04040142 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT 7 CON'�TRACTQR INFORMATION:
BU ILDING ADDRESS: OLD COUNTRY ROOFING PERMIT N004040142
OWNER'S NAME: PERMIT ISSUE DATE
TEK WEI -B R BR 2004
ONE:
SANITARY NO. CONTROL NO.
(707) 864-5557
ARCHITEC AINGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
.0 LICENSED CONTRACTOR'S DECLARATION
A t� tea®
F 1 hereby affirm that l am licensed under provisions of Chapter 9(commencing Job Descri 10 �}y[�
c with Bemion](gxp n(Division3of Ne Business and Professions Cndc,and myliecnu is
in Tau tutee and erne' REROOF AUG 2
St ea Z Licemm Class Li0.M ZOoar
C-1 Dam Contractor Y
ARCHITECCS DECLARATION
6v 1 understand my plans shall W used as public records Be ® �ppppp y�3ry/q��
ka.
o� Licensed Professional B@9ILIn.VMN
h S OWNER.BUILDER DECLARATION
1 hereby affirm that I am exempt fru.the Conlracmr's License Law for the
O O following moan.I . on]IIJ L$,Business and Professions Code:Any city Or county
C
$ which requires a permit in censnuct,alter,improve,demolish,or repair any structure
LZi prior In its issuance,also requires the applicant for such permit no rile a signedstatement
p < that he is licensed pursuant In the provisions oftheConnector's License Law(Chapter H Sq. Ft. Floor Area Valuation
y�0 Commencing with section 7(0187 of Division J of the Business and Professions Code)or _
i Nat he is exempt therefrom and the basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for apennit subjects the applicant o a civil penalty of 31 5I4�Ib$�er00 Occupancy Type
not more Nan five hundred dollars($580).
0 1,As owner of the property,or my employees with wages AS their sole compensation,
will do the work,and the strontium is not intended or offered for sale(Sec.7094,Business
and Professions Cade:The Contractor's License Law dues not apply to an owner of Required Inspections
property who builds or improves Nemon,and who dcessuch work himself or through his
own employees,provided that such improvements are not intended he.((end for sale,If.
however,lie building or improvement is sold within one year of completion,the owner,
builder will have the burden of proving Nat he did not Wild or improve for purpose of
sale.).
0 I,as owner of the property,am exclusively contracting with licensed Smart acmrs to
construct the project(Sec.70d4,Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who Wilds or improves then on,and.
who connects to,such projects with a contractor(s)licensed pursuant to lie Contractor'
License Law.
0 1 antexempt under See. .B&P C far this reason _
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby M.under penalty of perjury one Or the following docare ions:
1 have and will maintain a Certificate of Consent to self-insure for Worker's Cheapen.sation,as provided for by section 7]00 of the Ishtar Code,for Na Performance of the
wor for which this onot is issued.
1 have and will maintain Workers Compensation Insurance,as required by Section
3 o(Ne"her Code.for the performance of the work for which this permim is issued.
My Worker's Compensation lnyunnenJc—eanter and Policy number am:
Cartier.n/ATL w5It1
64 /f;19 Olicy NO.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This Section need not be completed if tube Tcrmit is foronc hundred dollars(Sla)
nr less.)
I eeniry Be,in the perrnsmmee Of the work for which this permit is issued.1 shall not
employ any person in any manner so az In became subject the Workers'Compensation
Laws of Caliro..ia.Dam -
Applicant
NOTICE TO APPLICANT:IL after making this Cenilicatc of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
�Q forthwith comply with such pnoisiom or this permit Shall he deemed revoked.
y tiCONSTRUCTION LENDING AGENCY
(--t I hereby affirm that there is a construction lending agency for Ne performance OF
(y' the work fur which this permit is issued(Sec.J(yD,Ci,C.)
W� Q Lenders Name
a z Under's Address
V Q I cenify that I have read this application and some that the shove information is
correct.1 agree to comply with all city and county onlinances and state laws relating to
V building construction,and hereby authorim representatives of this city to enter upon the
U above.mentioned propony for inspection purposes.
1 (We)agree to save,indemnify and keep harmless the City of Cupertino against
aF-t cn liabilities,judgments,costs and eepemes which may in any way aceue against said Ci ty ,
C) z in conuyucncc am
granting of this perm it.
APPLICANT=ER STAND D I Y ITH ALL NON OINT Issued by: Dale
SOURCE CATIONS.
1d Re-roofs
Signal r of ApplicanUCOnnacmr Dat
HAZARDOUS MATERIALS DISCLOSURE Type Of ROOF
Will the applicant or future building Occupant Store or handle N000duus material
defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
nae,s❑tYmena 25532a)'. �'Nn All roofs shall be inspected prior to any roofing material being Installed.
Will me applicant or contra building«capam u equipment or devices which
If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air wnmmments u dcOned by the Bay Area Air Quality Management all new m t rials for inspectio .
irtrict? -
[IYes )Cho - --
I have mad the havaNuusmaterials requirements under Chaprer6.95 of the Callfor- v 9
niaHcalN&S ctyCode,Scnions 15511 55JJ anJ 255J4.1undcrsonJ Natif Nc Wilding e><J
does oat c Iy hove a 14
I Nat' ' spa ihility m nedty tbe occupant or Or
require whimmua t d ce NficamorOccupancy. S na[ureofApplieant Date
O crurauNorizeJaFein Dai - All roof coverings to be Class"B" or better
a
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
�
CRY OF Fax(408)777-3333 UPEI�TINO
Building Department
JOB ADDRESS: �O /2 Sege �i SpRrNG3 �/z, PERMIT ,
OWNER'S NAME: ZhIc wei PHONE - _23.00
GENERAL CONTRACTOR FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followinginformation:
60 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
oofing 0G.b 0-oymayG ?
Septic Tank
Sheet Metal
Sheet Rock
Tile /
dqe /Contractor Signature DJV
SRI'
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
CITY OF Fax: (408)777-3333
UPEkTINO
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: / j G /--Z S Le- V e2-N cS/4Z I n/G S 'D /C-
Roofing Company Name: L� C-O U 11` 1—ic..vJ /T OO I-tnIG
Ap"cant's Signatur ! CyW/ J Date:t/— 2�— 0Y
\�IJ�lI�10�.Xi
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
II ,
CITY OF CUPERTINO
REROOF
CUPE,RTINO PERMIT APPLICATION FORM
APN# 3 G `o 7!5-4/ O ! �5 Date:
Building Address:
6 !a 13 is V6-0 'S/'/l I/1/6 S -P/(— t- v�
Ow er's Name: Phone
Contractor: PIlone License#:
OLS (�.m (4N-1— (Ko 0Pt rJtr`/ Fot Fr3t+� & as
Con ct: on Cupertino Business License#:
G�55 i� --T $3o C bL
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-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 CoTply ComplyWith Cu ertino's Tear Off Policy:
Job Description:Y� 2F H'i o ✓c.' CSX I STi I✓ SMYNl_1�c� /N 's TSL 3 0 �
1201 Irr cl L%L K It- C_Oe 701' — I'-}L L"!1 -m ti S 2
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: Ll
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