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04080089' CITY OF CUPERTINOUufftll I A'''4 A BUILDING DIVISION PERMIT ;,CO,NT.ItACT()RINFORMAfI(jLV�. BUILDING AGGRESS; DANIEL S. KIM PlxMrr No 04080089 OWNER'S NAME: PERMIT ISSUE DATE, ONE: SANITARY OL N0. ARCHITCC 7ENCINEER: BUILDING PERMIT INFO BLDG ELECT' PLUMB MECH 0 0 0 0 LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm Nal I am Ikxved under provisions of Chapter 9 (commencing with Sermon 70114) of Division ] ofthe Business and Professium GodC,lOd my license is in full brae ad eRecL License REROOF W/ ASPHALT SHINGLES Datz Conn ARCHICS DECLARATION 1 undcrsunJ my pons Mail W used as public rtmem Utmowd Pndessional OWNER -BUILDER ER OECe CN V I hereby (Sero that 1 Conte nsc Lew for gW eBusin from tete Cnm,acters 711]I.S.BYalM66mpr PNfelilnNGrade:Anycity orcounty moon. t. e: A Beya1NLWm w hichfollowing reuiresaMount, ructom which requires .Meant CnnsWel,alum.pplic Irefor re suherdtsho Fie a sig to its issuance,also mgothe the appliosOffor suchPermit toicessignedstatement Sq. Ft. Floor Area Valuator that (co menlicensed cigwitpursuantIntheofDivisionfdeCenuacmrndProelaw(ChoPur9 (commencing with ion of ] Code) or Any na70xd vi that he is exempt thcrtfrCm and the baso far the aIle{ed exemption. Any violation of dominantbasis f the al egBusinessdmpt on. 3JTVjbi gr00 Occupancy Type Section 7031.5 by airy applicant for a peonitmbjecu Neapplicant to a civil Penalty of not more than Rve hundred dollars (S5r10). r. ❑ Loa wrofthe property, ormy employeeswith"law Man rolecampcnvdon, Required Inspections will do the work, and theswctuu k not intended eroffatW formic (See. TON, Business and Professions code: The Contractors License law does net appy m an owner or property who build. ser impmwa deeeon. and who does such work himself or through his Own employees, provided that such improvements tee not intended oroRcee l forsde. IL however, the building or improvement is sold within one year of completion. the owner - builder will have Ne burden of proving that he did not Wild or Improve for purpose of 1, as owner of du property. am exclusively contracting with licensed co mushas to - construct one pmject (Sec. 7004, Business and Prufmdons Code:) The Convectors Lt. come Law dors not apply to an owner of property who Wilds or improvse thereon, and who contracts for ouch projects with a contractor(s) licensed pursuant m the Contractor Lkenm law. I am e..MP�t under .Bh PCfor Ni mxwn SATION ECR ,?� WORKER'S LA clardion I hereby affirm order penalty of perjury aro of the folkwing dee sCmaP- I h nc and will maintains Certificate¢(Content m self -insure few Workermt provided for by Sudor 3700 of the lobo, Code, rat the performance of tee ai dno, n prod work for which this permit Is issued. ❑ I have and will maintain Worker Compensation Insurance, u m lural by Secdoe 7700 of the labor Code, for the pe,f0rmance of the work for which this permit is issued. My Workers Compensation Insurance carrier and Policy number am: Cartier. Polity No.: CERTIFICATE OF EXEMPTION FROM WORKERS' , COMPENSATION INSURANCE Crisis sectitm wed not W completed If the permit Is for one hundred dollars (SIM) or kaa) 1 certify use, in to performance of the work for which this Permit is issued. I shall not employmy 0 y atTlafte bjuue use worsen' Compensation - Laws arC if .Dau A Ilesnt AI— N CE TO APPLIANT: ILa cr akmg Nu CeNRca of Eacmphon, you Mould baco subject m the workms Compensadon provisions ser the Ise Wr cdoe. you most f with comply wdh such provisions or this permit mail be dimmed evoked. ' CONSTRUCTION LENDING AGENCY I hereby affirm Nat Nee it. cif.1fi n undid{ gcnry for Ne perfurmmwe of Ne work for which this permit is issued (Sec. 31197, Cl, C.) Lenders Nunn Lenders Addms I certify that 1 have read this application and suss that the AWw inform Won is correct. l aim to comply with all city and county MJImmxes and sou laws testing to Wilding construction. and hereby authafu mprosenwiws of this city in enter upon du above-mentioned properly, for inspection purposes (Wc ) agree to save, indcr nlfy and kap hardiest the City of Cupertino agdnst j Ilabilit!"je)dgments,costs and expenses which may in any troy aume against sod City in consequence