03030056 CITY OF CUPERTINO <' rtawaa a " r ,fix ''
Bin
aDlNc DIVISION PERMIT 0, T1tACTl�R INF�CIQN :
JAIt'CHITECUENGINHER:
NG ADDRESS: WINTER ROOFING INC PPEMITNO,
'S NAME: 151 WYANDOTTE DR PERMNISSU
BRENDA CT3/12' 4OH363SOSZ SANITARYN C OL NO.
- BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Ii
300
1 LICENSEDCONfRACIOR'S—DECLARATION Job DescriP tion
herabY affirm Net 1 am Ilmvcd unJer provWons o(CNper 9lemmencinj
wllh S0mbn70(XI)ofDividon3of tie Bminw end ProfeulaneCodo,.Mmyllcense is
L Anse it f ceendeO i. REROOF
License Clw Lk-♦
Oates •n ECrS EC REMOVE WOOD SHAKES, INSTALL 1/2 OSB &: 30 YR. CO
0t7t RC all be used
DEC re
Q 6 I undenund my Pum ahatl be wed u public rumrdo, - -
bLlcensad Pndculoml
5 OWNER-BUILDER DECLARATION
M1 hereby efllrm that 1 am Ciampi from the Contnmors License law for the A p R 2 9 2003
,
pfallowing mason.(Section 7031.5,Business and Predications Code:Any city of county .
which requires a psmmh to construct,alter,improve,demolish,At repair any muctem
�+ prior miuluunm.Auomquirestheapplhamforsachpermitto0le Aoignad Wlament Valuation
2E�F< thaiz Islimmed Innocent to the provisions of the Comunes Limns law(Cluper9 Sq.FL FloorArea ,33UIL®I
S� (commencing with Section 70l of Division 3 of the Business and Professions Code)Or
e dist he is exempt therefrom and the basis fat Ne alleged eaampuon.My violation of
Swim
mme 11h�n Ove any
ns,far a per it mbjew the aPPlimm m a NWl penalty of APN Number _ Occupancy Type
36943009 . 00
❑Lae names,of the property,or my amployma with wages as the48010 compensadan, -
will do the work,and thestructuCi isnotintendcd err Onerad far Wc(See.7044,1husiwas Required Inspections
and Professions Code:The Conoutore License law does not Apply to in owner of 305 - FRAME 9 p
property who bui Ids or Improves thereon,and who does such work himself or through his
own m1ptOYm2.provided dist much improvements Am net immodest or Offered far"I&If- 307 — INSULATION
however,the building w Improvement is said within ore yeast of completion,the owrwi-
builder will have the burden of Proving that Ire did not Wild w Improve fm purpose of 601 - ROOF TEAR OFF
i1e')' 602 - ROOF PLYWOOD NAIL
❑1,as owner of the property am ueludwil,contracting with licensed contraeton to
..Met the pmjml(Sec.IOU,Business and Professions code:)The Contractors Ll- 603 — ROOF BATTENS
more law does not apply to an inner of property who boom or improves themes.and. 604 — ROOF IN—PROGRESS
who contracts for such pmjetu wit a conuactw(A)licensed pursuant in use Conuacto'a
License Law.
❑1 am esempt under Sec. .B&P C for this moan
Owner Dau
WORKER'S COMPENSATION DECLARATION
1 I henby
WE
under pcod y of perjury ore of the following deelasatlmaK
haw and.111 rem W
an.CeAOcate ofComent to selbimme for Workers Campos-
Minn.in provided for by Section 3700 of the labor Code.for the perfomance of the .
work for hlch this permit is issued.hive and will mainWn Worimes Compensation Insurance,As required by Section
3700 of the Laborf.'mde,for do performance of dor work for which this permit u Issued r.:
My WorkersC pen etlan int nee iennd Polity number art:
carrier. OF Policy No.: go
FIC OF EM MON PROM WORKFiLS'
COMPENSATION INSURANCE '
(Thisvxtion need notbecompleed if the permit later=hundred dollars(SIM)
Or hu.)
1 certify that In the perftern a of Ibe work for which this permit u issued.I.hill am '
employ any person In any manner W As to bee mcwbject to ase WOrkcn'Compamauon
Laws of California.Dee
Applicant
NOTICE TO APPLICANT:If,ere,making thl.CenlBmto of Exemption,you ahanld
become subject to the Workers Compensation provisions of the labor Code,You muse
0z
forthwith comply with such provisions or this permit shall be deemed ranked. -
tiCONSR(UCITON LENDING AGENCY
(.r I hereby afhot Out Nero las construction lendingagenry for the performance of ,
y' the work for which this permit is issued(Sec.3097,Civ.Cd
GQ Lender's Name
z Lender.Mdmss
C)O[ comm,1=try that I haw mW this application and sou that dor above information 18 -
{ir t c .I Agree to comply with all city MW county oJimrmll And sac mating ating M
O building construction,and hereby authorize mpmcmutives of this city to enter upon the
W above-mcnuun0d property for Inspection purposes
c0sea
(we)agree to can.indemnify sad keep harmlw the City of Cupertino against
yIlebillues dgmenu,cosu and expensesw unsay in any wsYoaruc gsimi asid City
O 7 in con entt 0f the gnnling of this pe IL
F7 APP NT UNDERSTA ILL COMPLY WITH ALL NON-POINT Issued by. ate �J -0-3
RC R 0
Re-roofs
SI a ofA ics o Dam
MZC O US MATERIALS DISCLOSURE Type of Roof
ill the applicant or future Wilding Occupant or handle haasrdos material -
As
ned by the Cupertino Municipal Code.Chapur 9.11.And tie Health and Safety '
.Section 33330(.)7 All roofs shall be inspected prior to any roofing material being installed.
Oyes
Will the applicant or umrobuildingamupsntuseequipment ordevkeawhich If a roof is installed without first o taming an inspection,I agree to remove
h hazardous air contaminants as J J by the Bay Arn Air Quality Management all new crisis for inspection.
itrim7
' ❑Yes u
Ihsveread the huardousmauda6 menu unJcrCMpter6.93 of the Glifor• -
nuHulth& oyCOde,Sectiam253113. 3od23334.iundentsndthatiNe WiWing 1 —G3
dors nol c illy how a mrsat,that it' y res responsibility an notify tic omupent of ase
requl n which mu or uumm ora ccrulcseof Occupamy. Igo re of pficanl - Date
mer .mthorir .a to All roof coverings to be Class"B"or better
Community Development Department
\ Building Division
J � City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
C U P S kT I N O
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: rd G7A0 -
Job Site Address:
Ci4 G/
Roofing Company Name: K
AA plicanYsSignatu Date: z 19
Greg eel
Building Official
Revised 1/30/03
Pdnfed on Recycled Paper