03050053Y OF CUPERTINO
N".ttACOR x1�U12MA TUNS �..
BUILDING DIVISION PERMIT
n�a `g7gl� ,:i• 4a,„ �, surSK, �
BUILDING ADDRESS:
WAGNER ROOFING CONTRACTORS'TffeD03050053
OWNER'S NAME:
12242 SARATOGA-SUNNYVAL RIE'79713
/2003
NA BUTT
NE:
(408)777-8331
SANITARY NO. CONTROL NO.
ARCHITECT(ENOINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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LICENSED CONTRACTORS DECLARATION
Job Description
yFF
S
1 hereby eRlrm thel I am licensed under provisi eS of Chapter 9 (cammeainj
with Saline 76'10)orcivirian 3 ofthe Busirres and Pmfesdom Code. end my licenm is
�'�0.\n /A LEO
�VVNNA LWE
oro
In full farce end e(Rat y 6729��-
C^39
REROOF
i=
Lk...Clash Lt..
i
2
Dam Conusslor
ARCHI7ECT'SDECI.ARATION
MAY 2 7 2003
i
1 understand my plane "I he used As public memds
BUILDING
Licensed Profcsrional
DECLARATION
Oat
I am exempt, from Ince Contormrs License Lew for the
I hereby .(Sero the I
jo
t. Any city ormumy
ire moon. (Section 7o I.S.Besfter. end
$
ri repair any mCmM
improve. demolish. Or
which a permit re Comtcucs, W. Improv, tic
which
�n
ermit t.
its issu
o ment
prior b its iuueae. Jw requires the applicant for permit ro Ole a signed wtemenl
p
Contractor's License Law 9
Sq. Ft. Floor Area
�<
that he is licensed pursuant to the provisions at the (Chapter
$8Vylll®tion
-$
(commencing with Section 7003) of Division 3 of the Business and Profession Cade) or
that be is exempt do mfrom and the bub for the alleged exemption. Any violation of
3 2&413Qi6i15cr0 0
Occupancy Type
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not marc than fiw hundred dollen ($500).
❑ I, AS owner of she properly, or my employees with wages AS their sole compensation,
RR r d IDS actions
p
will do the work and tim.n.bm knot intended oro@rod far ale (Sec. 7044, Business
and Professions Code: Than ContortaY, License Law don not apply to an Owner of
build, improves dace wart himself or through his
307 - I NSULAT�F�
property who m thereon, and who ouch
Own employees. provided thnwch impronements arc not intended oraffeed for gale. If.
601 — ROOF TEAR OFF
however, the building or ImProwmem b Sold within one yew of Completion, the owners
builder wN new lite burden of proving that he did em build or improve for purpose of
602 - ROOF PLYWOOD NAIL
Sale.).
603 - ROOF BATTENS
01, AS Owner of the properly. am exclusively contorting with licensed comencl0rab
604 - ROOF IN -PROGRESS
Construct the toneless (Sec. 7044, Business and profeselors Code:) The Cormacbr's Li
..A Law does net apply ro an owner of properly wlm builds or Improves thereon, and .
who contorts for such pmjem wish a contractor(s) licensed pursuant b be Contractafs
License Law.
❑ lamexemptueder Sec ,BAPCfarthisr On
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury oro of the following dalatationa:
Thew and bineCW of Cenatmb selfai fa WaM'ace
for of the
forScotian 3700 of the labor Colic. for the performance a( the
.anon, provided fPe 3700
r mi
work for which Wa permit is Wtutl.
0 1 lave aM will maintain Workers Compensation Insurance, Co excited by Section
3700 of the labor Cade. for the performance of the wok for which this permit is issued.
My Workds Compensation Inaunnce aniv and Policy number are:
Carvin: Policy Nu:
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Iltlaseedm need rot be constricted if de result term oa hundred dollars (SIM)
or less.)
I certify that in ba perfmmanm or the wart for which this Permit is issued, l shell not
employ any some in any manner b mesu Wo 'Compar. on
Lew of Califomie. Dam
Applicant
NOTICE TO APPLICANT: If, after making this CcnlOam of Exemption, You shemid
become subject on the Worker's Compensation provision, of the labor Code, you must
O fomhwib comply with such provision or this permit shall be domed revoked.
,y CONSTRUCTION LENDING AGENCY
affirm that them h e covwctinn lending for she Performance or
3097, Civ. C.)
A
Wad
s NameIhereby
she work for which this permit Ie d (Sec.
0 Lendrs eNurse
Lenders AddrcCo
5/
Q 1 certify that I have sad this city and coon and rote that the shove Information Is
mesa. l agree c comply with all city and county ordinances and cum Iowa rotating e
bbovingcanewctloeand hereby suthon be
/ !1�
i 3�U
U ahovn(We)ned for
prepresenWivesofbbshymentorupon
properly
W (We) ego m Cosa indemnify And keep harmless the City of ageit
rA indmnify An keeph.
