04090241 CITY OF CUPERTINOa«^ atdxa°aa�+ "� -
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BUILDING DIVISION PERMIT nNWIXTI,O,.N.N i,...
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BU TIDING ADDRESS: WING' S ROOFING INC PERMRN00409024I
OWNER'S NAME: PERMIT ISSUE DATE
PE
ONE: SANITARY O. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
u0o LICENSED CONTRACTOR'S DECLARATION O O O
u❑ 1 kmby affirm Net I em It it under py v smm of Con is.,9(commencing Job DeSCrip[7 A /„�, II
ZU with tion )ofDivisian 3 oftWBualn�dProfesiov Cotle.and mylimmeis ///9tl lops
,q? u«I : %� Lica — REROOF W/ASPHALT SHINGLES
t Data canB.ater OCT04
££ CNTSCTS DECLARATION
C< I un tml my p ons shell W used u public records (P I
0 LicensedRl
afcssiona
p g OWNER-BUILDER DECLARATION N ®Its p
3 a I 1 hereby a(Sec on 1 am exempt from Uma Cosies Coal
License Law for the ® p6 'hp��/t■
w O following mason.Permit
t )(131.5,construct.altar. and w,de a li Code:Any city nr county
m�+ which in astx n permit ac.s.th slug improv,demolish,or e.i it any structure
prior in its issuance,also re to the Wa applicant for such permit to Ela a signed suumrnt
ac (that comma tingwd urromat Sq.Ft. Floor Area Valuation
��$ (commis exempthseafro. it di Diviaion3 oftWBuaincv and Professions Any
Code)of
_ Nu io u exempt b tkrtfmm and the Ease roe be alleged exemption.Any violation of
am a than f by ury applicant for a permit subjects Nc applicant m a civil penalty of 3 6h�3�u (;10 O Occupancy
not more than Rw hundred aon,a(ssop). � P Y Type
❑I.u owner of the property,or my employees with wages star their sale compensation,
will do Ne work.end Ne swewm isnot Rounded oroQertd forsa4(sec.]Bsa,Businw
umd Profession:Codc:]Te coneaemes f.ianse law don not apply m an owner of Required Inspections
property who builds or improve daemon,and who does such work himself or through his
awn employees,provided Nat such improvements..at intended or offered for We.If.
howeves,Ne Wilding or improvement is sold within one year of completion,me owner.
Wilder will have the Wrden of proving Nat he did not Wild or improve for purpose of
sola I.
❑1.as owner of Ne propcny,em exclusively contracting with licensed contractors to
construct Ne prejeet(Sec.7844,Business and Professions Code:)The Contromeri Li-
.Law docs not apply to as owner of property who Wilds or initiatives tkrton.and
who contracts for such projects with a carnations)licensed pursuant to dm Co osselors
License Law.
❑ l am exempt under See .B&P C for this won
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby aRmm under penalty of pmjury enc of the following declarations:
1 have and will maintain a Certificate of Consent o elf-insure for Workers Compen-
.r an,in provided for by Section 37M of Ne Latour Code,for the perfarmance of Nc
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation In..,az required by Section
37M.(ft LsWr Code.for Ne perf c , work lm which this Permit is issued.
M or Ys Cnm nsa'on loses a c m r d Polic/y numberare:
Ca ' licy ROI WZ S'
RTI 0 C FROM KERS'
COMP SAnON INSURANCE i
(Ths saran need trot kcampleud if the permit is forane hundred dollars(SIM)
or less.)
1 unify that in Ne perfunname,of mc work for which this Permit is issued.l shall not
employ any reams in any manner m az to become si 10 the Workcri Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If,after making this Comfuau of Eaamption.you should
became subject to tk Worker's Compensation provisions of Nc Labor Code,you must
.,O forthwith comply with such provisions or this Permit shall k deemed revoked.
z CONSTRUCTION LENDING AGENCY
[—� L hereby affirm that Here is a construction lending agency for Ne performance of
C$ the work for which this Permit is issued(Sec.3M,Civ,C.)
