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04020144 CITY OF CUPERTINO BUILDING DIVISION PERMIT CONTRA. tOR'L.N ©xtM TIUI� $ BUILDING ADDRESS: WAGNER ROOFING CONTRACTORS "W"04020144 OWNER'S NAME: PERMIT ISSUE DATE DA - ONE: SANITARY NO. CONTROL NO. ARCHITECTIENGINEER: BUILDING PERMIT INFO CM ELECT PLO MECH O il866 LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm Net 1 am licensed under provisions of Chapter 9 fmmmancing Job Description ^� with Section 7")or Division Sof the Bu,tncu and PromessicurigCodo,and my lice..is in full force derfaa.C3 L;a, 2 REROOF � ? Lice se Clui O nit, Dam —sis' nBCTSUEcu oN T/0 SHAKE, INSTALL 50 YR. CLASS "A" SHINGLES, rya IunticntanJ my plana ahallMu.J as p crtcaod 430 ASTM W/OSB �yU ;a Licensed Profcaslonal OWNER-BUILDER DECLARATION E 0 f I hereby.(firm Nat 11. exempt from the Contmmoos e:Any c taw for the p0 which mgarson.Permit e 7031.5.mBusiness and Pmfdeimu Code:Any city or county $ which its a permit re cores the alk.hnpmsu h permieh,'.pair ed tweent g:4 a prior to intcenseissuance,r6ant to the pre ilio ofnt memmutes Licensele a Law(Cha mem FF ss< that he cing wit pursuant loth))of Division of the eun.mhnd Pro Lions Cost)at Sq.Ft. Floor Area Valuation rAF$ (ammencinampthherefromon and the basis fro(theed Business pion.Any Code)ur Net he it 31.5 b therefrom and the hula for be alleged exemption.Any violation of Section thorn by any applicant for a permit aubjeeu Ne applicant to a civil penalty of APN Number Occu ane Tf��,� e not more Nan fie hundred dollen(5500). p y ']I3 ❑Luhe work, the sures ur myemployees wtthwegesatheirao..ampenatinn, will dolhework.ands:The ort lsnots LuxutleLaw does 7044.Business 0 Required Ins C�Ct�TIE and property who bar Code:The Connacmeh Liana law docs not apply m rt oust is q p 'N own crtywycos, ro ided thowa the.orandwh9 tlas,uchw'khimalfmrNrough his ^1.� ownemployees,provided provehimprowmantarcne year fc9roQered Intends.if. 4 however.Ne have ifte m improvement is hold within o'year completion,the ow'r- builder will hew Ne burtla of proving that he did not build ter improve for purpose of ant,, MAR El 1. 9 200 4g 1,as owner of the property,am exclusively connecting with licensed aac ntren to construct the project(Sec.7044.Business and Professions Code:)The Conlraceri Li. came Law dean not apply to an owner of property who builds or improves daemon.and, t�,I'.(D1�It w who comment for men projecnt .Nm with a contractor(&)licensed pursuant Concmrs Vv Lice se Law. ,r ❑Iamemet,a mico Sec ,B&PCf'thisroarom Owner Doe WORKER'S COMPENSATION DECLARATION 1 hereby a0lmt under penalty of perjury one of the following declarations: I haw and will maintain aCenifiate of Consent to self-Insure for Worker'sCompen- mine,as provided for by Section 3700 of the labor Code,for the performance of the work for which this permit is issued. ❑1 new and will maintain workmen Compensation Insurance,as required by Section 3700 of the labor Code.for the performance of the work for which this permit is banned. M Workers ore .sari d�nsun eerier and Pali number ma: c.m r:5 "my No(b0013 CERTIFICATE OFEXE1 FROM WORKERS' COMPENSA INSURANCE (Thu section need not be completed if the Permit is foronc hundred dollars(Strap leu.) 1 ecnify that in the performance of Ne work for which this permit is issued,l shall not amploy my perm.in my manner so ss be become subject o the Workers'Compensation Law,of Califerola Date Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to to Worker's Compensation provisions of Ne Labor Code,you meet .Jz forthwith comply with such provisions'this Permit shall W deemed revoked. OCONSTRUCTION LENDING AGENCY (—i Ihe.hyeRimr Out then is a construction lending agency for the pounorr enauf Cls > the work for which this Permit is issued(Sec.3097,Cl,C.) W 0 Lender's Name z Lander's Address V Q I certify that I have read this application and site Net the above information u F counsel.I agree in comply with all city and county ordinances and some laws mlming to pU building convection.and hereby authorise represanutiws of this city to enter upon the W a1mve-mentioned properly for inspection purposes. gL (We)agree m ave,indemnify and kcep homerless the City of Cupcnino against wy fn liabilities,judgments.coats