04110122 (2) CITY OF CUPERTINO - ; '-
T t:
' Buamrlc Divlslory ^-t ,PERMIT_ �zi OIZA� M�'
BUILDING ADDRESS: - WING' S ROOFING INC PERMIT N1b4110122
`10276 VIRGINIA SWAN
OWNER'S NAME: _ - PERMIT ISSUE DATE
' JOHN MIYAMOTO . 3243 SYDNEY WAX 11/18/2004
ONE: .. SANITARY NO. CONTROL NO. -
(530) 889-9068
ARCHITECT/ENGINEER .. . . .
BUILDING PERMIT INFO
0. .. ELECT LPLUMB MECH
upp LICENSED CONTRACTOR'S DECLARATION
- 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing - - IOb Description
with Sued..7000)of Division 3 of the Business and Professium ode.end my l' sera
n � in full f race and off c ( REROOF '- •.
-Sg? License Cl a L�.p -
Dam - Cantiecmr - - -
ARCHITECTSDECLARAION
�i I undcrsmnd my plain shall M used a
public mrords -
D�U
C ,Licensed Pmf onimml -
OWNER-BUILDER Been
Com eo r
ON
1 hcmhy,(Sinn m 11. exempt from the Csmun, o e:censeA.,c Law for the -
a e O which mg mason Permit
t ]1131.5.Business and improve,
de oli Coos.Any city or roomy
N m which requires a pcmmt m construct.Nmr.Improve,demnluh,or repair any structure '^ "-'' _ -
m—y ._� .._ _ .. -.. ..
that m its issuance,aero requires to he IW applicant forsucIne Contractors
permit IoicFile s egad statement
t
he is mud pursuant mlhepmviamm oflhc Contractor's Lh<nscLaw(C ode)
.r - Sq..Ft.,Floor Area _ _...- Valuation----.- ^' .
z $ (co la,I,erg with ionfous and of bastsof r 0 the egeineuand Prefics.on.Any vi Code).r
3.. Nal he is exempt Nemfmm and Ne baso far me alleged exemption.Any violation of
Section 7831.5 by my applicant far a permit subjects use applicant to a civil penalty of - -3 Occupancy Type
.I more Nan firs hundred dellen(8500).
❑I,umnerofthepmpeny,wmyemploywwiffi"FsutheirmlccomPenatian,
will do Newark,and Ommecture is notimemledoro!fend hotels(Sec.70/4,Business Re UIICd Ins eCLIOHS
and Professions Codc The Cont semri License law don not apply m in owner of .r,.4a,::. ..a..tce',. +.. "-:•.- ,-.;9 ._. .. ..p.
property who buildsorfmproves themon,andwho doessuch work himselforthrough his - -
ownemployces,provided that such improvemmuarc notimmnded"offered forkne.If. -
however.the building or improvement is sold within one year ofcompletion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.). -
❑1,as owner of the property.am exclusively contracting with licensed contractors to
conswat the project(Sec.7046,Business and Professions Cede:)The Contractor's Li.
come law does not apply to an owner of pmpeny who Wilds ar improves themon,and,
who contracts for suchpjeeu with.contncmr(s)licensed pursanuothe Contmeltr'a.
Uaesve Law. .. _
❑1 am map[under Sec. .B&P C for this meson
1. 31M0
wner Data
WORKER'S COMPENSATION DECLARATION
1 hemby a((rce under penally of perjury one of the following declaruioa:
I haft and will maintain a Certificate of Consent m self-iaue for Worker's CmrPm- -
oon,a provided for by Section 37W of the Labor Code,for the performance of the
rk for which this permit I.itmed. -
I have and will rmimam Worker's Compensation Instance,ss unlimited by Sued..ofthelabe,Code.rorthcperfmcc of the work for which this Pool,is issued.
y Workers ampensail Rid uranin 'crmd Poli,numbemer. L Policy No.:
CERTIM'ATE OF E MPfION FROM WORKERS'
COMPENSATION INSURANCE
(This section raced not W completed if IW permit is for.,hundred dollars($1 00)
or lea)
1 certify that in the performance of the work for which this permit Is issued.l shall not
employ any person in my manner m as an become subject o the Workers Compensation -
Laws of California.Dam -
Applicant
NOTICE TO APPLICANT`.If,alter making this Certiocam of Exemption,you should
become subject in the Worker's CompcnNen previsions of the labor Code,you most
.7. z forthwith comply with inch provisions or thio permiahall W deemed revoked.
