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BUILDING DIVISION PERMIT.CON112ACTOR
INI'ORMA7JON .
BUILDING ADDRESS:
WINTER ROOFING INC
PeRMITNO04040090
OWNER'S NAME:
PERMIT ISSUE DATE
KATHLEEN MITCHELL
4
ONE:
SANITARY NO. CONTROL NO.
4083638052
ARCHITECT/ENGINEEK
BUILDING PERMIT INFO
BLDG ELECT PLUMB MF,CH
LICENSED CONTRACTOR'S DECLARATION
]pts Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9 (commencingj��
With Section 70AB of Divisian3 of NC Business and Professions Cade. and my license is
4jt'"�'` 5YALED
m full form and cffca.
Licen elaza C3 y Lie.. _ O
REROOF
Date
l�i��t f
MAY 1
Y ' 004
RCHITECTS DECLARATION
l understand my plans shallbe used as public records
BUI
Licensed In fesdnnal
OWNER -BUILDER DECLARATION
1� !e ®IN(a
I hereby affirm that 1 am exempt from for Contractor's Low for the
fallowing reason. e: Any c
]IDIS. Business andmpr rands Code: Any city or county
ve. d m any
which requites a permit improve, tle
Warms t enmlrueh alter,applicant
a790
prior its sensed e, also re Permit t e a rp nater of
the the forthe sucCoh permit toicense
FL Floor Area
that hre
License Law(Chaper9
e pursuant to Law (Chapter
pursuant to the ovisiosor
Nalbermin,
Sq.
..Valuation
bheCamm<mrt
oro with of Division exe and n
vi codon ar
exe with scadran nand of O 3 of rhe Btaialleged
osis f on. Any
Nat he is exempt Nertfrom and Ile basis for Ne alleged cscmption. Any vialmion of
d a is y
32+1 &&iR*cr00
Occupancy Type
Section ]011.5 by any applicant for a permit subjects We applicant o a civil Finally of
not more than five hundred dollars IS 500).
❑ I, as owner of the property. Lir my employees with wages az their sale compensation.
Required Inspections
will do the work, and the soucture is not intended or offered for sale (Sec. 70414, Business
and Professions Code; The Comacror's Liccrrse Law Cases not apply to an owner of
property who builds or improves Ncrcon. and who does such work himself or Ihmugh his
own employees, provided that such improvements arc not intended or offered for sale. If.
howcveq the building or improvement is sold within one year of completion, the owner -
builder will have the border of proving that he did not Wild or improve for poO n e of
sale),
E] 1, as owner of Ne proPeny, am exclusively contracting with licensed convenors to
consumer the project (Sec. 70x4. Business and Professions CWC:) The Contraaori U.
rue Law Juts not apply to an owner of progeny who Wilds or improves Werman. and .
who contracts for such projects with a contracmr(s) licensed pursuant to the Contractor's
Liten¢ law.
1 am exempt under Sec. . B & P C for this reason
net Date
WORKER'S COMPENSATION DECLARATION
I hereby af0am under penalty of perjury Linc or the following declarations:
1 have and will maintain a Cernmeate of consent to selpinsure for Worker'sectarian
xalien, as provided for by Section 3700 of the Labor Code. for the performance of the
work for which this permit is issued.
ave and will maintain Worker's Compensation Insurance, as required by Section
UO of the Labor ewe, for We performance of Ne work for which this permit is issued.
My Worker's Comp; sation Insurance ca icr and Policy number am:
.JJ
Cartier. Policy No.: CJCCNY�
ERTIFICAOF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This sectionnecl nolhecompined iftbe permit isforonchundreddallars(5la))
or less)
Icomfy Nat in the performance of the work for which this permit is issued. l shall not
employ any person in any manner so az m become subject to the Workers Compensation
Laws of CaliB,rnia. Dale
Applicant
NOTICE TO APPLICANT: If, after making this Ceraficam of Exemption, you should
become subject to the Worker a Compensation provisions of the Iahar, Codc, you must
mnhwdh comply with such provisions or this permit than be deemed mvoked.
CONSTRUCTION LENDING AGENCY
,
I here by affirm that the or is a construction lending agency far the Performance of
Ne work for which his permit is iemed (See. 3099. Civ. C.)
Leaders Name
lender's Add.
I really Oat have read this application and state that But shove information is
Correct. 1 agree to comply with all city and county ordinances and slate laws relating m
building construction, and hereby authorize rcgresematives of Nis city to enter upon the
above for unityionpugmscs.
(We).mprogeny
Io save, indemnify an keep harmless the City of Cupertino against
(APLICN
see
habmenls.<osu sad exporse hich may in any way acerae against said City
in Cc of the graining This rmil.
UNDERS"TA A WILL COMPLY WITH ALL NON -POINT
Issued by: DateGUL
ONS
Re -roofs
Type of Roof
si res m pp a o Dao
HAZ ut o S MATERIALS DISCLOSURE
ill the applicant or future building occupant stare m handle
Heart and Stormy d
the Cupeninn Municipy.Code. Chapter 9.10. antl the Health and Safely
Section
C. Sorrier zss3zea)2
All roofs shall be inspected to any roofing material being installed. "
❑ Yes lfrYr�(/
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future building acupamuse equipmenlordevices which
it hazardnus air crnmminams as defined by the Bay Area Air Quality Management
all new aterials for inspection.
isriCt? —/
Y< 6Ln
I hav mad NehanNres mamrialsrequi ens under Chapter 6.95 of UC Califoo-
ni Hcalt & amly Cade. Section 05.25533 123534.1andembanduratir Nc building
does n cu •ntly have a tenant, it my spunsibil'uy,, mtdfy the occupant of Ne
) c
mc, coser a Ibem IF cenr.cemfs,imofCCCu,Wmy.
^Date
Signa reo Appli nt P Date
All roof coverings to be Class "B" or better
ow
erora horizedage
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
i
/ on ctor Signature
J/,/-
Date
60
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 Vck
Til
i
/ on ctor Signature
J/,/-
Date
Community Development Department
Building Division
jr. City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
CITY OF Fax: (408) 777-3333
CUPEkT1NO
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.
Homeowners Name: �ni- 1. ' ( I Irp 11
Job Site Address:
Roofing Company Name:
Greg Cgiteel
Building Official
Revised 1/30/03
Date: _4L—A5- -41�*-1
S
cin of
CUPEkTINO
CITY OF CUPERTINO
REROOF
PERMIT APPLICATION FORM
APN #
Date:
Building Address:
—�
Owner's Name:
Phone #:
Contractor
Phone #: License #:
Contact: /
Phone #: Cupertino Business License #:
9420
T pe of Roof Covering:
Existing:
Proposed:
❑ Built -Up Roof
o Asphalt Shingles
Cl Built -Up roof
0-1V-ood Shakes
&Asphalt Shingles
C3 Wood Shingles
El Wood Shakes
13 Other (Specify)
❑ Wood Shingles
Number existing coverings
13 Other (Specify)
13 Provide I.C.B.O. Report #
L3 To bea Removed
❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Com 1 With Cu ertino's Tear Off Policy:
Job Description:
V /
Residential ®'
v
Cpow
ommercial ❑
Fire Zone: Yes ❑ No 0—
Confirmed with Planning Det. if
Cost of Project:
there are an restrictions: LJ
Type oCCapstruction: Occupancy group:
r
42
Fee
Permit
Res
Fee
,3etsrmc k.ommercral BUILDI
BPLANCHK Plan Check Fee . trr nT
BUILDING
1 /197.0