04100196 CITY OF CUPERTINO ' ,�
'. BUII:mrvc DVISION' PERMIT'BUILDING ADDRESS: - -WING'S ,ROOFING INC PERmrrNob4'100196
OWNER'S NAME: PERMITISSUEDATE
SHUAN
SANITARY -CdNtROL N0.-
ARCHITECT/ENGINEER: �- - ,_ _ BUILDING PERMIT INFO' - .-
BLDG ELEC, PLUMB'. - MECH
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- LICENSED CONTRACTOR'S DECLARATION - - —.IOb DCSCrIptlOn
U _ I hereby affirm that 1 am licensed under.provision of Chapter 9(commencing '• ` ... .
with Seen..70(lo)of Division 3ofNc Business and Professions Code,and my license is tip
g mrvI, as rre�.G3 �� REROOF W� SHINGLES
p�Z Licence Cl Lc.M
Contractor -
�e ARCHITECTS DFALARA 10
y i underttand my plena shell Ise used as public¢cards - - .-
OyU
° LicensedProfeaianal NOV
OWNER-BUILDER DECLARATION
y
N
i F I hereby.(Siem Not 1 amL cacmnt fromess ar the.readomConotacCc :Any cense Law for The -
_OO which mason.Permit
ZIT]IS,Business and improve.
d.inti Co de:Any tiny ormone
which myuires a permit to cnumWl alma Improve,demolish.or mpalr any xwnum - - rs
-
FZT prier W its issuance.also mquirn ale applicant forsuch Permit to file a signed statement
< that he is licensed pursuant W Nc provisions of Convectors License Law(Chaptm9 _ Sq..Ft. FIOOr-Area alUat On ,
1-$ (commencing with Section 7")Of Division 3 of the Businessand Professions Code)Or
.. Nat he u exempt tMmfrom and the beau for the alleged exemption Any violation of A�hiv�.
- Sarson 7031.5 by any applicant for a Permit subjects the applicant W a civil Faulty of - 3 7,rnw]aeg..v VO 0 Occupancy Type `
not more than Om hundmd delta.($500). �fIYWLLrFY -
❑I,as net ofthe property,or my employees with wages a their sole compensation,
willdo the wok...dthtstmctum is not WWndedoroffered fo...I.(Sea.7044,Busiva. -
And Professions Cadc:The Communes License Law dean not apply W an owner of - RegUlred Inspections r
+' 1 propenywho builds orimproves Narcan,and who doeatuch workhimselfarNmugh his - -- - '-
prowided pnovesimpsovemmaamne year dedoroQered for agile,Ir, - - —"-
huilder the have the
of pmmcieaat Im did not veerorimpolefarthe owner-
builder will hive Ne burden or proving Net he did not build Or improve for purpose of _
ale.).
- 1,as Owner of the property,am exclusively contracting with licensed contractors to
conswcn the pollees(Sec.7044,Business and Professions Code:)The Conuacter't L4,
cana taw dues not apply lm an owner.(property who builds¢improves themonfand
whocontracts for such projects nvacW
jects wiac. r(pn
licepursuanttlpursuantto the CantnS
etor - - -_ --.-
License
I. "
❑lam exempt antler See. .B6:PCfar this
Own Date -
WORKERSCOMPENSATIONDECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have end will maimain a Certificate.(Coneit a saff-o n,for Workers Compcn- -
sation,As povided for by Section 3700 of the labor Code,for dm performance of the
work for which this permit is issued.
I have and will maintain Workers Compensation Insurer=,as requined by Section
mf Ne labor Code,for the Perforce ttaf Ne work fuwhich this permit is issued. . .
My Worker(Ca Penauon 1 eynnce ca 'er and Policy num am: L .. .
Cartier. - Policy No.: Y a�u
CERT ICA OFEXEMPTIONFROM WORKERS'
COMPENSATION INSURANCE
'(This amnion need not hccompleted ifthe Permit is forone hundred dollass($1 00) ..
or leu.) -
I certify Nat in the performance of the work for which this Permit is issued,Isbell not
employ any person in any manncrso As W become subjecuo NC Workers'Compensation _
Laws of California.Dam
PP - .. - .. x-....-.-.. _.
