03110045 'CITY OF CUPERTMO > '"rs> at yw '`.a' ^ 0";A�
Bu1Ln1Nc DIVISION - PERMIT FyFORMw
MATION
BUILDING ADDRESS: WAGNER ROOFING CONTRACTORS PMtH003110045
OWNER'S NAME: 12242 SARATOGA—SUNNY,VAL R PERMIT ISSUE DATE
SHEPPARD WITITAM 14 ANT) DIA IF, 11 /10Z 003
°NE' (408) 777-8331 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I� o 0 0
OO LICENSED Emorad under
DECLARATION
I I hereby affirm that I em rBo,Bu under and
Paiva of Chapter 9(commensi is Job DCSCTIPIIOn
ii in
With Section 7IXIU)ofpivixion3of NC Buxi�ae seW Professions Cnde.endmylicense is
s<d Lifuli force o d fife ✓y e
Licenu Cla J�' — Lm,xra( (e7�Z'� REROOF A
e- DpN !O O
ARCHITECTS IgEeCARATI �INI�'a L D
1 understand my plans shall M used as public records
>yU 11 �]
eu.0, LicensedPmfcssiunsl Nov 1, ? ZU03
50.ac OWNER-BUILDER DECLARATION
0 0 1 hereby affirm on 11. exempt from she Contractor's License Lew for the
p o following reason,Permit
t IlDLS,Business and w,demolish,
Cole:Any city s county
$� which requires a permit rat construct,nlmr,improve,Jcmnlixh,nr repair any xtrunum
Ricon
zi prior us its issuance,star)requires he applicant far such Permit to file a signed statement
o that he is licensed pursuant it)the provisions of Ne Contractors Limmic Law(Chapter 9 Sq. Ft. Floor Area ation
$ (cnmm uclos with Section 7000)of Division 3 M the Business and Limitations Came)(it
that he is exempt therefrom and the.bau for the alleged exemption.Any vinlellan of 36212026 . 00
Section 7031.5 by ams Apple.,far a Permitsubjccts in.applicant la a civil lcnahy of APN Number Occupancy Type
nos mom than fire hundred dollars($500L
P Y YP
0 1,As owner of the property,or my employees with wages As Neil$ale compensation,
will do thework end Ne smaco m is nos intended or offered far ails(Sec 7044,Business
and Professions Code:The Contractor's Licenu law docs not apply to an owner of Required Inspections
property who builds or improves themon,and who docs such work himself orthrough his
own employees,provided that such impmsemems see mol intended oroffcfed fmulc.If.
however,the building or improvement is sold within ane you of completion.Ne Owner.
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑I.es mote,of to property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Coda:)The Comrutor's Li.
cense Law docs not apply to an manor of property who builds or improves thereon,and
who contracts for such projects with a eommctogs)liC4ved purauanno the Contractor's
License Law.
❑ l am ea1em.p't under Sec, p� ,B 6 P C far thb mann
Owner WPI I[../�w.v. Date (4/10/0)
ORKER'S CO ENS ION DECLARATION
I hereby affirm under Penalty of perjury one of Use fallowing daclarations:
I haus and will maintain a Cenifcmu of consent to sclbinsum for Worker's Compere
A
s
u provided for by Section 3700 of the Labor Cade,fur dte performance of the -
rk far which this permit is issued.
I have and will maintain Worker's Compensation Imuri nes,a required by Section
W of Ne tabm Code,for the perfmmance of the work for which this permit is issued.
Workcls Gram nsetfon lnt�'J'ttcamicnndPolicynumbcnrt:
unce: f T �1'cLhJ'f Policy No.: am 1*0—�7
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not he comptemd if the Permit Is intone hundred dollen(Slip)
M leas.)
1 comfy that in the prof imance of the work for which this Permit is issued.I shall not
employ any person in any manncru as to amount subject to be Workers'Componsadon
laws of California De¢
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
became subject to she Worker's Compensation provisions of Ne Lahnr Gude,you muse
�,Z forthwith comply with such provisions or this permit shall be deemed mocked.
z O CONSTRUCTION LENDING AGENCY
I herchy affirm that there is consuumion lending agency for the performance of
> the work far which this permit Is issued(Sec,3097,Civ.C.)
yQ Lander',Name
Dlanding Address �.
