05090038 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CQIVTRACTQR�TNT?UItMATTOIV ,4.
BUILDINCADDRESS: WINGIS4 ROOFING INC PERMrr N0.05090038
OWNER'S NAME: PERMIT IS5l1E DATE
MORRIS LIN 1241 AYnNRY WAY 09/ _7/9,00S
NE: SANITARYNO. CONTROL NO.
(510) 889-9068
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
l� l� 0 O
�oo LICENSEDCONTRACnderprevisions
DECLARATION
rk 1 ortby af1Um that I am Ilaued under proviicas of Chpar 9(commencing Job Description
with SaWn7Qq)ofDivision]of tho Bmimpe and Profnuium ,and mylicense 4
j� Lfall taro an Hect. ( REROOF--T/O SHAKES . INSTALL COMP. SHINGLES
Z Clause Cleo Lk.to
L k, Dam Conummr
A CHnEcrs DECLARATIO
see
�y 1 understand my plans Mall he used u public n
M� u
G Licensed proposal...I
i,
OWNER-BUILDER DECLARATION
Z 1 hemby aDirtn that I am exempt from the Conuacmes License Law for the
'a O Oy fallowing maaon.(Section 70211.5.Business and Promm um Calc:My city or county
1t$IL which requires a permit to c nsum a,star.Improve,dcmnRih,or repair my 4mc1aR $8250
F��n pdormitsiensedP Panamint
mine
ma,isocant for rock permi'.tj,. .tuncdsuamom
$< lbathcincinlsed Secilouotheprovislous ono( eBusi w'slucvelaw(Cltapm9 SQ.FL FIOOf Area Valuation
(commencinawiNSectirn70ndth basisan3nftheBedexemton.An vUCode)or
.. Seto 4 1.5 b lae.from and or aper far the,WcecO exemption.W Any violation of
Seale]than ve any applicant for•permit subjects the applicant m a civil penally of
of more than Ow hundred dollen($3007. ! Occupancy Type
0 I,u awder of Ne pmpaty,m my employees withweds u their mle compenmlon,
will do the work and the suucmrt is notiomeled aoRemd fo...e(Sec.]044,Buinese
and Prolessims Code:Tae Canlsacmes License Law door not apply m an owner of - Required Inspections
property who Wildsorimproves Nur on,end whoduessuch workhimselfor through his
own employes,provided thisuch Improvements me not intended confined for We.If.
however.the building
e improvement uholdwithin one Your of completion,the Owner. �
Wilder will how dburden of paving that he did not build or Improve f'purpose of
tale.). y//
[jm
I,u owr a the property rte exclusively correcting with licensed mnuactom to ED
construct the project(Sec.7044,Bwim...and Profusions Code:)The Conaacmfs Li.
cause law does not apply to an awn'of property who Wims or improve thereon,and,
who contracts for such projects with a contomun(s)licensed pursuant to the Coma ctoes n
License law. EP�8 ?005
❑lam exempt under See ,BhPCfo this mown
Ower Dora
WORKER'S COMPENSATION DECLARATION l�7�
Ibe.by anion under penally of perjury aro ofthe following declarations:
1 have and will maintain•Cenificaa ofCousenua ulf imum for Warkoes Compete
7[371M
lan.u provided fm by Section 3700 of the Luxor Code,for the performance of the
rk for which Nr permit Is ismem.
1 have and will maintain Worker's Compeuni resonance,u required by Sectio
of Ne Labor Code,far dta perform a the .,lochNispermilisissued.
WorkeM1 Compen/sedan mu e c 'r try number mam'.. S Policy No.:
CER7IFIC E OF EXEMPTION FROM ORKERS'
COMPENSATION INSURANCE
(Thr uetian recd Imtaceomplead lithe permit Is foronc hundm ldolla s(SIg)
m boa) •
1 ceni(y Nat in the performance of the work for which this permit is traded,l shall not
employ any person in my manner an as to become subject to the Workers'Compensation
Laws of Catifamr.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subjat NO the Work"CanPewdon Provisions Of tbe labor Code,you must
.J O forthwith comply with such provisions or Nr permit shall be domed revoked.
z y CONSTRUCTION LENDING AGENCY
F+ I hereby anBnn Na the.is a mmuuctiml lending agency for Ne perfurmancaaf
Ci> the work for which this permit Is Issued(Sm.3097,Civ.C.)