of the ganging of this Permit. APPLICANT Ury/j'�7"�'tR�gS�\(ANDS; WILLLCCCOMPLY WITH�YAL/L/NrO�N-P INT Issued Date Sr \ JS �i'� Re -roofs fs Type of Roof SI n teof on ter HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future Wilding Occupant srom or handle hmardo n material as kilned by the Cupertino Municipal Code. Chapter 9.12, and the Health and Safety CedeS=d..755]7(.r nnn��� No All roofs shall be inspected nor to an roofingmaterial beinginstalled. If a roof is installed without first obtaining an inspection, I agree to remove Will Nc applicant or ffut\uu building Occupont use equipment or devices which nth hwmdnus air imman, ran ss defined by the Bay Arca Air Quality Management all new materials for inspection. imieV ❑Yes Nu I have mW the Wooden materia, mquinnnu nu undo, Chapter 6.95 of de Califor- 10.oe', isHealth B Sdmy Code, Sach.25505.75577 and 25534.1 umknuM Nu if du Wilding ors not cunemly hew a unan um it u my mponsihiliy u nuu(y the auu ant nr ulmme is nstim ett bmudi�_ ancmdlkmeafaea Signature of Applicant Date d _ All roof coverings to be Class .B„or better <��' amhomud .gem Date CITY OF �UPEkTINO • Community Development 10300 Tofre Avenue Cupertino CA 95014 Telephone (408) 777-3228 Fax(408)777-3333 Building Department JOB ADDRESS: PERMIT # C},5 OWNER'S NAME -:--"'PHONE # ^ 3 GENERAL CONTRACTOR: FAX # I am not using any subcontractors: O t 2 - Signature Date Please check applicable subcontractors and complete the following information / t to 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 to OWNER -BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform: r A. XN All the work authorized by this permit B. A portion of the work C. None of the work If B or C is checked, complete 2 or 3 below. 2. A state licensed contractor will be hired to do: A. _ All of the work B. _ A portion of the work (complete section below) Contractor Address/City, Phone # State License # Type of work to beperformed 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or • portions of the authorized work. I understand that I may be an employer (see reverse side). A Certificate of Insurance covering workers compensation must be on file at the City of Cupertino Building Department office. of work to be I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner -Builder Information (reverse side . Property Owner's Signature: Date: Job Ad dress: N -\- Permit# 9 Department. Dear Property Owner. City of Cupertino Building Department 10300 Torre Avenue An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner -builder you are the responsible party of record on such a permit Building permits are not required to be signed by property owners unless they are personally performing their own work If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers compensation insurance, disability insurance costs, and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner -builder building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, • City of Cupertino Printed w Recycled Paper 0 • i r CITY OF UPEkTINO Community Development Department Building Division City of Cupertino 10300 Torre Avenue Building Department Subject- Re -roofing policy for the City of Cupertino Telephone: (408) 777-3228 Fax: (408) 777-3333 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: �; t �� �� .u` Job Site Address: Roofing Company Name: -iz KI Applicant' s Signature Q GregTt 0 Building Official Revised 1/30/03 Printed on Recycled Paper Date: �?/ \2l O � C 1W 0 CITY OF CUPERTINO (/Y- / REROOF UTo�U / PERMIT APPLICATION FORM APN # ? / Z Z 6 1113 BUILDING Date: Energy BUILDING BSEISMICRE 11 200 Building Address: BSEISMICOM Seismic Commercial S - BPLANCHK Plan Check Fee Owner's Name: BUSLIC Business License Phone #: Contractor: ( \ Phone #: License #: Contact: Phone #: Cupertino Business License #: Type of Roof Covering: Existing: Proposed: ❑ Built -Up Roof ❑ Built -Up roof X Asphalt Shingles ;K 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 Cl 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 w• Planning Det. 'f there are 4RY re ictions: LE Cost of Project: Type of Constructio Occup cy gr p: f=if Fee Descrintion Fee Groun 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