05030188 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT y CONTRACTOR+INFORMATION
6UILDING ADDRESS: PERMIT NO.
WINTER ROOFING INC 05030188
0200 Q_RRRTQN DR
OWNER'S NAME: PERMR LSUE DATE
ANE:
SANITARY OL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Loo LICENSED CONTRACTOR'S DECLARATION Job Description
w C 1 botchy affirm Nlicensed
at 1 am under provisions of Chmmr 9(commencing ,,(j/^t�1{
ra w with Section 70M)of Division 3 of the Business and Professinm Codc.md my licensor of `s1
ofull fare and effect
`oq= uanxcla C��y Le.♦ REROOF W/SHAKES
? �
Dam�? � Contractor
ARCHI ECTS DECLA ATI J /r
my C 1 undcrsund my plans shall be used as public records
Dx,U
aO�, Licensed Professional g (w
OWNER-BUILDER DECLARATION /,/{py(Y
1 hemby aRrm that 1 am exempt from the C.."Cu a Liecnse law for the Q// /////////ppp/�-��'}��).
00 following mason.(Seedon 1031.5,Business and Professions Cate:Any city or county /( a q 1 y'
m Ixi which mcl a Permit ro cmudruc6 alteq Impmw,demolish,a rep,my structure �i V// IL
prior to its issuance.also requires the applicant for such Permit to file a signed statement
ESCshat he is licensed Pursuant m the Pmvisinm of the Contractor's Liecrx law(Chepta9 Sq. Ft. Floor Area Value 00
st-$ (commencing with Section 70M)of Division 3 of NC Busincramd Profession,Cnde)ter w.'.�•
_ that W as exempt therefrom and the bus for the alleged exemption.Any violation of
Section 1831.3 by any applicant for a permit subjects the applicant m a civil penalty of 3 2IPfttp*er0 0 Occupancy Type
not mom dun five hundred dollars($500).
U I,u owner of the pmpmy.or my emplo with wages ss their sole c=Nnmdon.
will do the work,and the structure is not intended or Offered formle(Sec.1004,Business
and Professions Code:The Contractor's License law docs not apply m an owner of Required Inspections
property who builds or improves thereon,and who doessuch work himself or through his
own employees,provided that such improvements arc nut intended ooRered formic.If.
however,Iha building or improvement is sold within one year of completion.the owner-
builder will have de burden of proving that he did not build or improve for purpose of
sad.).
❑1,as owner of the property.am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Code:)The Contractors Li-
ccese Law does not apply to an owner of property who Wilds or improves thereon,and
who concocts for such projects with a comoscon(s)licensed pursuant to d¢Contractor's
License Law.
❑1 am exempt under Sec. .B k P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain.Certificate of Content to xlf-insure for WoracesCompm-
sall0n.u Provided for by Setion 37M of the LaWr Cock.for the x,fOmlNee of the
work for which this permit is issued.
e and will maintain Workers ComPensati0n Insurance,as required by Section
W of the Labor Cade.for the performance of the work for which this permit is issued.
My WorkeYs Co penxation Insurance carrier and Policy number me:
Cartier. Policy No.:
A OKEMPTION FROM WORKEI(S"
COMPENSATION INSURANCE
(This section need not he completed if the Permit is for one hundred dollars(SIM)
or less.
I cenifv Nat in the performance O(the work for which this permit Is issued,l shall not
employ any person in any manner an as to become subject to the Workers Cnmpemauon
Laws Of C.lifmr.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Ccrtiaum of Exemption,you should
become subject 10 the WorkcrS Compensation provisions of the Labor Code,you must
.JZ forthwith comply with men provisions or this Permit shall be deemed revoked.
z Q CONSTRUCTION LENDING AGENCY
E•-' Thereby aMom dont them i..construction lending.germy for the perfurmena of
C> the work fur which this permit is sued(Sce.3f191,Civ.C.)
L9 oLender's Name
IS. Lender's Add.,
U C I cenify that I have read this application and state that Nc above information is
F correct.I agree 10 Comply with all city Nd county ordinances and state laws mlaling to
0U building construction.and hereby mlamim mpresenmims of this city to enter upon the
�Lu alhoe-mentioned propcny for impccuon purposes
(We)agree 10 save,indemnify and keep hadless the City of Cupenim egaimt
H y n
liabilities, costs and expenses which may in any way accuse against said City
U z in
Cof due Bonding of I
NTUNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
` Re-roofs
gignvum ol'ApitcancCoduractor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store 9.1 or handle Health
material
u defined by the CUDenino Municipal Coda Chapter 9.12,and Nc HcaIN ant Safety
Cole.Section 233.2(x)?
