03100200 I'T'Y OF CUPERTINO : ' `t' zzTj
BUILDING DIVISION PERMIT gCONTRACTOR INFORMATION ;<
;Z�09➢_ae �.k•YSu `' av" 2r s.u�s.«Rsa.. k^%S-+tL..M'
BOCILDINGADDRESS: WAGNER ROOFING CONTRACTORS PTNC003100200
10439 TONITA WY
OWNER'S NAME: 12242 SARATOGA-SUNNYVAL RYEWIT ISSUE DATE
CHRISTENSEN DONNA H 10/28/2003
NE 408) 777-8331 SANITARY NO, CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 E 0
loo LICENSED CONTRACTOR'S DECLARATION
I U I hereby serum mal I on Licensed under previsions of Chapter 9(commencing Job Description
f� with Solion7 )of Division 5 of the Business d Professions Code,and my license is
.ore in fullfnme flet 2� REROOF ��®
>L,? LiccnuCLM.N� It
f ARCHITECTS DEQFlic records
et NTt9a%R6 Film
rds
1 undcrsland my Plana shall he used as 1yW��KB
- ,1 11 't 3 20
03
Licensed Professional-nal No V, 1
OWNER-BUILDER DECLARATION
7 1 hereby offirm mal 1 am exempt from the Contractor's License Law for the
❑o rollowing mason,(Section 7071.5.Business and Pmfessiuns Cade:Any city m county ��'�®�pA
<m� which requires a permit to construct,slot improve,demolish,or repairNany structure 9 9 2 0
°iy prior to its issuance,also requires the applicant rot such Permit to file a signed statement
-m< that he is licensed Pursuant to me previsions III the Contiutur'sLicense Lew(Chapter 9 Sq. Ft. Floor Area Valuation
uF$ (commencingwith Section 7")ofDivision 3ofthe Business and ProfrssinnsCode)or 35914010 . 00
Nat he is exempt thcmfmm
an the basis for me alleged exemption.Any violation of
Section 7031.5 by any applicant(at a permit subjects the applicant to a civil Penally of APN Number Occupancy
not more man rive hundred dollars(5500). P Y Type
p I,as owner of the prapeny,or my employees with wages as their uic compensation,
will do the work.and the structure is not intended or offered formic(See.7044,Busitou
end Professions Code:The Contractor's License Law does not apply to an owner of - Required Inspections
pmMny who bulletin,improves thereon,end who docuach week himself or Omagh his
own employees,provided that such improvements are not Intended or offered for sale.If.
however,the building or improvement is sold within one year of completion.Ne owner.
builder will have the burden of proving that he did not build or improve fur purpose of
ole.).
E)I,as owner of the progeny,am exclusively contracting with licensed contractors to
contract the praise,(Sec.7014,Business and Profciamus Code)The Contrumia Li.
cense law docs not apply an an owner or property who builds or impmvss lineman.and
who contracts for such projects with a contractor(.)licensed pursuant o the Contractors
License Law,
El 1.m exempt under Sec. .B k P C for this mann
13C737000
ner Date
YORKER'S 1 ATION DECLARATION
1 hereby affirm under penalty of perjury ane of the fallowing declarations:
I ban and will maintain a Certificate of Consent to ulGiasu r for WorkersComper-
on,u provided for by Section 3700 of the labor Code,for the performance of the
rk for which this permit is issued.
1 he.and will maintain Workers Compensation Insurance,as inquired by Section
of the Labor Code,for the performance of the work for which this Permit is Issued.
Wmkcei C n.alioo/yturn` uric,and Polic number are:
rtier.__ T,�r�Policy No.:V O O l33 I0
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thaiunite need not he completed If the Permit Is foronc hundred dnllm($i00)
loss.)
