99100071 03
q'q J_00 ,,0'7 ( PERMITR_
APPLICATION FOR CITY OF CUPERTINO NUMBER
INSPECTION DIVISION PERMIT EXPIRATION
REROOFPERMIT (408)777-3228 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 100 DAYS OF PERMIT ISSUANCE OR
. IW DAYS FROM LAST CALLED INSPECTION.
BUILDING
/ADDRESS
RESIDENTIAL COMMERCIAL OTHER
OWNER'S HAZARDOUS
S FIRE
AREA
YES ❑ ItyeaI ClassA
NAME ��y/p �f assembly I required.
NO InitleLC
.B.O.R
/ Sr
ADDRESS
EXISTING ROOF COVERING
PHONE NUMBER OF EXISTING COVERINGS
CONTRACTOR'SN� ;��C/
yP� y TO BE REMOVED TO BE RETAINED
NAME �
ADDRESS - 5/Sg_�j TYPE OF ROOF COVERING
CITY a ZIP / EXISTING
PHONE _ BUILT-UP ROOF ❑
NUMBER
b ; 7/ r� /a z —3 y ASPHALT SHINGLES
NUMBER
LICENSED CONTRACTORS DECLARATION
I hereby affirm met I am licensed under provisions of Chapter B(commenting with Section WOOD SHAKES
7000)of Gvlelon 3 of the Business am Prolesclons Code,and my license is In full force and
effect.
6
License Gere�� Uc.Number z WOOD SHINGLES
p Cantraomr �j/,�,�,o„ OTHER(SPECIFY)
Date �y�.uc�
ONNEREUILDER DECLARATION !/ PROPOSED
I hereby affirm Mat I em exempt from the Conimctore License law for the Ofbwirg mason.
(Sec.70.31.5,Business and Professions Code: Arty clry,or county which requires a permit to
conslrurt,alter,improve,demolish,or repair any structure,Pratte its issuance,also requires the BUILT-UP ROOF ❑
applicant for such permit to lila a signed statement fast he Is licensed pursuant to the provisions
of the Contractors Lkanse Law Chapter B(commenting with Sactbn 7000)of Division 3 of the
Business and Professions Cade or that h Ie amp therefrom and the basis for Me alleged ASPHALT SHINGLES
exemption.Any relation of section 31. y cant for a permit subjects Me applicant to
a CIVI panalty of not more an IN u ed I 500).): WOAD SHAKES
❑I,as,owner of the propm erty ' wages as their sole compensation,will do _
the work,and the structure is I o red for sets(Sac.7044,Business and Profes-
ebnsCode
:The Coniractore nse not appy to an owner of prop" he buildsa WOOD SHINGLES
improves thereon,and who does work N(hvsen or through hie won employees,provided that '❑
each improvements are not ler— or offered for sale.n,however,the building a Improvement
Is said
within we year of compleao the oxner-bulker will haw the burden Of Proving met he did OTHER(SPECIFY) Elrot build or Improve for purpose of sale.).
EJ 1.as owner of the property,am exdosvey contrectin with licensed ntraclom to construct
44
the project(Sec.70 ,Business and Professbns Code:The w
Contranors Ucarvsa law does not PROVIDE I.C.B.O.REPORT NO.
appy to an owner of property who bulks w Iimprovea thereon,and who contracts for such projects
with a contractorm)licensed pursuant to the Contractors License law. PROVIDE MFGR.INSTALLATION SPECS.
❑1 am exempt under Sec. ,B&P.C.for this reason
Owner Date APPLICATION DATE VALUATION PERMIT FEE
WORKER'S COMPENSATION DECLARATION
iI herebyeflirm under penalty of perjury one of the fallowMg declination:
vs,antl will maintain a Certificate of Consent to sell4nsure for Worker's Compensation, Buildin
ea provked for by Section 3700 of the Labor Code,for the pedaimence 01 IN work for whirl,this /L]\ g
Permit Ie Issued. L� -seismic
the❑1 heave end win maintain Workers Compensation Insurance,as required by Seton 3700 of �('�
the Labor Code,for the performance of the work for which this permit b Issued.My Workers OCT 1 199 "` /]O
Compensaibn Ineu carrier end Policy number are: Total/". 9
Carl— (— uN C/ PolkY No �`'�—ZB S�l l31D PERMIT AUTHO TION DATE
CERRFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE N.C.❑ p
(This section need cwt be contacted if the permit Is for one hundred dollars($100)or lees.) By `
I canny that In the performance of the work for which this permit is Issued.I shall rot employ
any person In acy manner w as to bacons subject to the Workers'Compensation Laws of Cali. All roofs shairt>6 inspected prior to any roofing material being
fornia. _ // installed. If a roof is installed without first obtaining an
Date ° Applicant Rspaction,I agree to remove all new materials for inspection.
NOTIC NT: It,aflermeklnpth ertilbataolExemptio'n, uksboCorr,Pmty Applicant understands and will comply with all non point
subject to the W rices'Compensation Provis of Ma Labor Coate, most
with such provlslem or this parmb shall W deemed revoked. source regulations.