and expenses which may in any way accmc against aid City V z in comet, nee of the granting of this reit. ^� APPLIC UNDERSTANDS A D WILLCOMPLY WITH ALL NON-POINT Issued by: Dat SOUR REGULATIONS. D Re-roofs r4 ApplianV — &Z Connac or —'\> Dame HAZARDOUS MATERIALS DISCLBSURE Type of Roof WIII the applicant or forum building occupant store or handle haveromm mamdal as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety Code.s)).den 2ss3x(aYr All roofs shall be inspected prior to any roofing material being installed. �Ycs 19 Will mho applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove mit havatdme.air contaminants ss defend by the Bay Amo Air Quality Management all new materials for inspection. Dimict7 (� ❑Yes �IwU l have mad the hvmdours materials requirements under Chapter 6.95 of Use Cedifory nia Hcalth&SafetyCodc,S6=25505.25533md2s534.1undcnwrote tifdw building dors no rcntly haven scant t it is my nmp9nsihiliiy m notify N '..pent of Ne requi ma winch most a noreismalk, aCcrtiOcatoorOccupancy. 1 tur ofApplic t Date oar nthmrixmd ascent Darin All roof coverings to be Class"B"or better Community Development 10300 Torre Avenue j,; j Im Cupertino CA 95014 Telephone(408)777-3228 CITI OF Fax(408)777-3333 OUPEkTINO Building De artment JOB ADDRESS:, / PERMIT # a1155 D UYe���X Dr , �v er t lVtc7 OWNER'S NAME: RAL) GENERAL CONTRACT lq� O F! C FAX # I am not using any subcontractors. O 2- 2te u Signature � Date Please check applicable subcontractors and complete the followinginformation: 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 Rock Tile c O2 � Zo /Owner/Contractor Signature Date 10/28/03 1 . J 103= taproom,cA zdoom: ((40)7"-=)7"-=lm-see CUPE1tTINO PW- ` l'T'�"g Building Department subject: R.MooftS policy for the City of Cupertino. I. ato permit hqualoC and � agnea to comply with 1997 UBC Standards 2 men:Ne oovedngs dull not be applied first obtaining aU � written approval from the bsdldhsg inspector.A final inspection and a ahallshall be obtahsd irons the building kwpectw when the reroofing is & All roots ahaff be hvgm ed prior to any roofing hftUagao„ 4. To receive a&+d . sign an[roan the City the following are 1 steps Preinepectlaas and/or tear off approval, 2) In pmgm&inspecdM approvaL 3) FhW inspectionXPROVaL a) Spark arrester installation. 5. If plywood is instalL4 a plywood riff inspection 6. Any roofing which is applied without first obtandug V inspection,will . require the M novel of aff naw material down to the sheathing so that the proper City inspacti a's can be podoxmed, D"ORTANTs 1. Flat roofs must have a minimum of%w per toot slope and demonstrate fiat there is no ponding, 2 An LC.aa z%mt is requimd to be an"job site at the tins of inspection. We understand the above policy an reroofing and will comply with this policy. Homeowners Name: /2/4-o DaY 4-W-re vL Address: 2//s—s &4t L,4,44 ,44 21 u£ A oonng Company Naas: Av Appliance Signaturm Q 9 JAnton ned (Chief Building Ofiidai) • a2soi CITY F OOF PERTINO' COPE iNO PERMIT APPLICATION FORM APN M 26 sJ Date: a - L Building Address: S' £ G a/O Owner's Name Phone M: DI h P v-r 07, Contractor: Phone fr License ff: -777. 8331 to-791Z.8 Contact: Phone#: Cupertino Business License M: .5'. ,a�„//� 777-$331 Type of Root Covering: lErdsd g: Proposed: O Byilt-up Roof O Built-Up roof D�Saplwlt Shioales O Asphalt Shiagles f!' wand shakes o wood shakes a wood Shingles O wood Shingles 'rcf%"14' O Other(Specify) Q--'Other(Specify)G.L..�As5 tf.a,".GS� s j�sSA Number of existing coverings O Provide I.C.B.O.Report M t/L.at 492 O To be Removed O Provide Mfgr.Jmtallation Specs. I Have Read,Understand and Will Comply With Cu 'no's Tear Off Policy: Job Description: /2awrove. s;A.4Acc ogano C. jwS // ,v&v -,$s yr e/frc *;I4vr,:oe• Sh u to44 111 t,PF .30 q s:w/ rv."A 3sl3 As-4/�+-to Residential Cr Comte tel ❑ F74sL•�S� Fire Zone: Yea ❑ No Confirmed with Planning if / there are any restrictions- Cost of Project: =IS Type of Coos o Occupancy group: / 0 Qty. if A lic Fee ID Fee Description Fee Group BPERMFEE Bldg Permit Fees BUILDING BENERGY Energy BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUn DING BPLANCHK Plan Check Fee BUILDING BUSLIC Business License BUILDING T-off Scln�wlF csro ✓ rKo.v Z-Z3- toot-/.