03060168 (2) CITY OF CUPEWrINp
r BUILDING DIVISION PERMIT CONTRACTRL..NFORMATION
BUILDINGADDRESS: WINTER ROOFING INC PERMITNG03060168
77 ATAZING-14001) A.17
s OWNER'S NAME: 151 WYANDOTTE DR PERMITISBUEDATE
ONE: 4083638052 SANITARY NO. 9 CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
BOO LICENSED CONTRACTOR'S DECLARATION
1 touchy affirm that I am licensed under previsions of Chapter 9(commencing Job Descrip[1)wD51 a� /s. n y++a{j��
Iwith S=tion70lM))of Divixion]ofth.Businman Prurcuion Code,and my Hemscis `r OIs +, �e A:z-1t3
+ „ m :11., d fat. REROOF
�N Z Llccnse a y Llc.N (t ']
9
Do
CumruARCH ITECTS F6olr,/.@A U U L 0 V 2G OJ
f i a red my ploy shall he used u pub records BUILDING ap Licensed Prifcssioml ®UILDIItlh
agO OWNER-BUILDER DECLARATION
2 E 1 hereby affirm that I am exempt from the Contractor's License Law for the
O O following reason.(Sworn 7071.5,Business and Plaremiour Code:Any city or county
5$ which requires•permit to convect,alter,improve,demolish,or repair any structure
-z>r^ prior m its issuance,also requires the applicant rot such permit to fie a signed statement
£9C that he is licensed pursuanunthe provisionoffine COnimaturiLianselaw(Chapter 9 Sq. Ft. Floor Area Valuation
ytt$ (commencing with Saction 7000)of Division 3 of the Business and Profession Code)of
>3-
that he b exempt therefrom and she buil far the alleged exemption,Any violation of 36920009 . 00
Section 7031.5 by airy applicant fon permit subjects the applicant i...Wil pcmlty of APN Number Occupancy Type
not mom Nen five hundred delta.(S5OO).
I,uowner of the property,or my cmploycu with wegeeu Nelr sole Compenuden,
will do the worc,and Nestneture B not intended oroffered fonale(Sec.7W,Business - q
oil Profeuiom Code:The Consomme,License Law does not apply m an owner of 307 - I NSULAT loth d Inspections
property,who buildsor improve thereamand who does auchwmk himselfor through his
Own employms,provided Nat such improwmems;art not intended or offered formic.If, 601 - ROOF TEAR OFF
however.Oc building or improvement is sold within ane year Of completion,Ne owner-
Wilder will haw the burden of playing that W did not bund m improve for purpose of 602 - ROOF PLYWOOD NAIL
sal.')' 603 - ROOF BATTENS
1,as Owner of the pmpeny,am exclusively contracting with licensed contractors to
convect the project(Sac.761a,Business and Professions Code:)The Contractor.U. 604 - ROOF IN-PROGRESS
acne law does not apply to an Owner of property who Wilds or Impram Nemon,and,
who contracts for such pmjects with a contruror(,)licensed pursuant Use Contractor's
License Law.
ED I am exempt under Se. .B h P C for Nb mason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declanuom:
I have and will mainuin a Certificate of Consent m self-Iuum for Worke'sCompen-
I
on.u provided for by Section 3700 of the IaWr Code,for the performmce of the
rk for which this permit is issued.
I haw and will maintain Worker's Compensation Insurance.u required by Section
00 of the Labor Code,far the performance of Ne work for which this permit is issued.
W ars COmpenutienl senna cartiennd Polity numbeAr art:
l 2CEFT PoIiry FROM
ORKERS' �V3
CERfIFICA OF EXEMPTION FROMWORKERS'
COMPENSATION INSURANCE
(1TH section need not b completed idea permit is for one Wndnddollan($101))
loss)
I certify Out in the performance of the work for which this permit is issued.I shell not
employ any person in any manner all u In become Subject o the Werke.'Compensation
Laws of California.Dau
Applicant
NOTICE TO APPLICANT:If,afar making Nu Certificate of Exemption.you should
become subject to the Worker's Compensation provisions Of the IaWr Code.you most
.J O forthwith Comply with such provisions or Nu permitahall W located revoked.
Z' CONSTRUCTION LENDING AGENCY
HI hereby aRrm that Nene is construction lending agency for He,performance of
ai the work for which this permit Is issued(Sec.7097,Civ.C.)
J 0
Leader's Name
z Lander'.Addreu
V Q 1 ttni(y that I have read this application end sou that Ne eWve information h
w L cenmr.I agree to comply with all city and county ordlml4Ta and seats laws Rating to
pU Wilding construction,and hereby authorise repreentatives of this city roamer upon the
1i7 .have-mentioned property for inspection puryosea.
gy (We)agree to eve.Indemnify and keep harmless the City of Cupertino against
fA IlabllitleLJudgments,costs and emerms which may in any way acne against midCity
C) in AP on oe^ UNDofffie RS ANOSling of tANhis D WILL COMPLY WITH ALL NON-POINT Issued by: Date
on
SOU ELL 10 S.
Re-roofs
Sigmm A omncmr Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will du applicant or future Wilding ottupantSur a or boob harudow material
u defined by the Cupertino Municipal Code,Chapter 9.13,and flue Health and Safely
We.Section 2553:(.)! All roofs shall be inspected prior to any roofing material being installed.
riY. �Je
Will the applicant or future building occupant use equipment or device.which If a roof is installed without first obtaining an inspection,I agree to remove
ill hmardous air contaminants u defined by rho Bay Area Air Quality Management all new materials for inspection.
i.trictT
❑Yca eN.
I have mad the hoarddew's mammals rcquimmenu under Chapter6.95 of the Califor. _
nix HcalN&Safcryy .s IWu 25505,25533 md25534.I andc.mnd lhatifdo Wilding }^
don n end aw en nt.that it u an,nsponibillly u notify dm occupant of the
laquireme and W cipriormissumceofaCcrtrfmsycopanry. SI aI o ppli an Ie
w tarot orixc ag t S w All roof coverings to be Class"B"or better
Community Development Department
Building Division
City of Cupertino
�yes 4,
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
I NO Fax: (408)777-3333 UPEkT
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: /V/(0Wn��Z- /7' S/ 1-l�
Job Site Address: 9.2 B l4 7�Alt< 142019D 1-911
Roofing Company Name: Ow7-,GiZ z�
A plicant's Signature: Date: t%? —2 Jr— Q 3
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO v 6 a
REROOF 3
CUPERTINO PERMIT APPLICATION FORM
APN# Date: p
Building ddr s: v
6 \041a0e Ar�
Owner's Name: Phone#:
Contractor: hone#: License#:
Cont t: hone#: Cupertino Business License#:
ASI/,2.�Z - ty
Nj Type of Roof C vexing:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
A1 - Asphalt ShinglesAsphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings��_ ❑ Provide I.C.B.O.Report#
❑ To be Removed ❑ Provide Mfgr.Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's TearOff Policy: ❑
Job Description:f� i c� n� o- P /�, C �
Residential YY ommercial ❑ Y J
Fire Zone: Yes ❑ No ❑ Confirmed with Plan
there are any restri ons:
Costo roject: Type of Cons Occupancy gro
al 67 6 c
Qty-
Appliabje) Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
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