03070084 (2) t CITY OF CUPERTINO - 4' •� ••' � 'x'
BUILDING DIVISION PERMIT r CONTRACTOR�INFORM4rr
BU ILDINGADDRESS: WING' S ROOFING INC "'""ND03070084
0262 13QNNY DR
OW NER'S NAME: 561 RUTGERS ST PERMIT ISSUE DATE
ONE: (510) 481-3818 NTRSANITARY NO. COOL NO.
ARCHITECI'fENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
0 0
3g6 LICENSED CONTRACD7R'SDECLARATION JobDescri tion
I hereby affirm that 1 em licensed under p nvi.iome or Chapter 9(co nora,m ng P
with Sued..7(M)o(Division 3.f Ne Bumocst and Professions Code.and my license Is
in m I mrh and Real. I
5 z trance e1. -e j Lie.N 3 REROOF
3 °a c°nlra.,Or T/0 WOOD SHAKE, INSTALL 7/16" O. S .B.
AICHf1ECTS DECLARATION
S u lament ndmyplautloddlhetecdupublicrccnrds INSTALL "A" ASPHALT SHINGLE
kG t; Licensed pndessimAl
3 OWNER-BUILDER DECLARATION
y I hereby alarm that I am eaempt from the Contractor's License Lew for the
COO following mason.(Section 703 1.3,Business and Pm(essiuns Code:Any city or county
$� which requires a permit to convect,eller,improve,demolish,or repair any swcture
_I j- n
prioo its issuance,also requires the applicant(or such permit to file a signed statement
p < thalheislicensed pursuanttothe proyhormsofthe ContractorfLeconte Law(Chapter 9 Sq. Ft. Floor Area Valuation
i G (commencing with Section 7W)of Division 3n(the Business and Professions Cole)or
i 3$ that he b exempt thert(mm and the btu for the alleged exemption.Any vioadon of $768
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number Occupancy Type
not more then five hundred dollars Mori). 35914041 . 00
❑
I.u owner of Nu e pmpeny,or my employcwith wages u their sole compensation,
will do the work.and the structure is not Intended or offered foualc(Sec.7Dea,Business Required Inspections
and Pmfesslans Code:The Contractors License law docs nut apply m an owner of 9 P
property whoWild,mimproves d¢mon,todwh.dos,,uchwmk himself.,through his
.we employ..,p...ided that such imponsmmu veno,intended oroaered(a,sale.If, 305 — FLAME lr� a1S1' GW1a I�I j
to weveq Or building or improvement Is said within mo yes c f completion.then,,
builder will have the burden of Fuming Out he did not Wild or impm o for puryme of 307 — INSULATION
e.in.). 601 - ROOF TEAR OFF AUG 0 5 2003
❑I,as owner of the propeny,am exclusively contracting with licensed contractonto 602 - ROOF PLYWOOD. NAIL
construct the pmject(Sec.70x,Business and Professions Code:)The Contractor's Lt
came Law docanot apply toanOwner ofproperty who builds orimprove%demon.and, 603 — ROOF BATTENS BUILDING
controls for each projects with a contracum ft licensed pursuant Contractors
License law. 604 - ROOF IN-PROGRESS
❑l on exempt under Sea .B&P C for this..a.
Owner pale
WORKER'S COMPENSATION DECLARATION
I hereby arm under penalty of perjury arc of the following declaration:
I have and will maintain a Cenificala of Consent to self-intro for Worker'sCompcn-
1C314111
lon,ss provided for by Section 370(1 of the Labor Crede,for du perfonneae of the
rk for which this Permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Scctlon
0 of Ne Labor Code,for the erfmman of Ne work for which Nis permit u award.