I cenify that in the perfntmauo of the work for which this Permit is issued.I shall not
employ any fiction in any manner u as to become subject to the Wafts'Corniontatton
Law.of California.Dao
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
b.mme Subject to the Worker's Compensation provisions of the Lahr Cock,you must
O forthwith comply with such provisions or this Permit shall be deemed revoked.
ti N CONSTRUCTION LENDING AGENCY
1 hereby affirm that mere is a construction lending agency for the Performance of
Y > the work for which this Permit is issued(See.3097,Civ.C.)
S1 A Isndch Nam.
5z Looder's Address
Q I cenify Nat I have read this application and state that In.above information is
L Ubuilding I agree m Comply with all city and county ordinances and Nk laws relating e
V aboveng punned propertyn,and hemby.mhonPurpoeunulivu of Ni.city to enter upon the
abovc(We) oed ho..lin imnify an keep
(Wc)agree m costs indemnify and hick harmless OOyaccru Cupertinoageinfl
h lieconsequence of
grsu.nd ofp.na.mit. may in any trayaccrue against mid City l a�
;� z Aconsequence of UNDERSTANDS
Slois Permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
��/a���� Re-roofs
sib ore ofSig ore of ApplinnUCon RDOU�� 0 eD e
HAZARDOU�ATERIALS DISCLOSURE Type of Roof
Will y t applicant or!Muni building k.Chapter
r 9.1 or handle Health
malarial
as defined by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
c.Section 15531(.)7 All roofs shall be inspected prior to an roofing material being
1 pYu te.f� P P Y g g installed.
web th.applicant or rulum building occupant use equipment or device!which If a roof is installed without first obtaining an inspection,I agree to remove
It havaMons it contaminants as defined by the Bay Area Air Quality Management
istricl? all new materials for inspection.
p Yes Iplvu
Ih&Sgei the h,SNao 25505lsmquiremcntaundcrChaPteddurahlheCaln ���`�
ria Health KSntly Cud.tommi,vhat it is
use
building, ra2g �/
mxia not cutmn0y have a tenant Net it is my rcsponsihilily It nnufy Nc rccuPml of Nc
quiet cnaswhich must bcmet prior tois.uanccofaCenificalcgro�.uPercy. Signatu of Applicant Date
Y > All roof coverings to be Class"B" or better
cent,or lhon.d agent uist
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
UPEIVTINO
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.
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 on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: '41f, VAN CA R 5 rl"V5 ex l
r
Job Site Address: �o S/39 To.✓/� GyJ�
Roofing Company Name: �do CClW7-
tl
A plicant's Signature: Date: /o O�
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
t
CITY OF CUPERTINO
REROOF
cuPE INo PERMIT APPLICATION FORM
AM 8 Date:
359 iy oin
Building Address:
/0 3 on/2rR w
Owner's Name: Phone It:
M/L. 004W zsr o98B
Contractor: Phone p License*:
Gt/Avn aa„� G -(3 i 67 a 9z g
Contact: Phone(i: Cupertino Business License M,
Type of Root Coveting:
Existing: Proposed:
O Built-Up Roof O Built-Up roof
O phalt Shingles O Asphalt Shingles
Wood Shakes O Wood Shakes
O Wood Shingles /Wood Shingles
O Other(Specify) Q Other(Specify)jo}d- c/W A Aox A;e ass
Number of existing coverings O Provide I.C.B.O.ReportM ✓L l�f'17 �'';�
O To he Removed O Provide Mfgr.Installation Specs.
