05090201 (2) CITY OF CUPERTINO d+' » ,z4'c. uia '- ' • `� 'er'
BUILDING DIVISION PERMIT aCONTRAC-TOR INFORMATION
BUILDING ADDRESS: WAGNER ROOFING CONTRACTORS PETWL"005090201
7573 BOLLINGER RD
OWNER'S NAME: PERMIT ISSUE DATE
CHIOU-FENG CHEN 12242 SARATOGA-SUNNYVAL RD 09/29/2005
NE: SA Ry NO. CONTROL NO.
(408) 777-8331
7ARC HITECTIENGINCER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
°0LICENSED CONTRACTOR'S DECLARATION lob Description
�m1 hemby affirm tar I am I'¢emed under provisions of Chapter 9(commencing s�
iSatikn70fkBofDivixion]ortaBusineuand Profciaiom Code,atWmylkcnmu 'I n� ummeanaercea g REROOF-T/O SHAKE, INSTALESHINGLESELuren case ClassOak,y
/P ` ARCHITECTS DECLARATION if
ri w 1 understand my plans shall be used u public«conks
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s C
Licensed Professional � 2005
g 3 OWNER-BUILDER DECLARATION /z
2<I 1 hereby affirm Nat I am exempt from the Contractors License Law for the
O O following mason.(Section 7031.5,Business and Proressiom Code:Anycity or county ff
K which mquims a moral,moral, mwct
it to cn .A mr,improve,demolish,m repair any structure II�ft 17 I.s'! t( xgiaI5460
ymi
poor o its issuance,also requites the applicant(orsuch Permit o rile aslgned statement
vc that he is licensed pursuant Io the provisions of WeCanuacmr'sLicense Law(Chapter 9 Sq. Ft. Floor Area uLValbati'o`n
r�a (commencing with Section 7")of Division 3 of the Business and Professions Code)or
i 3$ Nat he is exempt Wardroom and We baso for We alleged exemption.Any violation of
Section 7031.5 by any appliam for a permit subjects We applicant to a civil penalty of 3 APR MAger U Occupancy Type
not more than five hundred dollars(S500),
1,as owao or the property,or my cmployta with wage m Weir Okla compensation,
will do We work.eadte soucmm is nor intemmd orarced rmvm(sm.loan,Bkainesa Required Inspections
and Professions Code:The Come.emrs License law docs not apply m e an owner of q P
property who builds orimprnvcs Lemon,and who dassuch work himself or through his
own employes,provided tat such improvements are nor inmrvJed or offered for sale.If.
however.We building or improvement is sold within one year of ec mplction,the owner.
builder will have We burden of proving that a did man build or improve for purpose of
sale.).
I,as owner of the property,am exclusively contracting with licensed commcmrs to
ekkstmel the pmject(Sec.70x4,Business and Professions Coae:)no Cknoaemr's Li-
se Law docs not apply to an owner of property who builds or improve thereon,and
who contracts for such projects with a contractors)licensed pursuant k We Conoacmfs
License law.
❑1 am exempt under Sec. .B&P C for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of We following declarations:
I have and will maintain a Certificate of Consent o self-insure for Worker's Camper.
sation,as provided for by Section 37W of the labor Code,for to performance of We
work for which this permit is issued.
1 haat and will maintain Workcr's Compensation Imuran,as mquimd by Section
3700 of the labor Code,for We performance of the work for which this permit is issued.
My Workcr'syf/Otn nsai n Insu a icr and Polity num am:
Cartier: /C C� Policy O
CERTIFICATEPE COMPENSATION
EXEMPTION MOM INSURANCE- COMPENSATION INSURANCE
(Thisataion mcd not beeompleted if the Permit is foram hundred dollars IS 100)
or Ie1
1 ccnlfy thin in the perrommncc of the work for which this Permit is issued,1 shall not
employ any person in any mannerso ss to become subject m We Workers'Compensation
Laws of California.Date
Applicata
NOTICE TO APPLICANT:IL after making this Cenirmam of Exemption,you should
become subject to to Worker's Compensation provisions of to labor Code,you must
.J z fortwit comply with such provisions or this Permit shall be method invoked.
Z CONSTRUCTION LENDING AGENCY
Ihereb affirm War them iso eonsuvcLUM lendin In We rfurmana or
Y .C.) 'Y r F
x dm work for which this permit is issued(Sec.JfA],Civ.C.1
(A A
Lender's Name
6.
Lenders Address
az
V P 1 certify that I have mad this application and more tat to about information g to
II,0 F correct 1 cora to comply with all city and county ntainanas and sum laws r upon
m
p U sinewngconswdogand hominy toPrposes.representatives of this airy to color upon to
r shove ment(We) ned
Propene for ininspectionnifAkeep ha
n f]. (aju agme u save,indemnify and hap harmless to City of against id City
at C7 A
rn inconsequence or the
atsing expenses which may inany way accrue against mid City
C)z Aconsequence oftegmnb Nof DSthis permit.
APPLICANT U ERSTANOS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale 1-f-2riTjf/-
SOURCERE AT s. ��
Re-roofs
Sigsmt a Applica USonuanor Dam
HAZARDOUS M RIALS DISCLOSU E Type of Roof
Will to applicant mfumm inti dingaccupanismmorhandichea ousmdmrial
I.dick by the Cumnino Municipal Code,Chapter 9.12,and to Health and Safety
ode.Seed..25532(.)7 All roofs shall be inspected prior to an roofing material being installed.❑Yes �
Will Wtapplies nroa(alum building«cupantuse equipment ordevices which If a roof is installed without first obtaining an inspection,I agree to remove
it hazardous air contaminants az defired by to Bay Area Air Quality Management all new materials for inspection.
D'soict7
Q Yes
1 have mad We harardous materials requitemcuts under Chapter 6.95 of We Ulifor
nix Hcalt&Safety Coat,seem.25N)5.25533 and 25534.1 undersand Nat lithe huilding
docs not cumemly haw a mmol that it is my responsibility to nodly the mcupam of We
mquircmcna ichmu bcmetpoor 'smanccafaCamteam ofOccup y. � Signature of Applicant Date
own k Wmucal.,cut mAll roof coverings to be Class"B"or better
Community Development
_ �. 10300 Torre Avenue
{ / Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
®UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
b J'6 Y 6 2-,;1-
OWNER'S
0OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: FAX #
I am not using any subcontractors: ?124L6
Signature ate
Please check applicable subcontractors and complete the owing 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
Owner/Contractor Signature Date
09-06-2005 07:32 PRGE:8
Bunding Division '
10300 Tort Avenue
` CVerfm%CA 95014-3255
00 Teleplmmu: (408)M-3228
CI PEkTINO Fax: (408)777-3333
Building Depar�ent
Subject: Remoffng policy for the City of Cupertino.
1. Prior
and mto permit issuance,you must agree to comply with 1997 UBC Standards
anufactures 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) Preinspecti(n 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 requited 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 Z22 5 . G"/,f IV
Address: 7 5 7
I;eraofing Company e GtJ b v Cd
Applicants Signature: -
Date: _9��oS
r
Joe
Antonucci
(Chief Building Official)
6/25/01