03080066 w CITY OF CUPERTINO "'
BUILDING DIVISION PERMIT CONTRACTOR INFORMATIONC
• 1BUILDING ADDRESS: WING' S ROOFING INC PERMIT"03080066
10116 ADRTANA AV
OWNER'S NAME: 561 RUTGERS ST PERMIT ISSUE DATE
0JAMES CH OR/I4/20D3
"E: (510) 481-3818 SANITARY NO. CONTROL NO
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
!Op LICENSED CONTRACTOR'S DECLARATION
i it I hereby affirm that 1 em licensed under previsions of Chapter 9(commencing Job Description
with Section iOfgBof Division 3af NC Busin irmt!Pmfiessmru Cade.andm license is t'^
+ � in full forte and f(ea>;.G3C (,C/(21�� y REROOF uu`p.1 �®
j L1 Z Licenu CI Lic,N a
Dom Contra[uf
ARC ITECI'S DECLARA ION 7
3q� F q
a< 1 understand my plane A all he used u public rccnNS S'�•� Al 203
)eu
.O� Licensed Professional
m� OWNER-BUILDER m m DECLARATION BUILDING
ING
n1 hcrchy o(Erm on 1 ore exempt from the Contractor's Co :Any c Law for Nc {,Y IL a,!' g V
00 following mason Permit construct,elecsmnd Pmfdeoli Cndc:Any any of county
5$ which require.a perish to the elect.Improve,h Permit t or repair any structure $F R R n
�Z i prior N its iuuo d pars u requires to he he applicant for Comerr anti w icenssigned(Chaps statement
� Net he is lice nud pursuant to the pmvisiousn(the Comracmr'.License Law(Chapter Sq.F[.Floor Area Valuation
2 (commencing with Section 700)of Dnnion 3 of the Business and Prufessinns Code)or
3$. 'hat he Is exempt therefrom and the buts for the alleged exemption.Any violation of
3262 0 010 . 0 0
Section 7031.3 by any applicant for A permit zub)ecus the applicant to a civil penalty of APN Number Occupancy Type
not mom than five hundred dallan(5508).
I,u owner of the property.O my employees with wages u Nair isle compensation.
will do the work.and th e...to.I...,intended oraff,.d far Axis(See 7844,Business OUD —. PX/d1vIL' Rea Inspections
ins eCtlOn$
and Pmfeaziom Code:The Contrutori License Law dace not apply M An owner of 307 — INSULAI lUN p
property who build.or irepraves thereon,and who does such work himself or through his
awn cmploye provided that such improvements art not untended in offered for Ask:.If, 601 — ROOF TEAR OFF
however.the building or improvement is old within one year of completion,the owner
budder will have the burden of proving that he did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL
"In.). 603 - ROOF BATTENS
0 1,as Owner of the property,am exclusively contracting with licensed CYntiA0lam re 604 - ROOF IN-PROGRESS
construct the protect(Sec.7044.Business and Pro(esmons Code.)The Contracuri Li.
cents Law does not apply to an owner of property who builds or improves daemon,and,
who contracts for such por pcts with•contnam(s)licensed pursuant to the Cone anar.
Lacanx Law.
❑lain exempt under Sac. B k P C for NU reazon
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby.
from under penalty of perjury mm of the fallowing declunimuc
1 have and will momuin A Ceniricate of Consent Id self-mmm for Worker.Compere
station,u provided far by Sectmn 37M of the labor Code,for Ne performance of the
work for which this permit Is loved.
0 I have and will maintain Worker's Compensation Insurance,an required by Section
3780 of NC labor Code,(or the performA car the wad far which this permit is issued,
My Work Open adn sunnca c icr and P cy number anti 'J
r: YNO.: ��\L .��1
CERTIFI TEOF MPGONFROMWORKERS'
OMPENS IONINSURANCE
(Thlsucumt need not Mcomplcled if the permit is for one hundred dollars(SIM)
or less.)
1 comfy that in the peff mama of the work for which this permit is issued.l shall not
employ any person in any mannerm u to he.ome subject to the Workers'Compensation
Law.of California.Da-
Applicant
NOTICE TO APPLICANT.If,after making this Certificate of Exemption.You should
became subject to the Worker'.Compensation provisions of the labor Conic,you must
JO forthwith with comply with such prnviain or this permit shall he reamed rewkcd.
?rA CONSTRUCTION LENDING AGENCY
[—i I hereby Affirm that them is a conslm.tinn lending agency lm the Performance of
Old > the work for which this permit Is tutted(Sec.3097.Civ.C.)
{[7 Q Lcndcr's Name
jz Lender's Addre^
J O 1 cenry the,I have read this application and mute that the above in(mm olom i.
{ks F" correct.1 Agree a comply with all city and county ordinances and state laws totaling to
O V budding construction and hereby authonm minmenmiws of Nn city to enter upon the
W shove"menlic ci propgo.run Inspection purposes. y^ �1
0. (We)agree to save,indcmndy and keep ha.tm the City of Cupertino Against
fag liabilities,judgments,cam and expenses which may In any way accrue against mid City
(„)'[ mconsequcnc o(I)ERST ND,this permit,
" APPLI ANT NDERSTANDE AND WILL COMPLY WITH ALL NON
�POINT Issued b Date
ST jEqULAT[ONS.
Re-roofs
Signs a pplic ontractar Detb
t o
AZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the a Cu,panl rm(Muni building occupant r 9.1 or and Its h VArdaus material
u defined by the Cupertino Municipal Core,Chapter 9.12,and Ne Health and Safety
de•S Over
25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes Nu
Will the applicant or a re building Occupant use equipment of devices which If a roof is installed without first obtaining an inspection,I agree to remove
h husrdom air contammanu defined by the Bay Area Air Quality Management all new material for inspection.
❑Yes
I ban mail the hnardOU 15505.n533 55341 trndentard ft,fac Califon
niaHeslth&Safcl Cgotle..Secruu 255(13,25531 uW2a3N IUnMmand thudllsmmWm
does not comedy h a tenant,that n s my roponsNilhy u noufyyy��4tthe ace pmrefine
mgmelear hush tau Mme prior.iuumce of.CoercyT,oYOC ty. Si ature of Applicall t Date
/( All roof coverings to be Class"B" or better
Ow sera o rice I Da
Community Development Department
Building Division
it
410i City of Cupertino
10300 Torre Avenue
' Telephone: (408)777-3228
CITY OF
U P E ITT I N O 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: (/ l'k) C
Job Site Address: /J j f /n� rt CA-VICA /JK�-
Roofing Company Name: f
A licant s Si afore: — I rll ?�?i Date r—
P g" � � ( Z63
CA/�lh1Dl�
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO 3 ,
CUPE REROOF RTINO PERMIT APPLICATION FORM
APN# � � U Date: /
Building Address:I t'V
Owner's Name: Phone
Contractor:W l one# License#:
tJ(a`S (�,ov{-GUC9 Ip..� �"/� �����6�
Contact: wl iv� Phone#: g�-t ab Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
Built-Up Roof A4 Built-Up roof
X 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 CuPertino's Tear Off policy: ❑
Job Description: .7/� �X.is+K„ hin�&Q /ICY ,13ct�c'tr r/-OV c,� asty(a./i Sf1.�P k, ake(
Residential Commercial ❑ ice T
Fire Zone: Yes ❑ No ❑ Confirmed with Plan ' t. if
there are any res 'ctions: LJ
Cost of Project:
61 n�— Type of Constructiop/1 Occupancy up: /a
D ��/ -
Qty. if
Applic ( Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees I BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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