03030048 ;OWNF
Y OF CUPERTINOBUILDING DIVISION PERMIT 0 INMAING ADDRESS: WINTER ROOFING INC PERMIT NO.
1999c; RRRIMA ("T
R's NAME: 151 WYANDOTTE DR PERMIT ISu
BRENDA CT. HbA 45
E. 4083638052 SANITARY Ng g 2 2AML NO.
ARCHI7ECDENOINEER: BUILDING PERMIT INFO
BLOO ELECT PLUMB NISCH
O l�
30o LICENSED CONTRACTOR'S DECLARATION -Job Description
I horcby alrom]hal l am
teamed under provisions of Chapter 9(commencing P
with Sol 1bn70I111)ofDlvalon3 of tint Dual must and Professions Code.and my license it
n ice full force and effect'- � REROOF '
Lice nAn Cl (.
ARCHIIEC'SoCLARATL N REMOVE WOOD SHAKES, INSTALL 1/2 OSB & 30 YR. CO
3'S L underwnd my pians shall h n used a public me md$
t u. Licenssd Professional
h, OWNER-BUILDER DECLARATION MAY 0 5 2003
I hereby afron Nm de al 1 am emmpl from C-MOerora Ucenw Law for the
aO following mason.(Seetiun 703 L5,Business aid Pmfesolons Code:My City ar county
12 which requires a permit In conswm,elect.borrow,demolish,at repair any monum
-a�^ prim to Its Issuance.alsomsuimatheapplicantforsuchpermittofileasignedwiternnl
-
< thalbulelimnmdpurmanllanc�provisianenflhe Co0lrectork Llconss Uw(Chaptsr9 Sq.Ft.Floor Area BUILDING Valuation
.� (commencingwith SeNon70DO)of Division 3 ofthe Businessand probations Code)Or
Nat he B exempt discro m and the basis for the alleged Assumption.Any violation of
Section 7031.5 by any applicant for a permit objects the applicant to a civil Penalty of APN Number Occupancy Type
ons mart man Iiw hundred dollars(5500).
❑Las ownmarti pmpemty.urmyemployceswW andesastievaolecompensslim. 36943001 . 00
will do the,we&and meatocwm is not latmded or offered for sale(S=.7044.BWneu Required Inspections
and PmfeW mu Code:The Convector's Lmerue Law does not appy se An Owner or q P
pmpenywhobuildtooimprows menton.and whodoeeswh wort hlmWfor through his 305 - FRAME
owncmployw,pmvidee that such Improvements arenotiatmded oroRmvd retrain.If. .307 — INSULATION
however,me building or improvement Is within one year of completion.me owner-
builder will have the burden of proving that he did tot build or Improve for purposed 601 - ROOF TEAR OFF
602 - ROOF PLYWOOD NAIL
D 1.a owner of use Proper am exclusively mntmcting with licensed cams mom in
construct the projeci(Sm 7Du.Bain.and Profeaalons Cade:)The Convamora Ll- 603 — ROOF BATTENS
cenm Law doll not apply to to owner of property who builds or improves lhemann,and
, 604 - ROOF IN—PROGRESS-
whocommeuforsuchpmjeeswideA nvamortO licensed P..,to dm Convada'a
Lkenam Law. .
❑l Am exempt under See. .B k P C fee tids reason
OwnerDam
WORKER'S COMPENSATION—DECLARATION
I hereby Arron under penalty or perjury one of the following deduNom:
haw and will maintain aCeel6esec of Consent to self-insuro for Worker's Cmnpan-
cation,es provided foe by Section 3700 of the Labor Code,fm the performance of the
Wwork r which this pernit is issned.
it and will maintain Worhfe CompeauUon hoom nce,u required by Section
3700of the Lobar Code.for the performance arms wort for which this permit is 1—M
My Worker's Comp "tion annce carrier and Policy number Am:
Carder: Policy No.:1'3r3rbbu 2
CERTIFILATEOFL EMOTION FROM WORKERS'
COMPENSATION INSURANCE -
(This rection need not be completed if the permit is foam hundred dollars($100)
carless.) .. . ,; _ _ _ ._.. . . __. --
I c"fy that in the Performance of fee wort for which cola permit is Issued,I bull ata
cmpioyanypcmninuymonerwumbecomembjwltathe Work WCMPe don ,
Laws of California.Date
Appllcam
NOTICE TO APPLICANT:IL after making thin CeAECate of Exemption,you should
become subject on the Worker"Compensation Provisions of the Lahr Code,you mull _
,J O forthwith comply wife inch provisions m this Permit that]race deemed myelo1. .
CONSTRUCTION LENDING AGENCY - -
�-m l hereby affirm that them is a construction lending agency for the Performance of -
LYs the work for which thin permit Is instead(Sec.3097,Cih,Q
WM Q Lentlers Name
P z Lenders Addmu
()0 1 cenlfy that 1 Iuw read this Application and nam that the"bow Information is
pry torten.I apce to comply with all city and county ordinumes and mec Lew mlating On .
C building co mumloo and hereby authotim tepmonratiwa of this city in eater upon Oe -
W shove.mentioned proper fm inspection purpoeca
(We)agree to new,indemnify and keep harmless the City of Cupcnitw Against
�y f4iq liabilities,judgments,costs and expense"which may In any way atom against mid City
V 2 In conwq an.of lM Nn ling of this roll. 7
Ll APPLIC NT UNDERST S A WILL COMPLY WITH ALL NON-POINT Issued by: Dat
SOU RE ATI
Re-roofs
ignar of ppm I Data
H RDOUS MATERIALS DISCLOSURE Type Of Roof
WDIdeapplicam, rforumbuildingacctepolaceswMndlchuudow MAWW
defined by the Cupertino MuniCI I Cade.Chapmr 9.12.and the Health and Salary
ode,Sued.25532(x)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yet u
WIII theApplicant m future building Occupant am equipment aPdem et which If a roof is installed without first to ping an inspection,I agree to remove
rss
b
It rdow ole conlaminmu as toed by the Bay Area Aim Quality Management aAnewmaials for inspectio
It
.e
❑Yea u
Ihave me
NJ"HesWB ey Cohdae,saSreMetiarmqulemenuundeurn6.95 mG
mul end2553d.1warAnftirbuiaint
mnot oilyNw a m 1
6my feasibility tonofify oce.faant ofthe
�^
meq in, c Ic a mto hauenceofa Cerillmatiorpicupancy, Sign U Of mpliori Date
owm a m ado ami em All roof coverings to be Class"B"or better
M-101
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
pCITY OF' Telephone: (408)777-3228
CU T Ek71N0 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:
Roofing Company Name: HC.
A plicanYsSignatu Date: .U3
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper