03100115 (2) CITYOPCUPERTINO
: BUILDING DIVISION PERMIT t CONTRACTORANFO.RMATION '
BUILDING ADDRESS: WING ' S ROOFING INC PERMIT No.03100115
1022% W T,2TAT�R DR
OWNER'S NAME: 561 RUTGERS ST PERMIT LSSUE DATE
NE: SANITARY NO.
(510) 481-3818 CONTROLNO.
ARCIIITECrIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
M 0
ton LICENSED CONTRd under
DECLARATION
C I hereby affirm that 1 13 licensed under pdir ions o , dc,r 9(commencing Job Description
i with Section 7(gIlp of Divisron7 fth B sirtcss and Pmfcuium dc,and myliccrosc is ��..y
fu farce an ffcetz; V
Lori cls= a �� REROOF
F Da¢ Co ltracw /
AR HII=amptl. 1
5 h,u undcruanJ my plans shall M uuYpuMic acaNs
°o U; Lice sed essional
g OWNER-BUILDER DECLARATION
<$ 1 hereby affirm that I am exempt from the Cnmraaor's License Law for the
no following reason.(Section 7031.5.Business and P.fecsiou Cade:Any city or county
E$ which require=a remit to construct,alter,improve,demnlish,or repairanystructure
pnor to its issuance.also requires the applicant for such permieu file a signed statement
a< that he is licensed pursuant othe pmvisionsorthe Connector's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
j 1•� (commencing wi lh Section NAq)nl Division J of the Business and Professions Cmle)Or
that he is exempt theref.m and the buffs for the alleged exemption.Any violation of 36922027 n
Section 7071.5 by any applicant for a permit subjects the applicant to a civil Penally of APNNumber Occupancy Type
not more man me hundred unit...(5500). PanC Y YP
I,as owner or the property.a my employees with wages u their sole compensation,
will do the work.and the structua is not intended or offered No sale(Sec.7014,Business
and Professions Code:The Contuaors License law dors not apply to an owner of Required Inspections
,.petty who builds or improves thereon,and who due=such work himself or through his
own employ=,provided Nat such improvements are not intended oroffcred for sale If,
howeycr,the building or improvement is sold within one year ofcompletion.she owner-
builder will have the burden of proving that he did not Wild or improve for purpose of
sale.).
❑I,as owner of the property,am exclusively contracting with licensed contractors to
consumer the project(Sec.71N4.Business and ROlextron=Codc:)The Convactnr's Li.
ccue law does not apply to an owner of propcny who but Ids or improves memon,and
who comets for such pmjects with a eoadaelnr(H licensed pursuant to the Conlrae.rs .
License law.
❑I am exempt under See. ,B&P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of perjury ore Of the following declarations:
1 have and will maintain a Ccnifcue or Crosson to self-insure for Worker=Compem
union,u provided for by Section 37M of the tabor Code,for the pefformance of the
work for which this permit is issued.
❑1 have and will maintain Worker's COMPrnsalion Insurance,as required by Section
37W.1-the labor COO,for the rforma a of the work hm which this permit is iwued.
My Workers Co Ilion In a c ler and P
Na number art:
C(lTef./ IQ n y
Polic
CERTIFICA OFF EMPOON FROM WORKERS'
COMPENSATION INSURANCE
(Thu somian need not heeomplcwd if the permit is Barone hundred dollars($100)
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 to become subject o the Workers'Compensation
Laws or California.Due
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should
become subject to the Worker's Compensation provisions or the Labor code,you am
�Q forthwith comply with such provision=or this Permit shall he deemed revoked.
ZN CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance of
]: the work for which this permit is issued(See 3097.Civ,C.)
Y Q Under'a Name ,
Z)2 Lcadcr'=Address
0 1 certify that I have read this application and sate Our the above information is
i Hcoaccl.1 agree to comply with all city and county Ordinances and state laws relating to
�U building Construction,and hereby authorise op entrui m or this city to enter upon the
purpo
es
W ahovcties,judncdnis cst for inspection which may
y (We)agree to save,indemnify and keep harmless the City of Cupertino against
rzTz incoidesicrutc rot costs and cabernetwhichmay In any way accrue against mid City
J r7, APPLI qucncc ND grant ng ofRSTANDS thisPermit.WIL
"
SOURCE
ULD RSTANDS AND WILL COMPLY WITH N,POINT Issued by: - Date
SOURCER LA IONS. J l//
Re-roofs
arc of r HAZAR a US MATERIALS DISCLOSURE Data Type of Roof
Will the applicant or fu arc building occupant core a handle haruduus material
ar defined by the Cupertino Municipal,Code.Chapter 9.12,and the Health and Safety
Code,Section 25532()1 All roofs shall be inspected prior to any roofing material being installed.
❑Yes
WBI me aPPlinnl orfot c building Occupant vin equipment orchvient which If a roof is installe without first obtaining an inspection,I agree to remove
tit W/Ardnus air comominents'u defined by the Bay Arca Air Quality Management all new materials f r inspection.
[ni.Hoddr&Sabciy
trict,
byes a
Ihave d oho>aNtus imus2505a25is quircmc5534.Icr Chapmn.9t,fthe Califon
oM.Secdou 255(15.255]]and255J4.1unJcrsend thallfthc lvilJings not cinoody ase a renam,mat it is my respu ciamy m idly t up tofmelre whit bcmetpriorwissuanceofaCcniffate of ponignature pplicant e a to ty D,te All oof coverings to be Class"B"or better
f� l
Community Development Department
� Building Division
�rE 1 City of Cupertino
10300 Torre Avenue
CITY OF Telephone: (408)777-3228
U PE kT'NO 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 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: Pte- t,
Job Site Address:
Roofing Company Name: P V �'N (S
AP'
icant's S�ig�nature: Date
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO
REROOF COf
" ( ° " ( � 1
CUPERTINO PERMIT APPLICATION FORM
APN # Date:
3 2. Z 027 /p -/-S-- 0_3
Building Address:
Owner's Name: Phone#:
Contractor: VLicense#:
W140/s ; �N� r&4
Contact: U(N o e ItU-A Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
A Asphalt Shingles %, Asphalt Shingles
❑ 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 Comply With Cu ertino's Tear Off Policy: ;ioi
Job Description:
Residential Commercial ❑
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are an restrictions: LJ
Cos f Project: _ Type of Construction: Occupancy group:
Qty. if
A licable Fee ID Fee Descrition Fee Group
BPERMFEE Bldg Permit Fees BUILDING
BENERGY Energy BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
\ G
BUSLIC Business License BUILDING
3�
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