City
Ih ma againsts
smiteh may In anywyaante egalnn said
inconeascruxmentaecaetaenof this
I ",� AcPLICANca of the RSTAgrantingof this permit.
F -I APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT
Issued by: Date
SOURCERE LATIONS
Re -roofs
Type of Roof
noun ofApplic ZOAE
RDOUS MATERIALS DISCLOSURE
Will lira applicant or future building occupant cmc or handle heundouc material
Co defined by the Cupertino Municipal Code. Chapter 9.13, W be Health and Safety
ede.Sectionu533(e)7
All roofs shall be inspected prior to any roofing material being installed.
❑Yes C] No
If a roof is installed without first obtaining an inspection, I agree to remove
Will she applicant or future building Mcupsm use equipment or devices which
mit bavardom air Communanta As Claimed by the Bay Aro Air Quality Management
all new materials for inspection.
Diwict7
OYce No
In readithoordnu,mated bmqui..M antic,Chapm,6.95ofbe Califon
1 D�
nicer .
aru133hifity nosh cups building
Jan nos cum:mly hew a tenant that it b my responaihillly b testify the occupant of the.
no, currentlybusam, dualIt my the
uentlyY am
mqulremen Inch be met 'Or uana ora Catilcateof Oce
Sia re of Applicant Dat
6
,91 oof coverings to be Class "B" or better
0. 41". authorised agent te
CI
10300' Avem
apW" G 9loWUM
Tdl*= (408)7774=
PW crap m -33n .
Building Department
Rerooftpallyforthestyofa1PU,
2. Prior to pit jo�
2 .N41114 � aPa�ca�Wft �� �+h 1M vac staaar�a
„n w� a°D a `� � f agPW witi'°`8 f A obtaining � n zrkd a
aPPW'at shall be obtatlladulrdiV A 9ne1 fnepaM{on and
Wading when the reroofing is
& All roofs MIUD be MeMaRem
t To receive a final ft � �B
POCUCM and/cc � � +6 sopa are required
jppgovaL
3) PhW k%xcdoi approval.
approval.
a) SPA& armee
d. Any roafing wrequire " P&d without & °bWM WM
proper be
an the a�attdrg so ti,at the
DAPORTANTi
L Ed roofs anlet
there is no a mn of it' slops and dww u mte that
2 An LC,H.p, rap is the job site at the time of bWpWU=
We madessland the above pohfay on reroofing and wM comply wlth this Policy..
HCUMMMIMMIName: W1: 41,;vf
Address: /06S-7 ,Imu ter pi,
Applicant
« ,.
62fA1
■ .
CITY OF OFRTINO
CUP INO PERMIT APPLICATION FORM
APN ff
Elldit Permit Fees
32tfl -Y3- 067
Date:�3 �.w3
Building Address:
BUILDING
/ObS7 fi97NLt% Ag.
Seismic Fee Res
Owner's Name:
BSEISMICOM
BPLANCHK
Seismic Commercial
Plan Check Fee
Phone 0:
BUSLIC
Business License
COnft=tW. PhonO
li/
License if:
l2 .�:r✓� reMhs
7Z 1 t 9
Contact: Phone O
Ste.& /
Cupertino/2 Business License (f:
7771 933
Type of Root Covering:
0 Built-up Roof Proposed:
uilt•Up roof
O 9�ptult Shingles O
Asphalt Shingles
wood Shakes O
o wood shingle.
wood Shakes
Oto (Specify))L0
whoa Shingles0
%rs/•'.R T/LN
Other fy)
of existingcoverings O
—--
Provide l.C,B.O. Report N
To be Removed O
Provide Mfgr. Imtallation Specs.
I Have Read,Understand and WillCom i With Cu o's Tear Off Policy;
Job Description: Re, jav a bil9.Ye ,@e, X;1667+ to A, C",'- 5b ya.pa. t/R-IS '.9 "�6ex, oe" i..P i/�
�tGc,
GtS3 S�+ 4S. UA,*Cee MW.4 At' -?e .9•S -7-M W.,014 O.;B.t ''iy4.v-F/as 4. hyj-r.
Residential commercial O
Fire Zone: Yes C3 No
Confirmed with Planning if
there are any restrictions: C�
Pmject: Type of Construction:
89y0.
Occupancy gyp.
Qty. if
Aoolicable
1p . T
BPERMFEE
Elldit Permit Fees
r= %jnM
BUILDING
BENERGY
BUILDING
MEISMICRE
Seismic Fee Res
BUILDING
BSEISMICOM
BPLANCHK
Seismic Commercial
Plan Check Fee
BUILDING
BUILDING
BUSLIC
Business License
BUILDING
,Z �