03050025 CITY OF CUPERTINO ' '^'`*� "' A! ' "
BUILDING DIVISION PERMITCONTRACTOI2=TNF,O'RMATON
BUILDING ADDRFS - WAGNER ROOFING CONTRACTORS PMENO03050025
i
.4 "NIMPA
OWNER'S NAME: 12242 SARATOGA-SUNNYVAL R "ER"T"WR6/2003
ANG LING-RU C AND ALEXANDER C
ONE:
N -
O"E' (408) 777-8331 SANITARY NO. CONTROL NO.
ARCHrrecr/ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
p 0
yOO LICENSED CONTRACTOR'S DECLARATION JobDescription
1 hereby affirm that 1 am licensed under provisions Or Chapter 9(commencing ��
wlm Sudan 7").f Division 3 of dm Busioeu and Profession,C/o�de,and my license is �'N
mom mfall forteandcBLie.0 7 Z7 REROOF
z' Z Detenc ciao rantranar <1 'C
' ARCHITECTS DECLARATIONS MAY 2 0 2003
I understand my plan shall he used u public meet&
3u• Licensed Pmfessionel 1 NG
C atIam OWNER-BUILDER DECLARATION Com cto grVlI.DIN
S: 1 naso .(firm thin 1 I.S.exempt from me Cu ars Co License Law co Iha
S:00 p O whichfollowing mus a Permit
to 7113 commBusiness and w,Particulars demolish,or m or itym or county
u$ which requite n Permit re ennsuucs alter,impmsu apttri e a sig any structure
Fly that heor its lensed e.pursantto tn@ovisions o for such Permiuo BleaxiawpChned temcnl
ss< Nathatcingwi Section? the ofDivision
ivisNafmCGanuinesa dPnmssio CUUO)or Sq. Ft. Floor Area $13yat{}�tion
FS (commencosmii therefrom and
India n3 ofthe
ciped euand Profusions Code)of
That W h exempt therefrom and Ne but for me allc{nd eanmpdan.Any violeUon of
Secdon 7031.5 by any applicant for a permit subjeco the applicant to a civil penally of 3 0J-mbef00 Occupancy Type
not mom man fin hundred dollars($5001,
❑Lo the vnrof me pro,wrotwr intended
wlmweges ruic(soe1044. nunon,
will do me work and me auucwm0not intended oro@rtd farsat(sea 70N,Business 3Ub FRAME
-
and Profcarions Cade:The Convamors License Law doss Out apply in an Owner of 1 3 0 7 - INSULA lUNed Inspections
v
property who builds orimpmmemon,and whodoessuch work himself orthmugh his
own employees,provided that such imprewouno an,not intended or offered for We.If. 601 - ROOF TEAR OFF
hawever,the Wilding or improvement is sold within ane year of completion.to Owner.
builder will haw the Weden of proving mat he did not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL
°°le')' 603 - ROOF BATTENS
I,as owner of the property,am exclusively contacting with licensed conuacmta m
construct the project(Sce.,041,Business and Profession Code:)The Com=Uaes Li. 604 - ROOF IN-PROGRESS
cause taw docs not apply m an Owner of property who Wilda or improv Neuron.and
who comma for such project wifll, m 0 licensed pursuant to the Contractors
License Law. /
❑I am exempt under Sec. / � .B At P C for this moon
Owner / Date
WORKER'S COMPENSATION DECLARATION
-thaws
1 hemby of ion under penalty of perjury arc of me following deduattlans:
J I Nn and will m dawn aceNfinte or Consent toml6itnum fm Workers Counter.
Ration,or provided fm by Section 3100 of the labor Code.for the Performance of the
work for which this permit is issued.
❑1 haw and will maintain Workers Compensation Insurance.as required by Section
31W of On tabor Cade for the perfarm oce of the work for which this permit is blued.
My Worker.Co9mm9��N don pudommcamivandpolicynumorare:
Cartier.�� aL+tP� Policy No.: Cir131t
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thlasrcttco need not W completed If 1W Permit is foram hundmddollass(SIOU)
or leu.)
I certify that in the performance of the work for which this permit is Lusted,I shall nm
employ any person in any manna jn mpcgomc subjecttome Workors'Comptaudon
Laws of Califomla.D . ='� ��"'
Applicant s' l
NOTICE TO APPLICANT:IL after mating Nis CCNBcam of Eaemptian,you should
become subject in me Worker's CompemNon provisions of the ISM(Code,you must
,J Z farawim comply wire such provisions Or rot peroa t.hall W dcemcd conked.
zO CONSTRUCTION LENDING AGENCY
[-i 52 I hereby em.mat mem 4.roruuuedon tending agcney far the"em.of
!Yi > dm work far which mu pmmit h issued(Sec.3.91,Civ.C.)
