04070132 (2) CITY OF CUPERTINO -' ��-
BUILDING DIVISION PERMIT WONTRAGTOR I iFnORMATION t
BUILDING ADDRESS: T D ROOFING 111111,1904070132
OWNER'S NAME: PERMIT ISSUE DATE
SIEW-HOCK LAU 154n MARnATF, AVE. 117 12.2 9
ONE: SANITARY NO. CONTROL NO.
(408) 892-8872
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG EIEC! PLUMB MECH
0 0 0 0
u00 LICENSED CONTRACTOR'S DECLARATION Job Descri�tton
w 1 hereby affirm that l am Reamed under provisions of Chapter 9(Commencing /1
i with 5emian]B(IIl)of Division 3ofthe Bdinea and Rmfcssioe Code.and my license is d \\Wf/
n<> in full force and effect. ^
jt2� REROOF W
License Class Lic.g /COMP . � f1
Z;M DateCommclor JUL �J
ARCHITECTS DECLARATION 249 2004
i I understand my plans shall W used M public records
JyU n
o
Licensed Prof¢uianal 8 A®4 w
3
OWNER-BUILDER DECLARATION vY/ Byjf,�y
n1 naso .(fres that I am exempt from We Contractor's :License Law for the �ltl�\U/
_O O following requires
a.permit
t IIl3 L5,Business and Professions code:Any easy or county
u m which myuire a issuance.
also
retium the L olum.applicant
Improve,h PerliadOmollilsfi repair any Structuuatroam
a"^ bar he incensed e,alsu re to Me the isimianf for suchrseux'miecom file a gawdsutemem
seat(commencing
with
pursuant to the of Division
of thee Business nd Professions
(chapterCore)or Sq. FL Floor Area VaIURIIOn
¢i-� (commencing with Section]OW)of Division3 of the Business and Professions Cndc)m
SO Nat he is exempt therefrom and Rte bums for Ma staged caemption.Any violation of
Section 7031.5 by arty applicant for a Permit subjects the applicant to a civil penalty of 35kgING4bA*er0 O Occupancy Type
nos mart Nan five hundred dollars(SSW).
0 1,as owner of the property,or my employees with wages as their sole compensation.
will do Ne work and Ne swcture is nos intended or offered for sale(Sec.7040,Business
and Pmfessioru code:The Contractor's License Law doe not apply m an owner of Required Inspections
property who builds or improves Momon,andwho docssuch worhhimselrar through his
awn employees,provided Nat such improvements arc oat intended oroRered for sale.It,
however.Ne building or improvement is sold within oro year of completion,Ne awnen
Wilder will bays the burden of proving that he did not build or improve for purpose of
sale.).
D h as owner of Ne propcny,am exclusively contracting with licensed contractors to
construct the project(Sec.7004,Business and Professions Code:)The Conuatuo's U.
cense,hew does not apply to an owner of property who Wilds or improve theteon,and.
who contracts rot such prejeeu with a eomomor(q licensed pursuant to the Comncmh
Lict.law.
O0 am eempt under Sec. .B g&P C for Nis mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of Ne following declarations:
I ban and will maintain a Certificate of Consent to self-insum for Woraces Compere
salmon,az provided(or by Section 3]00 of the labor Code,for Ne performance of the
work for which Nis permit is issued.
[Iyl have and will maintain Worker's Compensation Insuranw,u Iryuired by Section
3]00 of Ne Labor Code,for the performance of Ne work for which this permit is issued.
My Worker's Comps-fnsation Insurance carrier and Policy number am:
clan"., s4 d\ IS- -t\\sA C� Policy No.: ( A-.2 f 1 J (I .
CERTIFICA OTE FERE MON FROM WORKERS'
COMPENSATION INSURANCE
(Thusecticn need not c completed ifthe permit is for enc hundred dollars(SIM)
or less.)
I certify Nat in Ne performance of she work for which this Permit is issued.I shall not
employ any person in any manner so a to become subject to the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making his Ccniftcate of Eacinnion,you should
become subject in the Worker's Compensation provisions of the labor Code,you most
.,Z forthwith comply with such provisions or this Permit mail be deemed mwkcd.
zO CONSTRUCTION LENDING AGENCY
[-. I hereby all Nm there is a cons"cona lending agency ler the Performance of
fX the work fur which this permit is issued(Sec.3031 Civ.C.)
{i3 Q Lender's Name
G Lcnder's Addy•
�z
U C) 1 cedfy that I have rozd this application and suss that the above information is
ly t"' crrtccL I agree to comply with all city and county ondinances and sum laws relating to
QU building construction,and hereby amhoriM aepreenceives of this City to enter upon the
W above-mendaned P.Nny for inspection Purposes.
D. (We)agree to save,indemnify and keep harmless the City of Cupertino against
F h
liabilities,judgments,costs and expenses which may in any way accmc against mid City
U in consequence of Me granling of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: D to
SOURCE n�GO ATIONS.
d .�X57.1. 1 IQ 7� a °`l Re-roofs (57
Signammof ApplicanUCutione f 'Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicable,far..building uccupam srote or handle hamidous material
az dcRned by Ne Cupertino Municipal Code.Chapter 9.11.vnd the Health and Safety
ID,xhic,l
tic,Section 15532(.)?
'A
/ All roofs shall be inspected prior to any roofing material being installed.
❑Ye No
Will the applicant or/future building reception use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hammous air coomminanu as defined by the Bay Arca Air Quality Management all new materials for inspection.
Dyes �J Na /
I have real the hvardousmverials requiremcnu underCW Parr 6.95 of Bic Califor-
Health&SefctyCodc.Stmou 15505,15533 am1255U41 undcrsuM dwifdc Wilding ///l�/ ,��(� '� a� 0 ,-/
cs trot curmn I I,ve a ameaL Nat it u my respomsihiloY m notify the o=cuPem of the 1 - r �l Uf/✓ l� _ l / I
immenkdwbin stmmntgpn exissaanceoraccodc oroc =y Signature of Applicant Date
a04,V, r a f 0 l All roof coverings to be Class"B"or better
Owner authanyed agent Q, Dao:
p
Community Development
' 10300 Torre Avenue
41' Cupertino CA 95014
Telephone(408) 777-3228
UPEkTINO Fax(408)777-3333
Building Department
JOB ADDRESS: PERMIT # (/
6 S � ri » Wy D l o74,132--
OWNER'S
' "/ 3OWNER'S NAME: S PHONE #(,4,3-9 ) g & '9 g ,Z
GENERAL CONTRACTOR i ro o n FAX #
I am not using any subcontractors: 7A IASZ / ...2 o
Signature g— 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
LV
Owner/Contractor S' tune Date
Community Development Department
� � Building Division
�• City of Cupertino
✓"' v ; 10300 Torre Avenue
CITY OF Telephone: (408) 777-3228
4UPEkTINO 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: �o S n zl LN y
Roofing Company Name: I ]] T:O o- 1 r)
Ap"AcanYs Signature: Date: A-t O 4
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper