04070187 CITY OF CUPERTINO " "� 777, w� �7
BUILDING DIVISION PERMIT Ci1NRACORINFU1tMATCIN
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BUILDING ADDRESS: WING' S ROOFING INC PFn""04070187
•OWNER'S NAME: PERMITISSUEDATB
^ GENERynmpy
ONE: TRSANITARY NO. CONOL NO.
i
ARCHITECTIENGINEERt BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
LOo LICENSED CONTRACTOR'S DECLARATION Job Description 1 cM y eflirm that I am licensed under,yymviuom of Chapter 9(commencing p ,�]
wishs 9IXIB)arDlvisihm3ofdm Businmfebd tufa ons Co rad my he..bis 'w�
n�� inffo a rce ✓ J/ REROOF W/PLYWOOD/SHINGLES �Q
j�Z Lo., 1 s Lie.
tgq Datc Gaalr �� qOO4
a A CHfIBCI'S C Ah-
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7 1 umor muni my em.hall k used as puhlio n:cnNs. p
u. Licensed Professional
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OWNER-BUILDERamemptDE me Cont ION
1 Maso alum on I em mempt from the Contractor's Cc License Law for IW
p0 whichfollowing im imports
Permit
]onstr B,Alan,smrove,de ium Co dc:Any city as county
which requires a permit m construct,slur,improve,demolish,or resale any structure goon
prior in its issuance,also requires the applicant forauch permit a rile a signed statement
stG the,he is licensed pursuant to the previsions of the Communes License Law(Chapter 9 Sq.Ft.Floor Area Valuation
t$ (commencing with Section 70001 or Division 3 o(me Busincssand PM(essinna Code)or -
'3 Nat he is emempt IkuOom and the basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3 3%Y213tcr0 0 Occupancy Type
not mom than five hundred dollen($500).
❑I,umneroftkpmpmy,mmyemploycowiNwagesulklrmlecampenwtion,
will do Newark and the mumure is notinrended Affiliated forsale(See.701 Bualneas
and Profusions Code:The Contractor's License Law done not apply to an owner of Required Inspections
progeny who bui Ids or improves motion,and who does such work hi mulf or through his
me emplayces,provided that such improvements art nothminded aro@red formula If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not Wild ar improve far purpose of
tile.).
❑1,as Owner of the properly,am exclusively contracting with licensed contractors to
construct the pmjem(Sec.7044,Business and Professions Cade:)The Commoners Li.
cense Law data not apply to an owner of property who Wilds or improvise Ihemon,and
who contractsfor such projects with a contractor(s)licensed pursuant in the Co eactar's
License Law.
❑I am exempt under Sec. ,B k P C far this moon
Owner Date
WORKER'S COMPENSATION DECLARATION
I hemby affirm under penalty of perjury one of me fallowing declarations:
I have and will mainuin a Certificate of Consent m sel6411ure for Worker's Compcn-
utian,as provided for by Section 3700 of me labor Code.for me perfmmma of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of me Labor Code.for the Rorma cartheworkfor which this permit is issued. ,
My mker' Co pen aline le n e ca 'erand Policy...ts,
Ca LQ Policy No.: Lta '
CERTIFICA F ON FRO ORKERS'
CO PEN ON INSURANCE
(This section need not k completed tribe Permit I.fnronchundmd dollars(5100)
or less.)
I anify that in the perfmarmncc of the work for which this permit is issued.I shall not
employ any person in my manner an a in become subject a the WorkeraCompensation .
Law.of California.Dale
Applicant
NOTICE TO APPLICANT.IL after making this Cenibcate of Esemption.you should
became subject in the Workers Compensation provisions of Inc Labor Code,you must
fanhwith comply wire much provisions or this permit shall k deemed revoked.
'Z y CONSTRUCTION LENDING AGENCY
[—c l hereby alfm lhal mem is a construction lending agency for the Performance of
RS c7 IW work fur which this permit is issued(Sec.3097.Civ.C.)
QLender's None
D z Lender's Address
U O 1 certify that I have read this application and state that the above informatiun is
Ii r correct.l agree to comply with all city and county ordinances and state laws relating to
0U building conswction,and hereby authorise representatives of this city of enter upon One
[Id ahovc-mentioned pmperty for impaction purposes
F G (We)mg.to move,indemnify and kap harmless me City of Cupcnino against
TA Imbilities,judg nts4mtsand capemes which may in any way seems against mid City
inconsequence the granting of this permit.
APP I ANT U IDERSTANOS AND WILL COMPLY WITH LL NO DINT Issued by: at
SOU ER GU. IONS. r/v/'f�
404e Re-roofs
Signist A icmV ant cmc A Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupmt store or hamilc hammous material
As defined by Om Cupertino Mun'ipeI Coit.Chapter 9.12.end the Health and Safety
Code,SCNon 25532(.)? -Q,Jt.� All roofs shall be inspected prior to any roofing material being instill ed.
❑Yes �nu
Will the...lic.m or fumrc building occupant use equipment or devices which If a roof is install d without first obtaining an inspection,I agree to emove
mit Im.COCA air conal anis as defined by the Bay Arta Air Quality Management all new materials or inspection.
District?
❑Yea Nu y /
Ihevc mad the hoe rdnus ateriala mquimmenu under Chepmr6.95of me Glifor- / 1/// O
nice Health ASe(ctyCoO tions 5505,25533 and 25534.1 understand thm if lk Wilding l/
does not cu rad hove a ant.Net it is my rcsponsihilily m notify I e occupant of c
myuiremcn wh' m t cl prior to issumcco(a Cenlficzre of u m SI atUC Plicae \ Date
6 All roof coverings to be C~"B"or better
Owner ser+Yted a t Date
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
CITY OF Fax(408)777-3333
#MkTINO
Building Department
JOB ADDR S: OMIT*
7�
OWNER'S NAME,/
#
GENERAL CONTRA TOR: p F #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the followin information:
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 AJ
Septic Tank
Sheet Metal
Sheet Rock
Tile
Vn /Clkractcr Signature \Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
UPEkTINO
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: ZC) (� '� C C
Roofing Company Name:
A plicanYs Signature: ` Date:
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF
REROO RTINO t7
CUPE�NO PERMIT APPLICATION FORM
APN # e r /S� a )�/ Date:
Building Address: zo / > � n
Owner's Name: y l' I Phone#:
Contractor: V� Phone #: License#:qaq
Contact: Phone #: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑� Built-Up roof
ri/
❑ Asphalt Shingles Asphalt Shingles
,A Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide LC.B.O.Report#
To be Removed ❑ Provide Mfgr, Installation Specs.
I Have Read, Understand and Will omply With Cu ertino's Tear Off Policy: ❑
Job Description:
Tlo W oS a�Q. Zh�� v" tff Residential Commercial ❑Fire Zone: Yes ❑ No Confirmed with Plannthere are any restrictio
Cost of Proj t: Type of Cont i n• Occupancy group:
y. i f
,KpplVaJj1 Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
�ilj3Ld BUSLIC Business License BUILDING
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