02080127 CITY UILDINCUOPERTONNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10640 STOKES AV WAGNER ROOFING CONTRACTORS INCO2080127
APPLICATION SyB DAT
OtrffGE EDWARD J AND DENICE 12242 SARATOGA—SUNNYVAL R 08/22/2002
( PHONE: (408) 777-8331 SANITARY NO. CONTROL NO.
netO ARCHITEC MNOINEER: BUILDING PERMIT INFO
E ❑ BLDG ELECT PLUMB MECH
vU r-"_t L"J I_I L-J
,8?i LICENSED CONTRACTOR'S DECLARATION Job Description
o `"0 1 tachy uffifm but I am I¢ensee under provisions of Chapter 9lcommcncingfS REROOF
Z w with Saaion rlgxp of Division Jof the Business and ProfewinnaC Je yli t
Y M:' is in full force and effect. °y"n�in f�se
ex a4 h Liccna Clog s (. h p Y L OY
Dam/ E Lantracmr
a a'
to ARCHITECCCfff777SSSbbbECLARA ON
F'-O g 1 understand my plans shall be used as public records
r
ami z p O Licensed Professional
z OWNER-BUILDER DECLARATION
ts�o LL 1 hereby M.that I am esemN
pt from e Conwcror's License Law for the AUG 2 J 2002$8430
1-z< Following motion.(section rolls,Bustrim and Professions Cade:Any city or county
E x O which minims a permit to construct.alter,improve,demolish.or repair any strucwm
a3aO 'Prionoiu issuance.also requires the ePPlkant fw such permiuofilen siguuM smamem '---'-"-- --- '-"" - - -
- tet.theia0ccn:.Jpuiadattotnepio.:;omortneeontractoraLianrelawlchapter9 f -�r; ! ,tQ`' (� (�, Valuation
(commencing with Section TJpO)of Division J of the Business and Professions Code) f_ �,3 bt .t 1. -. .. 1 A'�ai,11.W 6�I La+�t�'�`a
or that he is esempt therefrom and the basis for the alleged exemption.Any violation
of Section 0031.5 by any applicant for a permit subjects the applicant to a civil penalty'
'of not mom than For hundred dollars($500). 3 0 5APN Il1Occupancy Type
❑1.asowneroftheproperty.ormyemployee,vithwageaastheirsaleeompensa0on 307 - INSULATION
-will do the work.and he structure'x not intended or offered for .In(See.row: 601 — ROOF TE7$$ 1G1��IH5 ectlOns
Business and Professions Code:The Contmamr's License Law does not apply to an Q p
owner of property who builds or improves thereon.and who does such work himself 602 — ROOF PLYWOOD NAIL
or
through val on employees,provide)Nat such improvements are not intended or ... P. ..,.i-..
completion.
ompleion.sthe If.however. wibuilvet eburdenofprotIs that within not year of 603 - ROOF BATTENS - ...
oprovei fnfthcnwncrfbda).will have the burden of proving that he did not build or 604 — ROOF IN—PROGRESS
improve purlrvtmo
_ co I.as owner of the property,am exclusively contracting with licensed contractors to
news the proses(Sec, to a Business and Professions Code:)The improves
trema', •t .
License Lica does not apply m an owner of a conso who Colles es improves thereon,
...' .. ...and who commas foe such.Prolcc¢.with a mntrucrods)IiccnttJ pursuant to the
Contractors License Law. . -,, n ,
o ❑I am escm unIerssee /.�B&P C far Nis mason
Owner' ENS 7 CCsa� /
ION
WORKER'SCOMPENSATIOE , ^ ^
I hamby aRrm order pi of perjury one of Ne following declamtlnns:
01 have and will mainioio'a Certificate of Comm to self-insure for Worker's
Compensation, as provided for by Section 37M of the Labor Cade. for the
_ perlormaner of the work for which his permit is issued.
❑I have and will maintain Worker's Compensation Insurance.as required by Section
3704)of the Labor Codr,for the performance of the work for which this permit is
issned.'My Workers Comp ohicumn Insurance carrier and Policy number are: .._._,... ..
Carr er I ro S.Policy Nd: Iv .1.,
CERTIFICAI ION OF EXEMPTION FROM WORKERS"
- COMPENSATION INSURANCE-3 v' .. .... ... .. .. __....-. .-. ... _.. ..._._. .. ..._. . - _ _.__ _ ._ __- .._.
r
r (This.action need not bfcomplemd if the permit is for one hundred dollar '
($Ilk)or Tess.)
''•` 1 cenify that in the scffo'mtance of Ne work for whicM1 this permit is issued,I
shall not employ any Person in any manner so as to become subject to the Workers
Compensation Laws of California.Date `
Applicant ..
NOTICE TO APPLICANT:E'after making this Certificate of Exemption,you should "
0 O become subject to the Warkcr's Cbmpcnsprevisions ation pvisions of the Labor Cade.you must
forthwim comply with such provisions or his permit shall be deemed revoked.
z'y CONSTRUCTION LENDING AGENCY
' 1 hereby affirm that them is a construction lending agency for the performance
of the work for which this permit is issued(Sec IM7.Civ.C.1
Lender's Name .-.._ ... .,.__. .. .. _ .. -.. .. .. _. ._ ... ..
z Lender's Addrexs - t
V 0 1 cenify that 1 have read this application and tlom Nut the above infwmution is
63: Pcorrect.1 agree to comply with all city and county ordinance:rod state laws tearing
0 V to building constmctiontmd hereby autharim representatives of this city to rum up an
rhe.hove-tnernoned property for Inspection pugmses.
Fr•` y (We)agree to save,indemnifv and keep harmless the City of Cuper ino against
N liabilities,judgments,.,is and espenses whkh may in any way accrue against said
f) City in cunsequance'of the grant Ing alibi, .it.
\PUHCANTU DERSTANDSANDWLLCOMPLY WITHdL(N N-POv-r Issued by; Date
si re of ApplicsntiCostmcto a am Re-roofs
HAZARDOU TE RIALS DISCLOSU
W II the applicant or Tuna Wilding uccupen:stom w handle harzudous mmterie Type of Roof_. .-. _ , ._ ...,,........,,.., .._. _....
as definal by the Cupertino Municipal Cade.Chapter 9.12,and the Health and Safety ;,,,, ,
Cade.Section 25532(a)? sat l )`, f' n "..,i{ i s., s;'a Flt
''` .All+roofs shall be inspected prior.to.any.roofing.material.being installed.
.. ..___
❑YdONo - __ _
-Will Ne applicant or form.Wilding occupant use equipment or desires which If a roof is installed without first obtaining an inspection; 4agree to remove
emit hazardous air contaminants as defined by she Bay Area Air Quality Management
District. all new materials for inspection. Applicant understands and will comply with
ores �0No all non-point source regulations..
"thchazardous,mmena)s nc�hazardous,mmena)s tequimmetns under Chapter 6.95 of Ne
Sft',Cd Sion 25505 5533 and 255341 d .fundthats ante dvheat t tht its my :po.Flity t ,try the qui a t. n n met b r p' mun ture of Applicant _ suee gent .Dare All roof Brings to be Class "B" or better
.. ,. .. . '. . ... . .. .. - OFFICE .. .. . -- .- ". .. ..... ...
Building Division,
OCIOF
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Fax: (408)777-3333
CUPFRTINO
Pudding Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
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%"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.
Homeowners Name: 9-
Address: UG c( D
Reroofing Company Name: =—
Applicants Signature: Date:4z v 2
'Joe Antonucci
(Chief Building Official)
6125101