J 0 1 certify that 1 have read this application and sum that the above infmmmiun Is
W j.. correct.I agree to comply with all city and county OMMIA S And,mm law,relating to
p U An..ngcons ad pro it barely auNonp reprraenutim of this citymenter upon the
4k) ehovc(We)agre in save(m inspectionpurposes.
gy (We)agree m ave,indemnify and kith harmless the City of Cupertino s against
N liebilin macurm,of ts.0.gratsind expmues nit, may In any way smut against said City
U APPLICANTeUNDERSTANDS ng of Lhis AND WILL COMPLY WITH ALL NON-POINT Issued by: Date /7
SOUR REG LATIONS.
///0/0 Re-roofs
Signsturc of Applimn"Commemr ate
HAZARDOUS MATE DISCLOSURE Type Of ROOF
Will the applicam ser fuwrc built' _,upenRmm or boodle har4Nuus material
As defied by the C.,m, Munici Code,Co.
9.12,and the Health and Safety
I.Lcom. Ever zss3xan. All roofs shall be inspected prior to an roofing material beim
❑Yes " P P Y g g installed.
Will the applicant or future building arupant rote equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
it hmardons air contaminants a]fond by the Bay Area Air Quality Management all new materials for inspection.
ouit"
❑Yes
[have mad the ha>L, materials requirements under Chapmr 6.95 of the Califon
nia I lealth&safety Crede,Sections 25505.25533 and 25534.1 undersand thuif the building D
Jena not eu artly hoc a¢rant.that is u my responsibility m mtufy the nxupant m the 1 /
�yrequirements which must he met Prior m issuance of a Ccnificate of Occupancy, gra re of Applicant Date
\ T_
Winer atnanmdagtr, ,m All roof cools rags to be Class"B"or better
1M Tam AV==
QVat"CA 030143271
'rale*== (408)7T7.=
CUPERTINO i= (108)777'33S
Building Department
Subject Reroofing PoU7 im the Cfty of Corset[..
1. Prior to permit le'Vm*e,ymust agree to comply with 1997 LBC Standards
=tions on reroofing.
.Near °pewou
2
and roo'n shall sot be applied without filet obWntng eII inspection
approval shall be o�btah" fsw Wilding
fropector.A final inspecd.end
building inspector when the reroofing is
& All roofs shall be Inspected prim to any roofing hnsh:lladon.
4. To receive a goal sign off from the City'the
1) Pr kM*cdm and/or��epproveL following sus are reTA d.
2) In progress inapec&m
3) MW kwpwdm a Spark arreeterappwvaL
bwW&ftm
if plywood
installed,a plywood nag
6. Any rooftg iswhichie app inspection i°�4ltired
require the removal inspec�. will
of an new material tsining�t
. pro;M City inspectlo�n can be p down to the sheathing so flat the
MWORTANT:
1. Flat roofs must have a minimum of%'per foot slope and demonstrate that
there is no ponding.
2. An LCB.O.report is required to be on the job site at the time of inspectim
We=da=und the above polity oa reroofing and will comply with this policy.
HomWwners Name: /4/2- 9"// a O,b,ve S flc ir0
Address: `792S ocTpB612 wy.
ReroofingEy Name:
''plier
Q �
�L
JAntmuwd
(Chief Building Offlds4
601
CITY OF CUPERTINO
REROOF
�CUPE INO PERMIT APPLICATION FORM
APN B 362 /2 0;L(c> Date:
Building Address:
795 oG7_06c.- C-4-- Y
Owner's Name: Phone M:
/7//'A In.-5
Contractor. Phone 0: 7 7 e 33 f License 672 9 L 8
W V 41x1
Contact: Phone M Cupertino Business License N:
�,n� �. <r ur✓ '77'7-933✓
Type of Roo[Covering:
Ems: Proposed:
a Built-Up Roof O Built-Up roof
Vsphalt Shingles a Asphalt Shingles
W/
nod Shale u Wood Shakes
Wood Shingles O�Other(Specify)/o yrs 6/t AM. 4 kvzoss .Sr'. , S
v Other(Specify)
tier co"nogs.�z O Provide t.CB.O.Report a ut NN'aTo omvegd
Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With 's Tear Off Poli
Job Description: R.nr..c_ Ev:st.' +.ds. .tivSl• a ivrw' 40 YR- Dass " o Fee c,ss
All "7M DSA We"I clo S —rvA r' .a✓eO.
Residential Commercial p
Fire Zone: Yes O • No Confirmed with Planning Root. if
there are any restrictions: uQ
Cost of Pro Typs Occupancy group:
Qty. i
A li able.._ Fee ID Fee Description Fee Grow
BPERMFEE Bidit Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Foe BUILDING
BUSLIC Business License BUILDING
P1eArse- pw+ v5 o,v %o f F S,r WAu(.e �-ov we)0 //-/2-2o03
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