A lICE
NOTICETOAPPLhe WorkIL after Compensation
Nisvisiosofficale BeLabor Con.de.
you became subject y the Worker(Campenr this provisions or Ntabor Codc,you mull
.J O forthwith comply with such provision or this Fermin shell be deemed revoked.
"' CONSTRUCTION LENDING AGENCY
•,�� Ihereby affirm Nat there is a convection lending agency for the performance of
(Yi> Ne work for which this permit is issued(Sec.3097,Co.C.)
W A Lenders Name
z Lenders Address - -
U 0 1 certify that I have reed this application And sate Nan JW above information is
W correct.I agree to comply with all city and county oMim noes and state laws misting to LDate O V building convection,and hereby auflodm representatives of Nia city m enter upon Neahmva-(We)a re property for inspection loop ba(Wc)agree so nuts idemnify and k=D hamean Na Clay of Cupenit againstliabilities,jutlgments,cosa and expenses which may in anyway accrue ageinstssd Cityinconmqucnccofthegrantingofthisroil.APPLICANT DERSTANDS A WILL COMPLY WITH ALL N N-POINT Issued by:
SOURCE EC L�TIONS. Uv/
(( "a Re-roofs
Signatu,of plic. C ue'" De
H ARDOUS MATERIALS DISCLOSURE Type Of Roof .
Will the applican or filum building occupant some or handle ha'raNOus measial
a defined by the CupenaO Municipal Code,Chapter 9.11,and the Health and Safety
Cade,S=umo 25532(.)n _..»__-- .-_ All roofs shall be inspected prior to any roofing material being installed.
Will Nc applicant or fm rc building occupant use cyuipmanl or Jcvices which If a roof is installed without first obtaining an inspection,I agree to remove
emit haardous air C.Aucc nna as dcOned by Be,Bay Arca Air Quality Management all new materials for inspection.
Gnvict7
❑Yes IK'O
I have mad Ne hamrdus mamrlaIS.gcirAmAAB.ndc,Chapter 6.95Of the CAir.,
niaHnINS:Saf yCodc,Sadou25505.25533end25534.1undcsswW thetifda building
Jots n curtcnn h.m a wnan4 Net it u my msponiMlity a notify Ne mcupmt of Or v
mquim cnawhi aatbemetpnoetoinuanco.r.certiB.amoroc party. SignatureofApplicant Date
a All roof coverings to be Class"B"or better
Oversee. uahamcJ agent I U 10.1c
acor
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408) 777-3333
UPEkTINO
Building Department
JOB ADDRES ZrERMI #
O R'S N PHO ll0q
GENERAL CONTRACTOR. FAX-4
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following 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
Septic Tank
Sheet Metal
Sheet Rock
Tile
O Contractor Signature l A Date
Community Development Department
Building Division
J ( ' City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
INU^E P,T'N OCITY OF Fax: (408)777-3333
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. r ,
. . 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 oninspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: �` C� u f/
Job Site Address:
._Roofing Company Name:. I A C
Aplicant's Signature: Date: [
VV
\�lh6l/0DCX1
Greg eel
Building Official
Revised 1/30/03 ,
- - Printed on Recycled Paper
CITY OF CUPERTINO
REROOF'
CUPERTiNO PERMIT APPLICATION FORM
APN# / _�, 3 0 / /`ODate: /6 Z /0
Building dss: / e ,( L r
S Z �- L
Owner's Name: ,,1 Phone#:
sh
Contractor: NJ t PhMe#: License#:
Contact: �, /� Phone#:�B�OG,6S �8 Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles )<' Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑' Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
1� To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: —7 i, /
-.- .,, tl p VW,t'1.,. . PLS41V � t?` S` f3 , �5
Residential Commercial ❑. . __
Fire Zone: Yes ❑ No ❑ Confirmed Wi anning Dept. I
there are restri 'ons: ..
Cost of Project: T o Cons ' cti Occup cy group:
S v0
Z•
is bl Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BE RGY Energy- BUILDING
B EISMICRE Seismic Fee Res BUILDING
SEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING.
BUSLIC Business License BUILDING
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