02110090 CITY OF CUPERTINO
BUILDING DIVISION PERMIT r°CONTRACTOR INFORMATION:,.
BmfJygagAgqRESS^ANTA TERESA DR WAGNER ROOFING CONTRACTOR PEINU92110090
oWNANOTSEK JAMES A AND JEANNE 12242 SARATOGA-SUNNYVALDPpLICATIP1YH1DyTY2002
ZONE: (408) 777-8331 SANITARY NO./ / CONTROL NO.
ANCIIITECT/IiNGINEIeH: BUILDING PBRMIT INTO
BLDG ELECT PLUMB MICH
l� 0 0
°0Z LICENSED CONI'NACTOR:S DECLARATION
°p Job Description
� Ihcrenyc rya���1 amliccnm OnJc Provlstonaorcnapmrv(«smmewing REROOF P
i wish Scctinn]t ft idn Softhc Bu anJProfcssians COJc,and myliacnse is
ZOIC= in
Liccnl fnC c't nr�29'�!
F�t=w Dam Clause
ARCIIITIiCTS Df: . 'PION
�o � rst dray aahml im oemus =� NOV 2 0 2002
ui3u.7, 1-memo al
c sston
OWNER BUILDER DECLARATION
1 hereby affiw
rm that 1 am cmpt from mmLicensee Cor's License Law far the BUILDING
$12408
t 6°o following ruuoo Oredim 81315,lluelnmz and Profcasiona Codc:Any cily,r cnumy
xm�+ which requires a permit at conswn,eller,improve,demolish,or repair any.n ixt..
'o'er prior to its imuanre.also myuims the applicant hamch permit m fifcasi,.d summcnt
�yp�a that he is licensed pursuant to the provisions Of the Contractor's License Law(Chapmr 9 3*61MR)"AfL(i) Valuation
(commencing with Seclion 70Cidol Division 3 of in.11-ince and Pref.ions Code)Or
y Nat he u exempt flcrefrom and the basis for the alleged exemption.Any violation of
Section 203[.5 by any applicant for a Permit subjects the applicant o a civil penalty of PN NgWrI5WE Occupancy Type
ant morethan five handled dollars($500). 307 - INSULATION
1,as owner of the property,or my employees with wages m their sole compensation,
will do the work.and the swcture,is not intended or offend for sale(Sec.7W,Business 6 e im
{��k}r �{kQ�,(1�
and Professions Code:The Contractors License Law does not apply to an owner of 602 - ROOF P W V n1tlH 1 LnS
property who huildsm improves thereon,and whodmi such work himaelfor through his
Own employees.provided but such improvemenla are nm intended or offered far sale.If. 603 - ROOF BATTENS
however,the building of implawarem is sold within one year of completion.the owner- 604 — ROOF IN-PROGRESS
builder will have the burden of proving that 3[e did not build or improve for purpose of
sale.).
❑ I,as owner of the pmpeny,am exclusively contracting with licensed coommims to
construct the project(Sec.7044,Business and Professions Code:)The Convector's Li-
se law docs not apply to an owner of property who builds or improves Neeson,and.
who contracts for such projects with a comractor(s)licensed pursuant to the Contractor's a
License law.
1 am exempt under Sec. B A,P C for this reason
Owner Dale
40 WORKER'S COMPENSATION DECLARATION
1 hereby aRom under penalty of pe1july one of the following dcclarttions:
❑1 have and will maintain a Ccnificam of Consent to self-insum for Workers Compen-
s lion,as provided for by Section 3200 of the labor Code.for the performance of the
work for which this permit is issued,
1 have and will maintain Worker's Compensation Insurance,as required by Section
370)of the Lunar Code,for the performance of the work Air which this permit is issued.
My Worker's Comets tion Insu c r end Pn icy number am:
Cenie:_y-C f Pu OM!WOR E 200
CERTIPICATEOP E)EM FROM WORKERS'
COMPENSATION INSURANCE;
(rots section need not becomplmed KIM Permit is foronc hundred dollars($10f)
less.)
1 certify Not in the performanm of the work for which this permit is issued.1 shall not
employ any person in any manner ser as to became subject to the Workers Compensation
Laws of Cali fomia.Dam
Applicant
NOTICE TO APPLICANT:11;at making this Cenilmate of Exemption,you should
beemsm subject to the Worker's Compensation provisions of the WMn Codc,you must
OO forthwith comply with such provisions of this permit shall M deemedrevoked.
z CONSTRUCTION LENDING AGENCY
[..N. I hereby affirm Nat there is a construction lending agency for the Performance of
a 7 the work for which this permit is issued(Sec.309],Co,C.)
W Q Lend<r's Namc
az Leader's Address
U C 1 ccnify Nat I have read this application and sum that use shove information is
W F cored 1 agree to comply with all city and county ordinances and state laws relining to
OU mdIdingcon.muction,and hereby authowc rcprescmmivcsof his city to Gnat,upm the
above mentioned pmpcny for inspection purlwus.
We)agree in save,indemnify and keep harmless the City of Cupertino against
tiN Liabilities.judgmenaa,costs and expenses which may in any way acemc against mid City
U z in consequence of Oc granting of this permit
r. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALIssued by: Date
SOURC E.GU IONS.
G Re-roofs
r, c ofApficanvcom"con Dmc
IIAZARDOU. MA IALS DISCLOSURE Type of Roof
Will the applicant m fmure b '1 mg occupant rare or hanme M1amrdous mourns]
as defined by the Cull MupGryal Codc.Chapmr u.12,and the Health and Safety
code.S ptikm 255321a25532(.)? 7n/a/ All roofs shall be inspected prior to any roofing material being installed.
Ya
Will the applicant m future but ring Occupant ore equipment or devices whichIf a roof is installed without first obtaining an inspection, 1 agree to remove
emit hriardous air contaminants as defined by the Bay Arca Air Qualdy Mars"naent all new materials for inspection.
District%
U Yes BNa
I have mad the hxmNousmau,nrlsmquiremcnts nnJerChapmr 6.95 Oldie Catint-
nix Health SafcryCa Sections 25515.25533 am125534.1 understand thaifthc building
Jres t mcntiy M1mc a mnanl.Nal it is my respomihility m mtilj'1M aucupant of Nc
my - Rw ' role the 'nnoiloodowofaCcniicamnf0.cupancy tVopureofApplicanl coveat
o m i uthonrcd agent s/DN roof rings to be Class " or better
Building Divwon
10300 Two Aveaae
QTmtm CA 95014-3253
T Td6Phm: (408)777-3228
CUfp Ek'NQ F= (408)777-3333
Building DepaAmi ent
Subject �f ng Policy for the City of Cupertino.
1. Prior to permit issuance,YOU must agree to comply with 1997 UBC Standards
manufachues specifications on reroofing.
2- New roof coverings shall not be applied without first obtaining all inspec cn
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' y roofing installation.
4. To receive a final���prior to an
sign off from the City the following steps are required,
1) Preinspection and/or tear off approval.
2) In progress inspection approval.
3) FinalinSpectimapprovaL
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 ft
mpecttml,will
• require the removalof all new material down to the ahem
proper Cit,insp�can be performed. thing so that the
nMrORTANT:
1. Flat roofs must have a minimum of%a per foot elope and demonstrate that
there is no ponding.
2. An LCB-0.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.
Homeowners Name: 7,0.4 NNC I4No.1SC K
Address. _ ///?./
Reroofing
oPY Name•
Applicants Signature: /—�n
zo�
� .9Joe Antan
maucd
. (Chief Building Official)
6/25101