03030058 (2) CITY OF CUPERTINO ' *"'° -'"+ i`^ °°' -4 '`•"'
BUILDING DIVISION PERMIT TOR
BUILDINGADDRESS: WINTER ROOFING INC FERMIT NO.
19980 BRENnA ( T
OWNER'S NAME: . 151 WYANDOTTE. DR PERMIT ll
BRENDA CT. HOA
E° 4083638052 SANITARY NO. 2 CO OL NO.
ARCHITECTIENOiNEER: BUIL.DINO PERMIT INFO
BLDG ELE(.•r PLUMB MECH
o I�
Sop LICENSED CONTRACT'OR'S DECLARATION Job Description
rO� 1 hereby affirm Nu I em licensed under provisions or Chapor 9(commeming
ith Section 70 W)of Dividon 3 of the Business and Professions Code,and my license Is
in rail fore and eD REROOF
(!car in, Class `t--n_Lk.« AW
.
D'le CHrtEcrsDRecu EMOVE WOOD SHA1F�NFXSq ffd' /2 OSB & 30 YR. CO
I understand my plans ahall be used u public mmmis awe+tUlx��JJ
Limned Pgofessioml APR 2 9 2003
OWNER-BUILDER DECLARATION
a 1 hereby affirm that I am exempt from the Comncor,License Law far the
a O fallowing reams.(Section 70315,Business and Prorcsshme Cade:Any city m county
IgE which acquiree a permit an emmrve4 slat.improve,demolish,Or mpair my umetun M1 III
tyA pdmoits issuurca.aim r�uim,the applicant for each permit to file a signed Mntreal
bo Nar ate i,Bcerrod purgoamotW provltlnns Uf theContncoB LImngo law(CMpIcr9 Sq.Ft.Floor Area Valuation
S (cmmecoingwWSmioo7M)of Diviaion3aftln Busimss,nd Prormlons Coae)m
cam W is exempt thuefrom and the extra fee the alleged exemption.Any violation of
naagmom Nan nK n Appllired donu:(sem it objects the applicant W a civil penalty Of APN Number Occupancy Type
❑1,As owner Of un property,army employees with wall.As ft4 wit. mnpewum. 36943011 . 00
willdoaawork.andote,wctumis.tinlendedoroReredrms le(See.7045,B%Wn.s Required Inspections
And Professions Cade:The Contractor,Lice=Law dais rot apply 10,n owner of 9 P
propenywhe Wilaamimprowa Nermn,and whodm„uch wmkhimselfmuumgh big 305 — FRAME _
own employees,provided thatmch impgowmants Am not Intended maligned funk.If. 307 — INSULATION
however,the building Or imp menm/e
et Is gold within aar of compledon.the ovmer•
builder will haw the Wndan of proving that he did ml Wild Or halove for purpose of 601 — ROOF TEAR OFF
Axis')' 602 - ROOF PLYWOOD NAIL
❑1,As Owner of the property am exelusiwly connecting with Ilmwd conteaon to
construct the project(Sec.7044,Both=and Pnefualens Cade:)Tin ConuacoM1 Ll- 603 — ROOF BATTENS
cow Law deu not apply to an Owner of property who Wild,or improves thereon,rod, 604 — ROOF IN-PROGRESS
who mnuacts for such project,witha contnoor(0 licensed pursuant o the Connemara
License Law.
❑Tun exempt under See .B&PC fm this reason
Owner Data -
WORKER'S COMPENSATION DECLARATION
I herobwy afOm under penalty of perjury, am of the following deciwtionD .
hew and wIllmalntsina Ccrdrmmof Cownttoulf-imumfor Warkce Cmnpen-
ion.u provided for by Section 3700 Of the Labor Cade,for the performance of the
work for c this permit is issued,
aw and will maintain Workers Compensation Insurance.As confused by Semon
7700 of the labor Code.for the performance of the wart for which this Permit is issued.
My Worker's Cam ma on logunn anler and Policy number am:
Caller. Pollry Na.;
CE 1F ATENFROMWORKERS'. -
. COMPENSATIONATIONINSURANCE .
nhh section tied not he completed lithe permit Is for one hundred dollars(SIM)
or lea,.)
I=try that in the performance of the work for which this pearl,Is issued.1 null not ,
employ any person in any manner an an o become subject to the Worsen'CUmpensnten
Laws of California.Data
Applicant
NOTICE TO APPLICANT.If,after making this Cenifica a of Exomptlan,you Should
became subject o the Workers Compensation previsions of the Tabor Code,you must
Z forthwith comply with such provisions or this permit shall be dmmcd rooked.
z y CONSTRUCTION LENDING AGENCY -
�-r I hereby affirm that there is construction lending gamy for the performance of -
Yg the work for which this permit IS Issued(Sec.3097.Civ.C.)
W�Q Landers Name
7 z Lenders Addr.e
UR 1 gantry that I lave reed this application and role that the above Inrormatlon h
U.U correct.I agree to comply with all city and county Undreamt,and mu laws miating to
0 rV' building convection,and berebyauthodm npremnuthe,or this city to enter upon the
W 'love-mentioned Property for Inspection pugases,
(we)agree to taw,indemnify and keep the City of Cupertino against
Pw
y IlabilWu,judgmenWcostsmdexpenrce whichm .any w.y xeerac galnnuia City
V`4in mM nee of0ogentingafthlapcmil,.
'•" APPLI UNDERSTANDS AND IL NIPLY WITH ALL NON-POINT Issued by: Date
SOU ECU Ng.
2—07 Re-roofs
III u Appl' UCon m Dna
HAZ OUSM ALS DISCLOSURE Type Of ROOF
Will the applicantor future building emupant non m handle humoous marmial
fined by INC Cupertino;M?UndCtp1l',PdlChapter 9.13,aro the Health and Safetyseas,Section 25532()7All roofs shall be inspected prior to any roofing material being installed.
[3Yu Win un applicant mutunWt upam w equlpmem or devices welch If a roof is installed without first obtai ing an inspection,I agree to remove
It harWnus air contemlnanu u do by the Bry Am,Air Quality Management all new rials for inspection.
ct7
oyn u
Ih read the hwndnumalerialsommi nsunderChapct6.95ofua Califao-
nla Heal SsimyCoae,Smumts25 .2557 255M.IuodrnrW thnlrun Wilding
doe, a Ally have a sem u nobility o nOify tis agaupant of see
a"it n ce of a Corti Bcaa'UrOecupamy�..,/�� Si at of Applicant ass >
Aer r romanme rot Dare All roof coverings to be Class"B"or better
., Community Development Department
' Building Division
j �.:. City of Cupertino
10300 Torre Avenue
J CITY OF A' Telephone: (408)777-3228
CUPE�T1N® Fax: (408)777-3333
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 Y4"'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:
Job Site Address:
G
Roofing Company Name: C4yf G
A pllcant's Signa Date: z I U3
Greg eel
Building Official
Revised 1/30/03
Printed an Recycled Paper