05050153 (2) 77 _
CITY OF CUPERI'[NO ivs ' '+uv a were a� "` zgr
BUILDING DIVISION PERMIT CONTRACTOR=INFORMATION
m:ren-
Bu1LO1NC ADDRESS: WAGNER ROOFING CONTRACTORS PINCNo05050153
OW NER'S NAME: PERMIT ISSUE DATE
ONE:
SANITARY 0. COMMOL NO.
ARCHITECTfENGINEER: BUILDING PERMIT INFO
SLOG ELECT PLUMB MECH
sop LICENSED CONTRACTOR'S DECLARATION Job Description
x F I herby affirm that 1 am licensed under provisions of Chapter 9(commencing P
"Zw with 11fo, ]d,ff Division7of the Busircv aw Profcti ons Code.and mYlicemc is ����®
zt2„ mmnrort anderr« 2 Z� TEAR OFF SHAKE ROOF
j a�Z Liccnre Chis Lk.N
I Date Contractor INSTALL NEW 50 YEAR CLASS A
ARCHITECTS DECLM r ord
i'ie lunderwnd my pans ah,n be n,edupuNie meards FIBER GLASS
=u,; Licensed Professional 1005
O OWNER-BUILDER DECLARATION
q 1 hereby affirm Nu 1 am exempt from the Conlncmfs License Law for the
Z O following mason.(Section 7031.5.Business and Pmfesumu Code:Any city at county
m m which requires a permit to construct,alter,improve,demolish.or repair any structure
rZr prior to its issuance.also mquites the applicant for such permit to file a signed statement
< that Mislictoxedpursuant inthe provisionsofthe Conowtor'sLicense Law(Chapter 9 Sq. F[.Floor Area alU O
'ti-$ (commencing with Section 7")M Division 7 of the Business and Professions CoJe)of '
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that be is exempt therefrom and the baso for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant m•civil penalty of APN Number Occupancy Type
not mart than Eve hundred dollars(S500).
0 1,as owner orthe preperty,or my employees with wages as their sole compensNon,
will do the work.and the structure is wrntended or offered for sale(Sec.71144,Business 3 2 6 4 3 028 . 00 Required Inspections
And Protestors Code:The Contractor's License Law does not apply to an owner of q P
property who builds orimprovm thereon,and who does such work himself or through his
own employees,provided Nal such improvements are not Intended oroRemd for sale.If.
however,the building or improvement is sold within one year of completion,the owner-
builder will have Ne burden of proving that he did not build or improve for purpose of
sak.).
0 1,as owner of the property,am exclusively contracting with licensed conuacurs to
wromael the project(See.7p ,Business and Professions Code:)The Contracmr's Li
ecru,Law does not apply to in owner of properly who Wilds or improve Merton.and
who connote;for such projects with a contractor(s)licensed pursuant in the Contractor's
License Law.
0 1 am exempt under Sec. B h P C for this reason
Owner Data
WORKER'S COMPENSATIONDECLARATION
I hereby affirn under penalty of perjury tree of the following doelaratiuns:
1 have and will maintain a Cenificm¢of Consent to self-imam for Worker's Compen-
137W
ion.az provided for by Section 37W of the labor Code,for the pmformance of the
rk for which this p,rmit is issued.
1 have and will maintain Worker's Compensation Immance,u required by Section
of the labor Code,for the performance of Ne work for which this permit is issued.
y Worker's Compensation Insurance canton and Policy nunsrrier. 37-47e Policy No.:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mors Section reed not be completed if the permit is for one hundred dollars(SIM)
or less.)
1 certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner So as as become subject to the Workers Compensation
Laws of California.Dart,
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject in Ne Worker's Compcnsstien provisions of She labor Code,you must
J O forthwith comply with such prnvisinns or this permit shall W deemed revoked.
N CONSTRUCTION LENDING AGENCY
'fa I hereby affirm Nat there is a construction lending agency for the performance of
fk Ne work for which this permit b issued(Sec.3097,Civ.C.)
V4 Q Lenders Name
Lenders Address
>z
U C) 1 cenify that 1 have read this application and sum that the chow information is
IL E. cored.l agree to comply with all city and county ordinances and sum laws relating to
�U building construction,and hereby autbmim repoes,nutives of this city to enter upon the
�.UU above-mentioned pmpery for inspection purposes.
G (We)agree to save,indemnify and keep harmitu the City of Cupcninouagainst
F'Tq
liabilities,judgments,costs and expenses which may in any way mean againsaid City
U in consequence of the granting of this permit.
.. APPLICANT DERSTANDS AND WILL MPLY WITH ALL NON-POINT Issued by: Date
SOURCERE LATIONS.
Re-roofs
HAZARDO Dat
Signatyre of a
Ap e
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant rstore9.1 or handle hazardous a material
As ticnncd by Ne Cupertino Municipal Code.Chapter 9.13,end the Health and Safety
ewe.Sceties zsaz(an All roofs shall be inspected prior to an roofing material beim
❑Ye (�Na P P Y g g installed.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
Fail hazardous air contaminants az defined by the Bay Area Air Quality Management all new materials for inspection.
District
O Yea Nu
Ihave&Sdrem thch,nr ..M505,.2553anics Material Ott5M 1u Chapterh95 if the Califon
nu Health'Anch" Code,Sections]SNlS.ZSS7J an SM.IunJerwnd NatiftM building
Joe not cuncntI In ve a tenant Nat it is my mibility,b fmtily Uro a<upnn of thee-
cardmmcnu 'eh,av be met prior a of a Certificate of Occupancy. Sign re0 pplcant Date
64.D All roof coverings to be Class "B" or better
Own —O adagent Oar
Community Development
10300 Torre Avenue
SUM
Cupertino CA 95014
Telephone(408) 777-3228
CITY OF Fax(408)777-3333
�UPERTINO
Building De artment
JOB ADDRESS: PERMIT #
/ o630 C e-Aw-P i r?
OWNER'S NAME: c4a PHONE # -75,2-- '73Z7
GENERAL CONTRA 4� FAX#
I am not using any subcontractors: ds 26 D�
Signatuee Date
Please check applicable subcontractors and complete the f llowin information:
60 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
19.
Owner/Contractor Signature Date
Community Development Department
r Building Division
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.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
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: , � _ � �
Job Site Address:
Roofing Company Name:
Applicant's Signature: /1 V � Date: or
i
Greg Casteel
Building Official
Revised 77/2/04
Printed on Recycled Paper
05050163
CITY OF CUPERTINO
Sit
REROOF
CITY OF
CUPERTINO PERMIT APPLICATION FORM
APN # 2 7co—q 3_ Oa8 Date:
v� O 6 D
Building Address: 11
%d o Ca4toonz Aup
Owner's Name: Phone#: 2.32— X327
Contractor: Phone#: License #:
7 7,7-X331
Contact: Phone#: 777— X33 / Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Bui t-Up roof
❑ Asphalt ShinglesZ---Asphalt Shingles
❑ Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings ❑ Provide I.C.B.O.Report#
be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job Description: SO c P,4-k ",
''
.l clnsf �`i6PRGh5;F
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning De t. if
there are any restrictions:
Cost of rojec , Y330 Type of Construction: Occupancy group:
Qty. i f
Applicable Fee lD 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