03010188 CITY OF CUPERTINO s "'•'int °fes "nom�^ '?,.„ . '
BUILDING DIVISION PERMIT -CONS CTOR INFORMATIONN
ENDING ADDRESS: WAGNER ROOFING CONTRACTORS FINE NO,
10384 MELISSA CT clioinisp
OWNER'S NAME: 12242 SARATOGA-SUNNYVAL RI ykPPLICATION SUB DATE
PLUMLEE DONALD E AND PATRICIA01/28/2003
IONS: (408) 777-8331 SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECII
(� t�
LICENSED I am hNTR ACEI DECLARE chap 1N^
t ION
1 hereby affirm that I am licensed under mvisiom of Cbapmr l(commencing C b�DjyQ[tOn
Nz with sari n]IXX11 of division 3nf NCBusin. nJProfcvsians CM. nII license is r `i`�g(Y7
H ntul caw cm. — REROOF
z0�4 Licen. lane- Lic.M
Ott, Law Dam - Grant�s,to) FEB 1 0 2003
qq,� AR'Ii1TECI\S fj,aPW,ARA'ION
M
1understandmyplansshall beusedaspublicrecords
BUILDING
FLL0.� Licensed l'mfcssional
OWNER-BUILDER DECLARATION
.°'' 1 hereby affirm that I am exempt from me Contractor's License Law for the
a a 0 following mason.(Section 7031.5,Business and Professions Code:Any city or county
Which requires a permit m convect,alter,improve,demolish,or repair any structure
of
Fz< prior to its issuance,also mimics the applicant for such Permit o file a signed statement
that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area $10)&"tlon
y+�0 (commencing with SectionNX1)of Division 3 of the B minas and Professions Code)or
y that be is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant m a civil Penalty of
not more than r.hundred dollars(351X). 6 Occupancy Type
❑1,a owner of the property,or my employees with wages as their sole compensation,
will do the work,and the suuctua is not intended or Offered for sale(Sec.7044.Business - g
and Pmfeseions Code:The Coshocton.License Law docs not apply to an owner or 307 - INSULATM{fd Inspections
property who builds orimpfoves thereon.and whudoesnuch work himselforthmugh his 601 - ROOF TEAR OFF
Own employees,provided that such improvements are not intended oraRered forsale.If,
however,me building Or impmvemenl is sold within one year of completion,the Owner.
builder will have the burden of proving man he did nos build or improve for pugwx of 602 - ROOF PLYWOOD NAIL
.)a')' 603 - ROOF BATTENS
El 1.as Owner Of the property,am exclusively contracting with licensed convectors to 604 - ROOF IN-PROGRESS
construct the Project(Sec.7044,Business and Professions Code:)The Contractors Li-
form Law Joos on apply to an owner Of P,,,,,ty who builds or improves thereon,and
who comracta for such projects with a conuactoos)licensed pursuant to the Contractor's
License LAW.
1 am exempt under Sec. B&P C for this reason
t
Owner IK Date
"..WORKER'S COMPENSATION DECLARATION
1 bemby in.under penaltyof perjury one of she following doclabroso s:
El 1 have and will maintain a Cer ifcate cremation to se,11'mount for Worker's Compete
sation,a provided for by Section 3700 mf the Labor Code,for the performance of the
work for which this permit is issued,
❑ 1 have and will mai main Worker's Compensation Insurance,as required by Section'
371X0 of the labor Coal,f or me performance of the work for which this permit is issued.
My—Worker's C n roof nlns me cco/Ificr an Policy number art:
CamXM; NfK P 'y NO116 15 �4rti�
V✓ CERTIFIC TOE CKRM NFROM WORKCRS'
COMPENSATION INSURANCE
(This section raced not be completed irthe Icon it is for one hundxd dollars(SIBS
ar less.)
I certify that in the Performance of the work for which this permit is issued,1 shall not
employ any Person in any manner so as to become subject o the WorkersCompesnation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:11,slier making this CemiOcam Of Exemption,you should
become subject to the Worker a Comprosetion pnwrsions of the labor Code,you must
OO forthwith comply with sue h provisions Or this permit shal l be deemed tevnked.
z = CONSTRUCTION LENDING AGENCY
(+ I berehy affirm that Nero is a construction lending agency for the performance of
CL t> the work for which this permit is issued(Sec.3097,Civ.C.)
1 Lenders Name
.7 Z Lender's Address
U O 1 certify mal 1 have read this application and sum that the above information is
Fcorrect.l agree to comply with all city and county ordinances and state laws relating to
U building construction,and hereby authorise representatives of this city to enter upon the
W abnvo-manhonwpmpcst rand expenses purposes.
(Wc)agree to save,indemnify and keep harmless the City of Cupertino against
J Z inconsequence f the costs and expenses which may in any way accrue egutat said City
U z A consequence of UNDERSTANDS
of this permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH All.NON-POINT Issued by: 67a Date
SOUR .RE 1 TIONS. -
Q Re-roofs
om
lType of RoofS' m of pplicamUAC2ARDOU ATE-RIALS DISCLOSURE at
wildingccupxtl swicor handle bvsrdous meteraWilt Jetpplicant or fm
as defined by the Cupertino Municipal Code,Chapter 9.12 and she Health and Safety
AIJWodc,
ityis25532O)7 ❑NO All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future wilding occupant use equipment m devices which .If a roof is installed without first obtaining an inspection, I agree to remove
I hasumoux air contaminants as defined by the Bay Arca Air Quality Management, all new materials for Inspection.
District?
❑Yes No
I have mad the h osrdnus materials requirements ower Chapter 695 of the Califor.
nix Ileahh&Safety Cute,Section 255115,75533 and 255V tun ionand Jut if the building �Gp
Jens not curie al,have a tenant,that it is my res,tommi ty m wry 0c tccupaat Of the 14
myui moy musth me 'nnoiauanccOfaCc am (Occupancy Ssdna( r of Applicant Date
w o o authorized agent
17 "PP/'
Dot All roof co rags to be Class "B" or better
CUPEI�TIm No
Td*O= (4rye
lac40�,,,.0777-M .
Buil
ding Department
t3pbJece: Ruccaus Poug for the(may of herd"
1. Prior to permit
2 ,Ne , Inuenci �on PIY�+'itt 1997 vBc Standard,
Ind w� �� ing+ildwithout fire!obtahft au inspection.
approval scull be obtained isom A final ft pece�and
completed +8pec6or when the reroofing
Is
a Allroofs shall be ineRMted prior to any roofing dation.
4. i o receive a&W sign ogfim the t�ty the
prahwPectfcm and/or proval Bt"are required
s �
5. If A) �k��rinawkticat
ywood
6. Any?00ftd.
B sa le appy v4d'Out first���u an ml.will
• require the removal of aII new material down to the sheathing eo that the
_ ProPar City MSPOctl6a an be perfaaaed.
IMPORTANT:
th�ere � a of A"Per foot slope and demonstrate that
2 An LCB.O.rgxvtis=Mrsd to be an the Job site at the time of inspection.
We understand the above polky On reroofing and wM amply with this polity.
Homaowrmre Namur Ins
Address; / o2 S ysSa ti
ReroofingCoatpemy N ivE /1,,.,�'>v
Applicant
m; ZA Lw 3
Q �
JAntonucci
(Chief Building OfiidaD
N17A1