A
Un
ddefs Name
z Lender's Address
U C) I.-try that 1 have mad this application and sure that tlm aWrc information is
U.P cancer,1 agree to comply with all city and county eminences and sou laws relating to
0U building construction.and hereby auhodoe representatives of this city in enter area use
akve-mentioned progeny for inspection whichpar,cens.
may
F G (We)agree to save.indemnify and keep harmless the City of Cupertino against
z oebilitio,Judgmcnts.casts and cxpcnsra which may in any way accmc against.sald City
U z onto
uence�IUMZIIIS
of Nis crmir,APPLI AND WILL COMPLY WITWWALL N-P NT Issued by:
RC GATIONS. /_Z 0
Signatur r 2 Re-roofs /
Plin[U Y tracmt ata
H ARDOUS MATERIALS DISCLOSURE Type of Roof
Will Nc applicant or future Wilding vccupanumre or handle he arches material
as,defined by tk Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
coda.Orion zss3z(a)? All roofs shall be inspected prior to any roofing material being installed.
Ycs Na
IniftWill Ne. ficantor m Wildin occupant awe If a roof is installed without first obtainingan inspection,I agree to remove
rr gquip utat Mmcawhim P
ism hmardous air contaminants u defined by Nc Bay Arca Air Quality Managcmcm all new mate Rats for inspection.
Diavia?
❑Ycs Nu
I have remj tk hanudm materials requirements under Chmucr6,95 oDk Califer' ( %
nia Hcuhh&SafctyC ,Samom 2SN5,25533 and 25534.1 understand Nat tfdbe Wilding k
does not eurramly ha a¢none Nat it u my rcspamihility m nntily the acupant of Ne
requircmc iah u.,kmnpdorwivumceoraCmruauaracupancy. igna[ureofAppli nt Da[e
12 1
Owner or dagcnt, Dau All roof coverings to be Class "B"or better
Community Development
' 10300 Torre Avenue
Cupertino CA 95014
µ J Telephone(408) 777-3228
CITY OF Fax(408)777-3333
UPEkTINO
Building Department
JOB A SS:
OWNER'S N H NE # �o 6— c-,S- v
GENERAL NTRACTOR: 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
Septic Tank
Sheet Metal
Sheet Rock
Tile
Ow er/Contractor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
OUPEkTINO CITY OF 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 yvith
�the, above stated policy on re-roofing.
Homeowner's Name: J '
Job Site Address: �— n
Roofing Company Name: ( ( 1
Aplicant's Signature: Da e:
Greg teel
Building Official
Revised 1/30/03
Printed on Recycled Paper
CITY OF CUPERTINO /
176112EROOF
�CUPE�f[NO PERMIT APPLICATION FORM
APN # 1_� ,Z `� Date:
Building Address: J / L
lnl
Owner's Name: 4'r C A
Phone#:
Contractor: Phone #: License#:
I N Ell Sno f tv C ►\G Y4 9 7 -1/Aw
Contact: Phone #: Cupertino Business License #:
Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
Asphalt Shingles A,, Asphalt Shingles
❑ Wood Shakes. _ _- __., - ❑ Wood Shakes
❑ Wood Shingles ❑ Wood Shingles
❑ Other(Specify) ❑ Other(Specify)
Number of existing coverings 1 ❑ 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: /° as - 51 _ 1� r�` 'tw� C C kS G S ��I�t Sn•✓ le
Residential CoV1mm cial ❑ f
Fire Zone: Yes ❑ No ❑ Confirmed with Planning Dept. if
there are any restrictions: LJ
Cost of Project: C� Type of Cotru n: Occupancy group:
Qty
. if
Xpplica le Fee ID Fee Description Fee Group
BPERMFEE Bldg Permit Fees BUILDING
NERGY Energy BUILDING
SEISMICRE Seismic Fee Res BUILDING
BSEISMICOM Seismic Commercial BUILDING
BPLANCHK Plan Check Fee BUILDING
BUSLIC Business License BUILDING
Z ( 37