I cert Ill l have food Mis application and state Mat the above aformetbn is correct.)agree
to comply who all city and county ordinances and state laws relating to bullring construcllon,and All roe} Verings t0 be class"C"Or better.
hereby authorize representatives of this City to enter upon the abawr-mentioned property for In-
spatlbn purposes. /
(We)agree to save,Indemnify and keep harmless the City of Cupertino against Iabllifies, ` �k
judgments,costs and expenses which may In am way accrue against veld City In consequence SIGN RE OF PLI ANT AT
of the grunting of this,perms.
PRE-INSPECTION: - PLYWOOD: - IN-PROGRES
INSP. DATE INSP. DATE INSP DATE
TEAR OFF INSPECTION: BATTENS: FINAL:
INSP. DATE INSP. DATE INSP. DATE
NOTE: OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION
OFFICE'COPY
• , CITY OF CUPERTINO - BUILDING DEPARTMENT
RE-ROOFING POLICY
1. Prior to permit issuance, you must agree to comply with U.B.C. standards and
manufacturers specs on re-roofing.
2. New roof coverings shall not be applied without first obtaining all inspections 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 types of roofs.shall be inspected prior to any roof being installed.
4. In order to receive a final, you must complete steps 1,2, and I
1. Pre-inspection or tear-off approval
2. In-progress inspection approval
3. Final inspection approval
a. Operable smoke detector verification
5. If plywood is installed, a plywood nail inspection is required.
6. If any roof is applied without first obtaining an inspection, you will be required to remove
all new material down to the cheating and a building inspector will inspect all sheating at
that time.
LWORTANT:
1. Flat roofs must have a %' per foot slope, or demonstrate that there is no ponding.
2. I.C.B.O. reports are required to be on the job site at the time of inspection. If you do not
have one, contact the building department.
WE UNDERSTAND TIM ABOVE POLICY ON RE-ROOFING AND WILL COMPLY
WITH THE POLICY. __�/
HOMEOWNER'S NAME: ! 6 ' _ 7
ADDRESS:
RE-ROOFING COMPNAY NAME:
APPLICANT'S SIGNATURE: .
• CITY OF CUPERTIZ40
BUILDING DEPARTMENT ,
Re-mol7winword
CITY OF CUPERTINO
It* 1 of 1 BUILDING PERMIT RECEIPT OPERATOR: chrletya
COPY k 1
Sec: Twp: Rng:. Sub: Elk: Lot:32613031.00
DATE ISSUED....... : 10/14/1999
RECEIPT p..... .... : 10332
REFERENCE ID N . . . : 99100071
SITE ADDRESS .....: 10457 VISTA KNOLL BLVD
SUBDIVISION
CITY CUPERTINO
IMPACT AREA .......
OWNER CHANG
ADDRESS .......... :
CITY/STATE/ZIP ... : CUPERTINO CA, CA 95014-1039
RECEIVED FROM ....: DAVE
CONTRACTOR WAGNER, SCOTT R LIC M 12594
COMPANY WAGNER ROOFING CONTRACTORS INC
ADDRESS 12242 SARATOGA-SUNNYVAL RD
CITY/STATE/ZIP ... : SARATOGA, CA 95070
TELEPHONE (40B)777-8331
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- ----------
SPERMFEE VALUATION 9,000.00 147.00 0.00 147.00 0.00
BSEISMICRE VALUATION 9,000.00 0.90 0.00 0.90 0.00
---------- ---------- ---------- ----------
I*PERMIT : 147.90 0.00 147.90 0.00
METHOD OF PAYMENT AMOUNT NUMBER
----------------- ------------ ------------------
CHECK 147.90 2636
------
TOTAL RECEIPT 147.90
VOICE ID DESCRIPTION VOICE ID DESCRIPTION
........ ........ ............................
305 FRAME 307 INSULATION.
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRESS
•
INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
CITY OF CUPERTINO
• BUILDING PERMIT INVOICE OPERATOR: chrlstya
Sec: Tp: Rng: Sub: Blk: Lot:32613031.00
INVOICE DATE...... : 10/14/1999
REFERENCE ID N ... : 99100071
SITE ADDRESS ..... : 10457 VISTA MOLL BLVD
SUBDIVISION ...... .
CITY . . . .......... : CUPERTINO
IMPACT AREA .......
OWNER . . . .. .......: CHANG
ADDRESS .. ........:
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-1039
CONTRACTOR . ......: WAGNER, SCOTT R LIC N 12594
COMPANY . . . . . .....: WAGNER ROOFING CONTRACTORS INC
ADDRESS . . . . . .....: 12242 SARATOGA-SUNNYVAL RD
CITY/STATE/ZIP ...: SARATOGA, CA 95070
TELEPHONE . . ......: (408)777-8331
FEE DESCRIPTION CHK TOTAL FEE PAID-TO-DATE BALANCE DUE
--------------- --- --------- ------------ -----------
BPERMFEE P 147.00 147.00 0.00
BSEISMICRE P 0.90 0.90 0.00
147.90 147.90 0.00
ID ------- DESCRIPTION--------- VOICE ID .-----. DESCRIPTION
....._.. ...............
305 FRAME 307 INSULATION
601 ROOF TEAR OFF 602 ROOF PLYWOOD NAIL
603 ROOF BATTENS 604 ROOF IN-PROGRFSS
•