Worker.Cpmp ration m nm a u and Polity number art:
mer: T/U.1_i -"fit. Policy No.: 2,0 '£v
CERTIFICA •OF PJ EMPTION FROM WORKERS'
COMPENSATION INSURANCE
(lhisseelion need not he completed if the parm0 is for one hundred dollar(SIM)
or less)
I certify that in the performance of the work for which this permit is issued.I shall not
employ any Whom in any manor ser as to become subject to the Worked Compensation
Law.or caiumn a.Data
Applicant
NOTICE TO APPLICANT:If.after making this CcniOcate of Exemption,you should
become subject to the Worko's Compensation pmvisions of the labor Code,you most
.`O forthwith comply with such provisions or this Permit shall bo deemed revoked.
z� CONSTRUCTION LENDING AGENCY
j—t IWrthy aRpm Na,Ncrt is•construction lending agency for the performance or
CG
the work fur which this permit Is issued(Sec.3097,Civ.C.)
L,Q lender's Name
z Lender's Address
U Q I certify that 1 have rod this application and mu that the above informadun u
0E CanmcLI.greectComply
and here all city and cranny ONLlwS or and Oa4lent Riptingtoe
p alowengcofirmed construction.and hereby aohorisertessol. tivcs of this city to enter upon Nc
Od above-memiun OT LO S M for indemnify
an keep ha
(1 esac)qua mcove,indemnify and kap humins w City ntCuPcnsts editor
' A
fq liabilities,judgments,encu and expense,which may in any way eccrus against said City
U 7 in conmyuence°f lm gmming of this permit.
F7 APPLICANT U ERSTANDS AND WILL COMPLY WITH AU/NON- INT Issued by: Dat
SOURCEfEGU ATIOWS. 1.,�1//h
atereoA n 1ucu .t ,T Pete Re-roofs
HAZ RDOUS MATERIALS DISCLOSUR���� Type of Roof
Will ft applicant Or future building occupant store or ben�eTiarardous material
as defined by dte earphone Municipal Code.Chapter 9.17.and the Hca1N and Safety
Code.Secdon 15531(a)? All roofs shall be inspected prior to any roofing material being installed.
❑YmV.
Will me applicant rwum buildingarupam use equipment at devices which If a roof is installed without first obtaining an inspection,I agree to remove
It havardnua air contaminants as dcnned by the Bay Arca Air Quality Management all new materials for inspection. - --
atric,?
❑Yat �Ilu
Ihevc read the h.rdoushmaterials requirements under Chapter 6.95 of the Califon /a" ///�///,
nia HcalN&Safety C.de,Sc d6.25505,25573md255N.lundersund Mmif Re Wilding / I I/' .__ 7
does mol curtent y have a tom.Not It u my responsibility to nutty the occupant of the 1 �V �- l L_�
mqulrtme Law ch must the me,priono issuance Ora ccranate oroaapancy. Signature of Apicant Date
cr a ri rad ag IDau All roof coverings to be Class "B" or better
Community Development Department
Building Division
9 . City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
UPEI�TINO
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 Nyith the above sstatpolicy on p-;o�g.
Homeowner's Name: / j L-
Job Site Address: J 3b _2 v A 1
Roofing Company Name: �y�v I v '�
A plicanYs Signature: 1 Date: j�
\�t/�6l/�1LXX1
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF
CUPEI�TINO PERMIT APPLICATION FORM
APN# Date: t ( a
Building Address:
10362 /U
Owner's Name: Phone
iht e _emsL1v �ag 2- -7 j f
Contractor: i S d 6r N Phone#: License#: / C D/(3
ML
Contact: r 1 t G C* Phone#:D g _ `� Cupertino Business`OLicense#:
o F�
Type of RoofCovering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles Q( Asphalt Shingles
X-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 Corriply With Cu rtino's Tear Off Policy: ❑
Job Description: 7/4, W e& _ Lt'tS 7
Li
Residential ommerc al ❑
Fire Zone: Yes ❑ No ❑ Confirmed with P De t. if
there are an strictions.
Cost of Project: �,GSo_ Type of Cons tR ti Occupancy gro
Qty.
A ca 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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