01090119 CI BU DI G DIVISIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1284 PRIMROSE WY WAGNER ROOFING CONTRACTORS INCO1090119
OWNER'S NAME: APPLICATION SUB DATE
CUBBAGE URBAN J AND CHRISTINE 12242 SARATOGA-SUNNYVAL RD09/27/2001
PHONE: SANITARY NO. CONTROL NO.
(408) 777-8331
c z ARCHITECDENGINEER: BUILDING PERMIT INFO
to{�- BLDG ELECT PLUMB MFCH
5 y 2 LICENSED CONTRACT'OR'S DECLARATION
z�O 1 ne¢by.from that I am licensed under provisions of Chapter 9(corrmencine Job Description
tm with Section 7000)of Division 3oftheBusiness.n Prifiessions Case.coollicense WOOD SHAKE TO COMPOSITION SHINGLES
C,71 is in full force and ecy 3 2 r
t a,K 6 License Class l Lic.p
%O a U Date Cnmranor
3 u.G ARCHITECT'S DELLA ATION
u_O d I untlemarW in,plans shall be olid as public amrds
i p O Licensed Professional
OWNER-BUILDER DECLARATION
u� I hereby arms that 1 am exempt from the Contractor's License Law for the
CZ following reamn.yethon 70315.Business and Professions Cade:Any citylir county $8100
E which requires a permit to construe(,alter,Improve.t emollih,M repair My SWtlure
�36 PpJmmq _ stria Pps ofthe Cc Business PPtnkssY Profits".. (,•y,t aN y .e .. ._. - _.. .. ..._ __......_., alta
(rm111la Elea 6i ned 61.1etiK111
- that hq' 1 itp ttmt the p .sof the Contractors tcense Law,(Chapter 9 Valuation
(commencing wrth Sen 7lIt and
te ) '3 f50'.0 t3; l°'2 r:Y7'O-sa�a y.t'4�
or that he 7 exam t Iany applicant
and the bass for the aIle due
exam'lion An violation
of Section than
I3 iv any hundred
doll mora permit subj«rs rhe applicMt to o tivil penalty
arum more two fi.e wndrea aanan(SN)()). 3 0 g:PN IPE ( Occupancy Type
O 1,as Owner of the propony,or my employees with wages as their sole compensation,
will do the work.Md the structure is not intended or offered for tele(Sec.7044,'
Business and Professions Code.The Contractor's License law does not apply to M 601 - ROOF TEARgtDrWrispections
owner of property Who builds or improves thereon,and who does such work hirnsrlf
or through his own employ«s.provided has such improvements are not intended or 602 - ROOF PLYWOOD NAtI L
.offered for sale.If,holvevcn the building or improvement is sold within one year of ;-- -__... .. .... . . .. .. .. .. _
ompletion,the onerwilder will have the burden of proving that he did not build or 603 - ROOF BATTENS
mw
prove for Forams,of sale.). 604 - ROOF IN-PROGRESS
_ . . i .. _
co 1;as he pr the Progeny, o exclusively a comracung with licensedcontractorsContractor
ontracts m -License
construct the project(Sec. to a.Business and Professions Code)The improves
tm thereon,
f
"'- and who
law docs not apply roan owner of progeny who builds or improves thereon,
` ¢ and who rs License
rLaw. Pmj«u with a Mmmctor(q licensed pursuant to are _ .. .. ... -1 - .. ... _ .... .-
131 tmao/a License IoW.
' ❑Tem exempt under Sec." " ,B&PC for this
Owner '" "Date ' -, TALE®
_ WORKER'S COMPENSATION DECLARATION
I hereby a(fir ander for of perjury one of the following detonations: OCT U L
9 r7 o al
0 1 have and will maintain n Cenificutn of Consent to self-insum for Warker',x s7
Compensation, as provided far by Section 37W of the Labor Cade, for the
'perf«rdance of Inc work far which this permit is issued BUILDING
01 have and will maintain Workar s Compemation Insurance,as required by Section
37M of the Inbar Cade,for the peAormmee of the work for which this Permit is
ux'inrdMy pe t 1 sumnce carrier and Pal cy numbm
number a . _
Lamer 1' p�; t.Pohcy
r., CERTIFICATION OF.EXEMPTION FROM.WIORKERS'! ftsy4 ! ;
`J'L ` s,"
COMPENSATION INSURANCE" .,�. -....__.. ._ .._ ._ __._. . ._... _ _..... _._.
" a sentreed
ion two be completed if the Permit is for n
one hundred dollars
l
(g100)oror lless.),,, ,
R . . for
"ll T certify Jhanin the in any maofthe work forwhieh subject
mot r issued;1
Cmuoat employ any Person Cod,or any manner so its m Become subject io the Workers'
Compensation Lova of Cellfomla.Date r
'Applicant,
NOTICE TOAPP the Wa I:1L Compensation
this meismn me of the Labptiovde.You must
bncorneh subjecttothe such
Compensation provisionsll @e Labor Code,you must
Q � forthwith comply with such provisions or this permit shall no,deemed revalued.
F'lr, CONSTRUCTION LENDING AGENCY -
1 hireby affirm that there is a construction larding agency for Bar performance
.., of the work for which this peril is issued(Sec.3097,Civ.Q ,
OGender's Name. .. .... _ _ .. ..... .
a-� Lender's AJtlxa .. t, .,
I certify that 1 have read this application and stem that the above information is
cori2at.I agree to comply with all city and county ordinances and state laws relating
Q [� m is
construction,and hereby authorize representatives ofthis city to enter upon
W the above-mentioned prapcny forimpection purposes._ ,
prm
.l (We)agree to save,indemnify and keep haluss-the City of Cupertino against
id liabilities,judgments,costs and expenses which may in any way accme against said
U.Z City in consequence of the granting of this permit.
APPLICA UNDER AND DWI SLY WITH ALE NO SOURC GUI S Issued by: Date
' O q�y Q� y'
sum sire appliHcMAZt AnRfDtOrtUw ld'ne - t " Re-roofsSign re APPlcanYC t tl« m
Ao.handle hazardous nwteaal Type of Roof
asde(nWbyrheCupenn M ;(pal Cpd«Care1,r.1
the Health andSafety
Code.section 25s3z(a) !
. .I 't
ov r ❑Nn. ,; ,.. I' -.-All roofs shall be inspected prior to.any-roofing material being installed.11 .
will d, applicant orfuture wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspeetion;'I'agree'to remove
emit hazardous air conmminants as defined by the Bay Arca Air Quality Management
04District? all new materials for inspection. Applicant understands,and will comply with
❑Yes aNOall non-point source regulations:
'' . 1,
I.Ht dad S.hly C ous materials ti.. 2 requimmenti under Chapter 6.95 of the
ifC.lac build,Healthy of con Ctide,Sections15505t it
Md25534. understand that _--- G—c� rC�S•.!// -
i"he building d«s not cuircntly have a mn.n6 that it is my responsibility to notify the
occupant of the requirements which must be met Prior to issuance of a Cenificme of
ere ney' Sig tura of Applicant Da(e
_,:i: All roof coverings to be Class"B" o'beiter
O erorauth ad agent ,' Dm
'- " OFFICE
Building Division
amar
Torre Avenue
Cupertinono,,C CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
ICUPEkTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance, you must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
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 reroofing 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) Preinspection 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 that the
proper City inspection can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of 1/" 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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: it 94/g iL
Address: Z e'111 r-) ec> J 4
Reroofing Company Name: �/4 ( 1,1�le
Applicants Signature: Date: '1/1
7
Joe Antonucci
(Chief Building Official)
6/25/01