Y .. / All roofs shall be inspected prior to any roofing material being installed.
❑ o+�
Will Nc applicant or fuwm Wilding oavpmt tax equipment ordevices which If a roof is installed without first obtaining an inspection,I agree to remove
r7d.�
i1 haum us air coomminanLL a.dofined Cy Ne Bay Arta Air Quality Managemcm all new aterials for inspect on.
f.Cl!/❑Yes Nu1 have mad Ne hamaNnus materials requirements under Chapter 6.95 of the Califonfelyave.5a1iom25 5,255.,mad 255J4.IunJcrsuM NwiTdr Willingn11y have a til s my ruponsibilily b notify Ort occupant of Ne 17
hichon V dorWWUxmXofaCcnifmamOfOccupancy. SI , Ure Ap c t Dateori' JaF n1 Dam All roof coverings to be Class"B" or better
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
UPEkTINO CITY OF Fax(408) 777-3333
�
Building Department
JOB ADDRESS: PERMIT# 6y?) 0/
O I
OWNER'S NAME: PHONE # p
GENERAL CONTRACTO - FAX #
I am not using any subcontractors:
S gnature Date
Please check applicable subcontr ors and complete the following 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 Wlr
Septic Tank
Sheet Metal
Sheet Rock
Tile
weer/(-*`ntfactor Signature Date
-y?, Community Development
� 10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
CITY 0, Fax(408) 777-3333
I
UPEkTINO
Building Department
JOB ADDRESS: /� / PERMIT #
OWNER'S NAME:/ L //C„• Q1,10 PHONE # r k
GENERAL CONTRACTOR: G t,� r 1 ,o l FAX #
I am not using any subcontractors:
Signature Date
Please check applicable subcontractors and complete the following information:
SUBCONTRACTOR BUSINESS NAME BUSINESS LICENSE #
Cabinets &Millwork
Cement Finishing
Electrical
Excavation
Fencing
Flooring: Carpeting
�'P g
Linoleum/ Wood
Glass / Glazing
Heating
Insulation'-*-'--'
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper +
Paving
Plastering / 1
Plumbing
Roofing /Ci 'UG Iuiy+ ¢E j�c�rA9tr nc ) ,
'r Septic Tank )A- ;
7 ,r
Sheet Metal ��
Sheet Rock % /A/
Tile,
%Owner%Contractor Signature Date
y
Community Development Department
Building Division,
/ City of Cupertino
10300 Torre Avenue
Telephone: (408) 777-3228
CITf 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.-'i; To receive a final sign off from the City; the following steps are
...required:
1),Pre-inspection and/or tear off approval. l_
2) In-progress inspectionapproval.
3)•Final inspection approval:
a) Spark arrester installation.
5i IS r If.plywoodtis 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 mateiial''down=to the sheathing,
J. so'a proper City inspectiorn can be performed:'tri 1,
Z:•, .N
t; OTE:-.If you call for a plywood nail inspection and the job-is not ready,
ayou 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.
.-
Id
un and will comply with the above stated policy on re-roofing:
Home
owner's /Has L�Ytt Ansae
job Site Address: /d3eAO omvin 0 :-
Roofing Company Name:
Applicant's Signature: Date:
` Greg Casteel
Building Official
Revised 71/2/04
„ Printed an Recycled Paper - - ,
CITY OF CUPERTINO
,amsaz, REROOF av
ICUPEI�TINO PERMIT APPLICATION FORM
APN # Date:
326
Building Address:
U
Owner's Name: Phone#:
—
Con ractor: Phone#: License #:
Contact' Phone #: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
p Built-Up Roof _ . _.. ❑ Built-Up roof
❑ iAsphalt Shingles 0/-.Asphalt Shingles
pl Wood Shakes Jd 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 Tear Off Policy: ❑
-Job Description: 4,ua' .5:^ _ cc- H _-'l_ J— J y
-. Residential- ' :. , ,,;.Commercial ❑ :i• , . .. . . 7�
Fire Zone: Yes ❑ •No. ❑_> '_ ,_ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: Type of Construction: Occupancy group:.
-- - ,_ Qty. if
Applicable 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