ALeader'.Name
a z Lender's Address
U 0 I notify that I ban mad%is application and stat that the move information is
COMM I agree to comply with all city and county ordinances and sot laws mlating to '
0U building construction,and lembyauthodm mpmuntauv of this city to enter upon d¢
Lk7 aovrmentioned property far inspection purposes
g1, (We)agree to an.indemnify and Ince humless the City of Cupertino against
M liabilidenjudgment.cmu and expenses which may in my way accrue against said City
U in consequence of the granting of this Permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGUL6TIONS. ��
/sN'r - i-ckl '-%'�7 3' l7> Re-roofs
Si ort ol'Applican onlnctorate
HAZARDOUS MATERIALSDISCLOSURE / Type of Roof
Will the applicant or future building rccupanumm or handle haurdous metrial
as defined by the Cupenino Munici W 1'Codc.Chapter 9.12.and the Health and Safety
cWe,scNon 255324)±
[-]Y., SNo All roofs shall be inspected prior to any roofing material being installed.
Will me applicant or future building accapant me equipment m devices which If a roof is installed without first obtaining an inspection,I agree to remove
t colt hammous air contaminants u defind by me Bay Arc.Air Quality Management all new materials for inspection.
,m ticR
0Y
Iban mad the huA nus materials mquimmew under Chapter 6.95 of the Califor. 'v
nia Health k Safety Cada,Sections 25505,25533 and 25534.I understand out if me Wilding
Jas not currently haw a tenant,Nat it is my msPonsie ity m Unify me occupant Of me
myuirement which must be met ptioctu issuance of a CcniRcate of Occupancy. Signal ofA (cant ate
i s�G
�— Al
Owner or authorivnd agent l roof coverings to be Class"B"or better
Dat
BuflalotDividon
10300 TansArmos
CVm*c G 0014-M
(4MM-ins
CUPEI�TINO ft'
Building Deparbnent
Subjeett Rn=$as policy fm the City of Ctrpertlao.
1. prior
and a�anutactures spe i$oaytions agm m g. with 1997 UBC Standards
2 ,New roof coveringe dull sat be applied�&at obtaining all hspectkm
imd written approval frost the building hupector.A&W Inspectim and
approval&hau&hall be obtained from the building irtepector wham the serooang is
I All roofs shallbe hupected prior to any suo&tg in&tenatism.
4. To reodve a&W alga off km the City the following steps ars required.
1) Frettt&pwdm and/oro tear off approvaL
In propose kwpecdm
3) ap�aL
a) Spark arrester htefalLelaa►.
b. If plywood Is installed,alywood nail hupection is required,
6- Any roofts{g which is applied without first obtaining an kVecdm will
require the removal of an new mutaw down to the&heathiag so that the
- Proper City ht&peed at can be performed,
nwWRTANTs
L Flat roofs mu&t hive a minimum of U,per foot slope end demonstrate that
there is no portding.
2 An Lr—B-a report is=Tdnd to be an tate job site at the time of haspectiat.
We madomtmnd the above policy on reroofing and will comply with this policy.
Hamwowmmr&Nasse: X22S. 4i.y4 Gv*VA,
Addmr '/6/ - ;25163 97: jw4ef wS At.
Re oofhtgCompartYNa= 6w Oe aft 3wt , .
Appliauttsa �—
JAntcamcal
(Chief Building Official)
_, 625/01
CITY OF CUPERTINO
REROOF
CUPS INO PERMIT APPLICATION FORM
APN M 35"(60-f 03 / Date: S/4/�cms
Building Address:
S7 A/rA/lE.✓S a. Ca.,ocFXJ
F. Owner's Name: Phone t..
Ir�tS. L�rtr wq.v�
Contractor. Phone M. '777'933/ License fh. 6 7.2 92 8
Contact: Phone#- -77?-9 3 3/
Cupertino Business License 8: -A
seoh� Asad a,�.✓
Type of Root Covering:
Fidsting: P opoeed:
O Built-Up Roof O Bulls-Up roof
• Asphalt Shingles ia
pe Wood Shakes O Wood Shakes
O Wood shingles O Wood Shingles
O Other(Specify) d Other(Specify) }o yA AW A'Bry
Num�¢yr of exLtiog coverings I O Provide I.C.B.O.Report M
p�`fo be Rentovad O Provide Mfgr.Installation Specs.
I Have Read,Understand and Will Comply With Cu rtino's Tear Off Policy:
Job DeseriptionAApto PC SAgke R..F'• -X+,W; o It/Vsw ¢p yfWt e/19, ; ' 6/K X-,ce'34-dl
S�: LS, v v0[ic• nr.41 .4t.30 4-.V1—w/ w•'th osQ . New F/•f4.�v S .
U Residential Commercial Q
Fire Zone: Yes 0—No Confirmed with Planning 1 'if
there are any re ons:-7/
Cost of ext: rl T of Cons t3 :X/I Occupancy p:
Zai yon•
Qty.if
APPlicab Fee ID Fee Description Fee Grout)
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING'
BSEMMICRE Seismic Fee Res BUR-DING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
' —S.Lw� N+ u5 ON -r-&4F Sc1v,LiC 'ivmorww• w�'-n� "� I Qir g
T4K.c. C," t"_ g, 6L—t- 8600C. ( /
• �Y t^it MIJ 64.4 "5 L t +Bows , lT (�?