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03070084 t CITY OF CUPERTINO - 4' •� ••' � 'x' BUILDING DIVISION PERMIT r CONTRACTOR�INFORM4rr BU ILDINGADDRESS: WING' S ROOFING INC "'""ND03070084 0262 13QNNY DR OW NER'S NAME: 561 RUTGERS ST PERMIT ISSUE DATE ONE: (510) 481-3818 NTRSANITARY NO. COOL NO. ARCHITECI'fENGINEER: BUILDING PERMITINFO BLDG ELECT PLUMB MECH 0 0 3g6 LICENSED CONTRACD7R'SDECLARATION JobDescri tion I hereby affirm that 1 em licensed under p nvi.iome or Chapter 9(co nora,m ng P with Sued..7(M)o(Division 3.f Ne Bumocst and Professions Code.and my license Is in m I mrh and Real. I 5 z trance e1. -e j Lie.N 3 REROOF 3 °a c°nlra.,Or T/0 WOOD SHAKE, INSTALL 7/16" O. S .B. AICHf1ECTS DECLARATION S u lament ndmyplautloddlhetecdupublicrccnrds INSTALL "A" ASPHALT SHINGLE kG t; Licensed pndcssimAl 3 OWNER-BUILDER DECLARATION y I hereby alarm that I am eaempt from the Contractor's Licenu Lew for the COO following mason.(Section 703 1.3,Business and Pm(essiuns Code:Any city or county $� which requires a permit to convect,eller,improve,demolish,or repair any swcture _I j- n prioo its issuance,also requires the applicant(or such permit to file a signed statement p < thalheislicensed pursuanttothe proyhormsofthe ContractorfLeconte Law(Chapter 9 Sq. Ft. Floor Area Valuation i G (commencing with Section 7W)of Division 3n(the Business and Professions Cole)or i 3$ that he b exempt thert(mm and the btu for the alleged exemption.Any vioadon of $768 Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number Occupancy Type not more then five hundred dollars Mori). 35914041 . 00 ❑ I.u owner of Nu e pmpeny,or my employcwith wages u their sole compensation, will do the work.and the structure is not Intended or offered foualc(Sec.7Dea,Business Required Inspections and Pmfesslans Code:The Contractors License law docs nut apply m an owner of 9 P property whoWild,mimproves d¢mon,todwh.dos,,uchwmk himwlfor through his .we employ..,p...ided that such imponsmmu veno,intended oroaered(a,sale.If, 305 — FLAME lr� a1S1' GW1a I�I j to weveq Or building or improvement Is said within mo you c f completion.then,, builder will have the burden of Fuming Out he did not Wild or impm o for puryme of 307 — INSULATION e.in.). 601 - ROOF TEAR OFF AUG 0 5 2003 ❑I,as owner of the propeny,am exclusively contracting with licensed contractonto 602 - ROOF PLYWOOD. NAIL construct the pmject(Sec.70x,Business and Professions Code:)The Contractor's Lt came Law docanot apply toanOwner ofproperty who builds orimprove%demon.and, 603 — ROOF BATTENS BUILDING controls for each projects with a contracum ft licensed pursuant Contractors License law. 604 - ROOF IN-PROGRESS ❑l un exempt under Sea .B&P C for this..a. Owner pale WORKER'S COMPENSATION DECLARATION I hereby arm under penalty of perjury arc of the following declaration: I have and will maintain a Cenificua of Conant to self-intro for Worker'sCompcn- 1C314111 lon,ss provided for by Section 370(1 of the Labor Crede,for du perfonneae of the rk for which this permit is issued. I have and will maintain Worker's Compensation Insurance,as required by Scctlon 0 of Ne Labor Code,for the erfmman of Ne work for which Nis permit u award. Worker.Cpmp ration m nm a u and Polity number art: mer: T/U.1_i -"fit. Policy No.: 2,0 '£v CERTIFICA •OF PJ EMPTION FROM WORKERS' COMPENSATION INSURANCE (lhis¢ction need not he completed if the parm0 is for one hundred dollar(SIM) or less) I certify that in the performance of the work for which this permit is issued.I shall not employ any Whom in any manor ser as to become subject to the Worked Compensation Law.or caiumn a.Data Applicant NOTICE TO APPLICANT:If.after making this CcniOcate of Exemption,you should become subject to the Worko's Compensation pmvisions of the labor Code,you most .