02060161Lt
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CUPE
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DI C DIIVIISSIIONNOPERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
10951 SANTA TERESA DR
WAGNER ROOFING CONTRACTORS
INCO2060161
OWNER'S NAME:
APPLICATION SUB DATE
MORI SHOW AND MARY E
12242 SARATOGA—SUNNYVAL R
06/25/2002
PHONE:
SANITARY NO. CONTROL NO.
(408)777-8331
ARCHI'r cTn7NGINEER:
BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECII
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LICENSED CONTRACTOR'S DECLARATION
Job Description
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I hereby affirm that I am licensed under provisions of Chapter 9 (commencing
with SeeWn7000)ofDivision 3of[heB.,aie,4/faidaimowCode.aadm I se
REMOVE SHAKE ROOF
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Li«oul me .a IT�n.-.3 Lic.x 6,72g2 �" �
INSTALL NEW 50 YR CLASS "A" PRESIDENTIAL
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°a1C AR HO]iDECL ATION
SHINGLES #30 W/OSB & NEW FLASHINGS
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1 undenorM my plans shall be used ex public records
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Licensed Professional
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OWNER -BUILDER DECLARATION
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1 hereby affirm that I am exempt from the Conuacmi s License Law for the
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following reason. (Section 7031.5. Business and Professions Code: Any city or county
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which requires a permit to construct, almr, improve demolish, or repair any a mnum.
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prion ussuan e, al>o rcqu th applican,fw such pcmutt fl asgaWsmmtnent
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y S Ft. Floor Area.-,. ((
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nation
$69W
wthglghc<n¢ p n nd p Cnhecnntm mraL <n<W (cn pie 9
(can ccng thsm 7000)fD-.'nJof the Buemessndfc'.CJ)
ur th t he N sxeniId therefrom and the basis for the alligcJ exeinPdon Any violation
d\. A�2V tl 9.. tl a,tiL;I AS.��\
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- of Section 703 1.5 by any applicant for a permit subjects the applicant to a civil penalty
iof not more than ave hundred dollar. (S500).
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'' a” Occupancy Type
❑ I. as owner or the antpeny, ur my employees war wages as their sets eompen>abon
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305 - FRAME Required Inspections
- will do the work. -and the stmcmre' is not intended or offered for sale (Sec. 70ad,'
Realness'and Poificii Cale: The Contractors License Law does not apply to as
awn` r of propcny Who Wilds or improves Merton, and who does such work himself
or through his own employees. provided that such improvements arc not intended or
30-7--'- INSULATION
is sold ear
offered fide ale: IL however: the building or iinprovemem is sold within one Year of
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601 — ROOF TEAR OFF �•'•'"' '
completion. the owner -Wilder will have the buNen of proving that he aid not Wild or
improve for puHose°rale).
602 — ROOF PLYWOOD NAIL
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am s usin selr d
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Prefiting i Crankd
he (Se 7 Ccouriwatu's
ownse the project(sec.7to a. ower of dna Prof who b codec Theves toreman.
builds or improves nn,
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604 — ROOF IN—PROGRESS
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a.comrwW
to
aomme cunwns forsuch.projats with a.conwetorb) licensed Pursuam ,o me
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01 am exem kende Law..
❑lamexcmpt under Sec'' ,BSA PCfar this reason
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WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty, of perjury one of the following decl notions
❑ 1 have and will maintain a Cenificate of Consent to self -insure for Wmker's
Compensation, as provided for by Section 37W of the Labor Code. for m
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kit . Ord .6,. of the work for which this permit is issued.
111 have and will maintain Worker's Compensation Insurance, as required by Section
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1111 1 O L�02
37W of the Labor Code, for the performance of tW work for which this permit is
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iaucd. My Workers Compcnsaiion Insurance canicraW Policy number oat:
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came:, �.._:'. -_... I'�D-ZOOL•
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f .( GC•RTIFICATION OF EXEMPfI OM WORKER$'!
:_ gVILU_SNC!„z'':ti;:;F_�ri•1:,��:t::,•
`_ COMPENSATION IN RANCF.•`•• .e
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�• s is far one hundred dollars
(This ienion need not he completed if the humu
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1$100)Or less.) .. ,.
I fly tM1, the per f ftl kf h hthis pc 1'. issued.l
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.lath nItvnploY'my pOr,.a to any meaneras a been ne sai tulhe Woders'
eotnpawxtlnn Lowe of Califnmia' Date'
.Applicant ..:. - __..
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NOTICE IO APPLICANT. If, after making his Certificate of Excmpion, you' should
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subject to the Worl Compensation provisions of the Labor Code, you must
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loal,fla comply with such provisions or this permit shall he seemed revoked.
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CONSTRUC"HON LENDING AGENCY -
1 hereby affirm that then is a conswnion lending agency for the performance'
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of the work for which this pennii is issued (Sec. 3097, Civ. C.)-
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Lener's d
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1cenil, that l have mad this application and .state that he above information is
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ora, 1 agree to comply with all city and county ordinances and.tt elating
to building couritraticiiii and hereby carbonic representatives Of this City to enter upon
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the thove mentioned pa lemy f inspection T
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(W )atl t s d fy dkeep h ml ss the City ofC p« oagamt
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I`hitt 1 Jg nl c, J v •s which Y any Y against said
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Cly r I cc of tM1 p t itt this pc 't
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AIT' tC\NT UNDERSTANDS \NDWI LLCOMPLY W ITH xlI NOV POINT
Issued b ! ��-- Date
SOURCT (dt ]PION ,.
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eo/APDlicanAZARD ror . •' I at
Re -roofs
HAZARDOUS N ALS DISCLOSURE
- will ppWam are Jog k<Chant.,am orhandle
----Type of Roof r
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Health Safety
as def W byah L pen M 'p Cal Ch pt 9 I and the Hcahh dna Safety
Cod' section2553Am
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'Dyes r+-••• '- ,'xlNn; . ; „•rf"ice \ ''
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All roofs shall be inspected prior [o_any roofng material being.. installed.
' will 'he ppaca t f building ro cuprot use equipment or devices which
If a roof is installed without first obtaining an inspection,-Iaagree to'teinove
e
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mit ha Ju. oat t definedbythe Bay Art�ality hfo
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all new materials for inspection. Applicant understands and will comply with
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- all non -point -source regulations:
. I have rcaa ,he.M1aaardow materials rcquvarwms under Chapter 6.95 of tIt
CaliforniaHealth & Safc,y Code. Sections 255a5. d55JJ unJ 255Ja. undersand th
if the building docs not currently have a mnmt ,hm h is my rcspowibiliq m amity t
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tar pt io
occupant thY.e requirements which lust W met r to issuance of a Certificate
p
atureofApplicant a
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Aft roc overings to be Class o better
namWri:Woe gen, Dat
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.. - .. .. .. _:. -OFFICE — _....
Building Division
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEPTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards
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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
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Homeowners Name:
Address: /0
Reroofing Company Name:
Applicants Signature:
•Joe 9 404;uc _
(Chief Building Official)
6/25/01
6 02 r oz --
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 that the
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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
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Homeowners Name:
Address: /0
Reroofing Company Name:
Applicants Signature:
•Joe 9 404;uc _
(Chief Building Official)
6/25/01
6 02 r oz --