CONSTRUCTION LENDING AGENCY -
[.r4 (hemby arum that then is. tostnwtion lending agency for the perfmma sur
C(.> the work for which this permit is issued(Sec.3097.Civ.C.)
W Q Lender's Nam.
z Lender's Address
U QI certify that 1 have read this application and Stam that the above information is
I2. H coined.I agree In comply with all city ad county oNinances and slam laws misting to .
0 building constroetion.and hemby autharim representatives of this city to color upon the
W .hove-mentioned property for inspection purposes.
Ly, (We)agree to ave,indemnify and keep harmless the City of Cupertino against r
r;y ferry liabilities.judgments,costa and eapmues which may in any way accmc against said City II/
U z in consequence of the graining of this permit.
APP) NQERSTANDs AND WILL COMPLY WITN ALL NON-POINT Issued by: Date
SOU CE E U{.A DNS. (/ /! O
1 ( Re-roofs
Signet of Applicant/ on Iter Dam
H RDOUS MATERIALS DISCLOSURE Type of Roof
wil the applic rat or future Wilding occupmtambe or bandit haardous material
u defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety
Code.section 25532(x)7 All roofs shall be inspected prior to any roofing material being installed.
❑res �Nu
Wthe applicant or Soca\rl:building occupant use equipment or devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
mit hazardous air comment a defined by me Bay Area Air Quality Management all nit ma erials for inspection.
District?
Cl Yes o
I have mad the hanardous materials requirements under Cumber6.95 ofthe Califon
nia Health&Safety Cade,Sections 25505,25533 and 25534.1 understand thatif dm Wilding C�
does not c m h a tenant.Nm it u my reaPernuh,1,y rod(y the occupant of Oc
mquimmcn w ch us,he acctpdonaissumccofaCcryf am of opine Signature ofAp li I Date
Owmr.r a orzed agmt f/I
6 Dam All roof coverings to be Class"B" or better - -
Community Development
aClOF
10300 Torre Avenue
Cupertino CA 95014
Telephone(408) 777-3228
Fax(408)777-3333
�UPEI�TINO
Building De artment
JOB ADDR SS: PERMIT#®� 10 I yZ
oZ7 VI r n IU SGJav�
OWNER'S NAME: PHONE #
GENERAL CONTRACTOR: 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
Linoleum/ Wood
Glass / Glazing
Heating
Insulation
Landscaping
Lathing
Masonry
Ornamental Sheet Metal
Painting/ Wallpaper
Paving
Plastering
Plumbing
Roofing c
Septic Tank
Sheet Metal
Sheet Rock
Tile
Ow ei ontr ctor Sig a Date
Community Development Department
N Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
OUPEkTINO
Building Department
.
Subject: Re-roofing policy for the City of Cupertino
Prior£o 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.
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 aproper 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:
Job Site Address:
Z i ✓L TGA , f/�C� N .
Roofing Company Name:
Aplicant's Signature: Date:1 (/
• Greg eel
Building Official
Revised 1/30/03
' Printed on Recycled Paper- .
CITY OF CUPERTINO
REROOF v c> I z2
�CUPEI�TINO PERMIT APPLICATION FORM
APN# , / o o Date:
Building Address: e
Io2 - �ir C
Owner's Name: PnS#:
-�o , 6 o4o.
Contractor:' ISG Phon*,, / License#:
t
Contact: i . 1 _ / e� Phone#: Cupertino Business License#:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
❑ Asphalt Shingles ;K Asphalt Shingles
Wood Shakes ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
- Number of existing coverings ❑ Provide I.C.B.O.Report# -
XTo be Removed ❑ Provide Mfgr. Installation Specs.
I Have Read, Understand and Will Comply With Cu ertino's Tear Off Policy: ❑
Job escriptitn
_ T/. Ws� •
Residential z<' era 1„i.Commercial ❑ .:''r
Fire Zone: Yes ❑ No ❑ Confirmed yWri Manning D t. i
there are'any restrictions:
Cost of Pro'ect: e o C ct, Opcupancy gro
sa
QtY. 1
A 1 le. 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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