`O forthwith comply with such provisions or this permit shall bo deemed revoked. z� CONSTRUCTION LENDING AGENCY j—t IWrthy aRpm Na,Ncrt is•construction lending agency for the performance or CG the work fur which this permit Is issued(Sec.3097,Civ.C.) L,Q lender's Name z Lender's Address U Q I certify that 1 have rod this application and mu that the above informadun u 0E CanmcLI.greectComply and here all city and cranny ONLlwS or and Oa4lent Riptingtoe p alowengcofirmed construction.and hereby aohorimrtessol. tivcs of this city to enter upon Nc Od above-m.miun OT LO S M for indemnify an keep ha (1 esac)qua mcove,indemnify and kap humins w City ntCupcnsts editor ' A fq liabilities,judgments,encu and expense,which may in any way eccrus against said City U 7 in conmyuence°f lm gmming of this permit. F7 APPLICANT U ERSTANDS AND WILL COMPLY WITH AU/NON- INT Issued by: Dat SOURCE ECU ATlf�ls. 1 l//h . �n '' S num,o A Iic�trCon ct Data Re-roofs HAZ RDOUS MATERIALS DISCLOSUR���� Type of Roof Will ft applicant Or future building occupant store or ben�eTiaraNuus material as defined by dte earphone Municipal Code.Chapter 9.17.and the Hca1N and Safety Code.Secdon 15531(a)? All roofs shall be inspected prior to any roofing material being installed. ❑YmV. Will me applicant rwum buildingarupam use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove It havardnua air contaminants ss dcnned by the Bay Arca Air Quality Management all new materials for inspection. - -- atric,? ❑Yat �Ilu Ihevc read the h.rdoushmaterials requirements under Chapter 6.95 of the Califon /a" ///�///, nia HcalN&Safety C.de,Sc d6.25505,25573md255N.lunderaund Mmif Re Wilding / I I/' .__ 7 does mol curtent y have a tom.Not It u my responsibility to nutty the occupant of the 1 �V �- l L_� mqulrtme Law ch must the me,priono issuance Ora ccranate oroaapancy. Signature of Apicant Date cr a ri rad ag IDau All roof coverings to be Class "B" or better Community Development Department Building Division 9 . City of Cupertino 10300 Torre Avenue Telephone: (408)777-3228 CITY OF Fax: (408)777-3333 UPEI�TINO 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 Nyith the above sstatpolicy on p-;o�g. Homeowner's Name: / j L- Job Site Address: J 3b _2 v A 1 Roofing Company Name: �y�v I v '� A plicanYs Signature: 1 Date: j� \�t/�6l/�1LXX1 Greg eel Building Official Revised 1/30/03 Printed on Recycled Paper CITY OF CUPERTINO REROOF CUPEI�TINO PERMIT APPLICATION FORM APN# Date: t ( a Building Address: 10362 /U Owner's Name: Phone iht e _emsL1v �ag 2- -7 j f Contractor: i S d 6r N Phone#: License#: / C D/(3 ML Contact: r 1 t G C* Phone#:D g _ `� Cupertino Business`OLicense#: o F� Type of RoofCovering: Existing: Proposed: ❑ Built-Up Roof ❑ Built-Up roof ❑ Asphalt Shingles Q( Asphalt Shingles X-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 Corriply With Cu rtino's Tear Off Policy: ❑ Job Description: 7/4, W e& _ Lt'tS 7 Li Residential ommerc al ❑ Fire Zone: Yes ❑ No ❑ Confirmed with P De t. if there are an strictions. Cost of Project: �,GSo_ Type of Cons tR ti Occupancy gro Qty. A ca 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 7 , 37. P