I Have Read Understand and Will Comply With Cu rtino's Tear Off Policy:
Job Description: A&,w,,e 5h4ALA,,I. XZVjrnI/ role✓ SD yt c�g3s':4"E/K F.sey+.aS
• S/i:v G3 vvoF¢c. ,i sf30 isr w.it h' aSA, AIAw— .r s OW
Residential Commercial ❑
Fi ne: Yes No Confirmed with Pl mg ryt. '
there are an restri lions:
Cost of Project: Type of Const i Occupancy grou
9 9 , r
�s
Applicable/-_ Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY EneFa BUILDING
BSEISMICRE is c Fee Res BUILDING
BSEISMICOM Seisnic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
sem, �
I'T'Y OF CUPERTINO : ' `t' zzTj
BUILDING DIVISION PERMIT gCONTRACTOR INFORMATION ;<
;Z�09➢_ae �.k•YSu `' av" 2r s.u�s.«Rsa.. k^%S-+tL..M'
BOCILDINGADDRESS: WAGNER ROOFING CONTRACTORS PTNC003100200
10439 TONITA WY
OWNER'S NAME: 12242 SARATOGA-SUNNYVAL RYEWIT ISSUE DATE
CHRISTENSEN DONNA H 10/28/2003
NE 408) 777-8331 SANITARY NO, CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDGELECT PLUMB MECH
0 0 E 0
loo LICENSED CONTRACTOR'S DECLARATION
I U I hereby serum mal I on Licensed under previsions of Chapter 9(commencing Job Description
f� with Solion7 )of Division 5 of the Business d Professions Code,and my license is
.ore in fullfnme flet 2� REROOF ��®
>L,? LiccnuCLM.N� It
f ARCHITECTS DEQFlic records
et NTt9a%R6 Film
rds
1 undcrsland my Plana shall he used as 1yW��KB
- ,1 11 't 3 20
03
Licensed Professional-nal No V, 1
OWNER-BUILDER DECLARATION
7 1 hereby offirm mal 1 am exempt from the Contractor's License Law for the
❑o rollowing mason,(Section 7071.5.Business and Pmfessiuns Cade:Any city m county ��'�®�pA
<m� which requires a permit to construct,slot improve,demolish,or repairNany structure 9 9 2 0
°iy prior to its issuance,also requires the applicant rot such Permit to file a signed statement
-m< that he is licensed Pursuant to me previsions III the Contiutur'sLicense Lew(Chapter 9 Sq. Ft. Floor Area Valuation
uF$ (commencingwith Section 7")ofDivision 3ofthe Business and ProfrssinnsCode)or 35914010 . 00
Nat he is exempt thcmfmm
an the basis for me alleged exemption.Any violation of
Section 7031.5 by any applicant(at a permit subjects the applicant to a civil Penally of APN Number Occupancy
not more man rive hundred dollars(5500). P Y Type
p I,as owner of the prapeny,or my employees with wages as their uic compensation,
will do the work.and the structure is not intended or offered formic(See.7044,Busitou
end Professions Code:The Contractor's License Law does not apply to an owner of - Required Inspections
pmMny who bulletin,improves thereon,end who docuach week himself or Omagh his
own employees,provided that such improvements are not Intended or offered for sale.If.
however,the building or improvement is sold within one year of completion.Ne owner.
builder will have the burden of proving that he did not build or improve fur purpose of
ole.).
E)I,as owner of the progeny,am exclusively contracting with licensed contractors to
contract the praise,(Sec.7014,Business and Profciamus Code)The Contrumia Li.
cense law docs not apply an an owner or property who builds or impmvss lineman.and
who contracts for such projects with a contractor(.)licensed pursuant o the Contractors
License Law,
El 1.m exempt under Sec. .B k P C for this mann
13C737000
ner Date
YORKER'S 1 ATION DECLARATION
1 hereby affirm under penalty of perjury ane of the fallowing declarations:
I ban and will maintain a Certificate of Consent to ulGiasu r for WorkersComper-
on,u provided for by Section 3700 of the labor Code,for the performance of the
rk for which this permit is issued.
1 he.and will maintain Workers Compensation Insurance,as inquired by Section
of the Labor Code,for the performance of the work for which this Permit is Issued.
Wmkcei C n.alioo/yturn` uric,and Polic number are:
rtier.__ T,�r�Policy No.:V O O l33 I0
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thaiunite need not he completed If the Permit Is foronc hundred dnllm($i00)
loss.)