W Q Lendcr's None
z Lender's Address
V Q I coolly that 1 haw read this application and mar Nu tW move informado is
moult 1 aura in comply with all city and county ordinances and sum laws.la int to
0 V Wilding construction,and hereby authodm representatives of this city In enter uponf
W above-mentioned property for Inspection purpoaei
fY (We)agree to taw,indemnify and keep hu bleu the City of Cupertino against
IYJ liabilWes.judgments,costs and pepenses which may In my way aarde against said City
fJ 7 In consequence of the treating of this permit
�i APP ,ICAl#UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date F_7—c)
SO G ATIONSt I ' I/Q F_( ,q Re-roofs ✓��,
sic fAppl can mom— Data
A7dRD0U$MATERIALS DISCLOSURE Type of Raaf
WIII the applicant'future building Occupant nucorhndle haeardaus
u dcOmd by the Cupertino Municipal Code.Chapter 9.13,and the HorIN roti Safety
-de,Semon335]3(a)7 I�'' All roofs shall be inspected prior to any roofing material being installed.
❑Yes xNo
U,
c0
Will the applicant or future Wilding Occupant ase equipment a dcviou which If a roof is installed without firs[obtaining an inspection,I agree to,remove
h h..Nnm air contamimn M defined by me Bay Amo Air Quality Management all new materials for inspection.
❑Yes NO I
I haw mW the hnmmasmmrialzraquiremcnts under Chapard.95 ofthe Califon
niaaulN@ alclyCnM,SccWns25505.25533a 23534.1umktau if Ne Wilding
dm.n I cu ndy mom a anent Nu It r my rupom hility m wtify a aeupant of the
.qai n whkh.uslWmctpdorlw of cc f amp Signature of Applicant Date
( U All roof coverings to be Class"B"or better
Ow thafi d Beal Data
aClOF
Community Development
10300 Torre Avenue
Cupertino CA 95014
Telephone(408)777-3228
Fax(408)777-3333
UPEkTINO
Building De artment
JOB,ADDRESS: PERMIT #
I O� 1 0 L 0 ,5-0 Dom
OWNER'S NAME: P14ONE #
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
Septic Tank
Sheet Metal
Sheet Rock
Tile
caner/Con actor Signature Date
Community Development Department
Building Division
City of Cupertino
10300 Torre Avenue
Telephone: (408)777-3228
CITY�F Fax: (408)777-3333
*UPEkTINO
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.
7. NOTE: If you call for a plywood nail inspection and the job is not ready,
you will be charged a re-inspection fee of$176.18. The re-inspection fee must
be paid before another inspection can be scheduled.
IMPORTANT:
1. Flat roofs must have a minimum of Y4" per foot slope and demonstrate
that there is no ponding.
2. An I.C.B.O. report is required to be on the job site at the time on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: Mokgk,S L(r�
Job Site Address: (, V f ✓�l 1 bV P `"
Roofing Company Name: l ) 1 S f /v
Applicant's Signature: Date:
Greg Casteel
Building Official
Revised 11/2/04
Printed on Recycled Paper
apt CITY OF CUPERTINO
REROOF
CUPERTINO PERMIT APPLICATION FORM
APN# 3 ! Date:
1 �
Building Address:
1,)W6 /� �� a4,i L
Owner's Name:
Oop ,5 /L')j Phone#$ I 3_ K3
�sV
Contractor: Phone#: License#:
w.Nc s tN� ► �� s io 98'1 --7
Contact: NC-1 �N/per Phone#:wd-D6 ` 0&/u Cupertino Business License #:
1J,�1 Type of Roof Covering:
Existing: Proposed:
❑ Built-Up Roof ❑ Built-Up roof
C) Asphalt Shingles K 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: (/❑ `j� I S f��S' 7/ 6 "0 S�l� �1�
IkResidential Gtt Cohmmercial ❑
Fire Zone: Yes ❑ NoConfirmed with Planning Det. if
there are an restrictions: L5
Cost of Project: 2s� Type of Construction: Occupancy group:
Qty. if
Applicable 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