anNonmde cat
DO All roof coverings to be Class"B"or better
Community Development
10300 Torre Avenue
-✓' Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
�UPEkTINO
Building De utment
JOB ADSFS • PRM #
(J
OWNEItS NAME: U H NE #
GENERAL CONTRACTOR FAX#
I am not using any subcontractors:
Signature D to
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
Z
"er/Co tractor ignature Date
Community Development Department
Building Division
a '
City of Cupertino
10300 Torre Avenue
OCITY�P Telephone: (408)777-3228
UPEkTINO 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 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:
Job Site Address:
Roofing Company Na A'� �
A pli
cant's Signatur Date:
c
Greg eel
Building Official
Revised 1/30/03
Printed an Recycled Paper
CITY OF CUPERTINO
REROOF O q 2
CUPERTINO PERMIT APPLICATION FORM
APN# / ZDate: / J /
Builn es.-
Owner'sN Vie- G V /`J lit Al
Contracto : Phone : License#:
a�— c L{
Contact: Phone#: Cupertino Business License#:
reqzk—
Type of Roof Coverin .
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ❑ Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ( Other(Specify) KIS F
Number of existing coverings ❑ -woAde 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: ,
. k/s t,& pccC/ VOw•t/
Re idential Comm rcial ❑
Fire Zone: Yes ❑ No ❑ Confirmed ' arming
th roe-afe�any restrictions:
Cost of Project: / Type of Cons cti ccupancy upi
Qty' ip-
Applj6abM 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
z6 ( � 2Z