I cenify that in the perfntmauo of the work for which this Permit is issued.I shall not
employ any fiction in any manner u as to become subject to the Wafts'Corniontatton
Law.of California.Dao
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
b.mme Subject to the Worker's Compensation provisions of the Lahr Cock,you must
O forthwith comply with such provisions or this Permit shall be deemed revoked.
ti N CONSTRUCTION LENDING AGENCY
1 hereby affirm that mere is a construction lending agency for the Performance of
Y > the work for which this Permit is issued(See.3097,Civ.C.)
S1 A Isndch Nam.
5z Looder's Address
Q I cenify Nat I have read this application and state that In.above information is
L Ubuilding I agree m Comply with all city and county ordinances and Nk laws relating e
V aboveng punned propertyn,and hemby.mhonPurpoeunulivu of Ni.city to enter upon the
abovc(We) oed ho..lin imnify an keep
(Wc)agree m costs indemnify and hick harmless OOyaccru Cupertinoageinfl
h lieconsequence of
grsu.nd ofp.na.mit. may in any trayaccrue against mid City l a�
;� z Aconsequence of UNDERSTANDS
Slois Permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
��/a���� Re-roofs
sib ore ofSig ore of ApplinnUCon RDOU�� 0 eD e
HAZARDOU�ATERIALS DISCLOSURE Type of Roof
Will y t applicant or!Muni building k.Chapter
r 9.1 or handle Health
malarial
as defined by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
c.Section 15531(.)7 All roofs shall be inspected prior to an roofing material being
1 pYu te.f� P P Y g g installed.
web th.applicant or rulum building occupant use equipment or device!which If a roof is installed without first obtaining an inspection,I agree to remove
It havaMons it contaminants as defined by the Bay Area Air Quality Management
istricl? all new materials for inspection.
p Yes Iplvu
Ih&Sgei the h,SNao 25505lsmquiremcntaundcrChaPteddurahlheCaln ���`�
ria Health KSntly Cud.tommi,vhat it is
use
building, ra2g �/
mxia not cutmn0y have a tenant Net it is my rcsponsihilily It nnufy Nc rccuPml of Nc
quiet cnaswhich must bcmet prior tois.uanccofaCenificalcgro�.uPercy. Signatu of Applicant Date
Y > All roof coverings to be Class"B" or better
cent,or lhon.d agent uist
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408) 777-3333
UPEIVTINO
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.
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 on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: '41f, VAN CA R 5 rl"V5 ex l
r
Job Site Address: �o S/39 To.✓/� GyJ�
Roofing Company Name: �do CClW7-
tl
A plicant's Signature: Date: /o O�
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
t
CITY OF CUPERTINO
REROOF
cuPE INo PERMIT APPLICATION FORM
AM 8 Date:
359 iy oin
Building Address:
/0 3 on/2rR w
Owner's Name: Phone It:
M/L. 004W zsr o98B
Contractor: Phone p License*:
Gt/Avn aa„� G -(3 i 67 a 9z g
Contact: Phone(i: Cupertino Business License M,
Type of Root Coveting:
Existing: Proposed:
O Built-Up Roof O Built-Up roof
O phalt Shingles O Asphalt Shingles
Wood Shakes O Wood Shakes
O Wood Shingles /Wood Shingles
O Other(Specify) Q Other(Specify)jo}d- c/W A Aox A;e ass
Number of existing coverings O Provide I.C.B.O.ReportM ✓L l�f'17 �'';�
O To he Removed O Provide Mfgr.Installation Specs.
I Have Read Understand and Will Comply With Cu rtino's Tear Off Policy:
Job Description: A&,w,,e 5h4ALA,,I. XZVjrnI/ role✓ SD yt c�g3s':4"E/K F.sey+.aS
• S/i:v G3 vvoF¢c. ,i sf30 isr w.it h' aSA, AIAw— .r s OW
Residential Commercial ❑
Fi ne: Yes No Confirmed with Pl mg ryt. '
there are an restri lions:
Cost of Project: Type of Const i Occupancy grou
9 9 , r
�s
Applicable/-_ Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY EneFa BUILDING
BSEISMICRE is c Fee Res BUILDING
BSEISMICOM Seisnic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
sem, �