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03090071 (2) CITY OF CUPERTINO 's'.+- ,t -mom BUILDING DIVISION PrRMIT CONTRACT,OR�INFORMATION >e ',' 1 ..u :i% .. BU ILDING ADDRESS: PERMIT NO WINTER ROOFING INC 03090071 477 PRTMRn.CP, WV OWNER'S NAME: 151 WYANDOTTE DR PERMRLSSUE DATE WON NE. 4083638052 SANITARY NO. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMMNFO BLDG ELECT PLUMB MECH +ce LICENSED CONTRACTOR'S under DECLARATION Job DeSC[LQj� f F 1 hereby affirm that I em licensed unJer pmvivinns of CM1oplcr Y(commencing rC `9 with Section 7000)of Division S of Nc Business and Profession$Code.end my license is ��w 5= in full force and effect— f—��s 1 D LiceseClam t 3� Lic.0 �21tS2Y REROOF 't:§ Dam CotMCWU qq ARCHITELTSDECLARA ION SEP 2.3 2003 E W I understand my plans shall W used as puhlic records aot; Licensed Profcssinnal w 3 OWNER-BUILDER DECLARATION �1� �■'�^ <2 1 hereby affirm that 1 am exempt from the Contractor's License Law(or the eY V 00 Following reason.(Section IfD1.5,Business and Professions Cade:Any city or county 5$ which acquires a permit to construct.that.improve,demolish,or repair any nnmmre prior to its issuance.slid acquires the applicant farsuch pormiuo rile aaigneJamamcat Ess< that he is licensed pursuant to the provisions of the Conwnur's License Law(Chapter 9 Sq. Ft. Floor Area Valuation tF� (commencing with Section lWB)of Division J of the Business and Professions ewe).1 that he is exempt thcaefsom and the suis for the alleged exemption.Any violation of 36617003 . 00 Section]851.5 by any applicant for a permit subjects the applicant m a civil penalty of ppN Number OGGn ant. T e not ream than Five hundred dollars($500). -- -- - - ---- - P y YP ---- ❑ I,As owner of the propeny,or my employees with wages As their sale compensation, will do the work,and Ne swcture is not intended or offered for sale(Sec.fad,Buainesa — FFAME and Professions Cade;The Connector's g�License Law does not apply to an owner of 3 0 7 - INSULATynffd Inspections property who builds or improves thereon,and who close; work himself or through his own employees,provided Ebel uch improvements arc not intended or offered for sale.If, 601 — ROOF TEAR OFF however,the building or improvement is sold within one year of completion,the owner. builder,will haw the burden of proving Inn he did not Wild or improve far puryose of 6 02 - ROOF PLYWOOD NAIL sal`')' 603 - ROOF BATTENS rl 1,a owner of the property,,Business exclusively contracting wile licensed canusaosa to 6 0 4 - ROOF IN-PROGRES S cease a the es not pply(secto an ofand rty who Wionslds Cade:)The es Beeman.Li who Law cocanosapplyean ownerofpropertywho Wilds terimproves Beeman.and, whocontractsLaces for such projects with o canuaaar(sj liccnsetl pursuant m the Conuanots License Law. ❑lam eaempt under Sce ,B&PCfar bit Mason Owner Data WORKER'S COMPENSATIONOECLARATION 1 hereby affirm under penalty of perjury one of the following declanstiom: _ I haw and will maintain a Ceni ricam of Consent to self-inure for Warker's Cumpem sation,u pravidcd for by Section J91ID of the LAW,Cade,far the perfmm uc,of Ne work for which this permit is issued. have and will maintain Worker's Compensation Insurance,u required by Section TW of the labor Code,for the performance or Ne work for which this permit is issued. My Worker's Com cess ion Insher.cemicr and Policy number am: Carrier. / 12; Policy No.: �r/u'1{'�i CERTIFICA OF EX PION FROM WORKERS' COMPENSATION INSURANCE (This Accdan need not be completed if the permit is foronc hundred dollars(SIM) or less.) 1 Ceni fy that in the peffurmance of the work for which this permit is issued.I shat]not employ any pc von in any manner an As to WCOTC labje t to the Wrrkeri Compensation Lawa of California.Data Applicant NOTICE TO APPLICANT:If.after making this ComiEcam of Exemption,you should become subject to the Worker's Compensation provisions or the Labor Code,you must �O forthwith comply with such provisions or this permit shall W deemed mvnked. Z� CONSTRUCTION LENDING AGENCY 1 hereby affirm that there its construedrin lending agency for the performance of 5 the work for which this permit is issued(Sec.3W7,Civ.C.) 31 Q Lender's Name z Lender's Address ;J Q I certify that I have read Nis application and sure that the Above information is , y f Comore'.1 agree to comply with all city and county ordinances and sum laws misting to 0U building construction,and hereby amhofim mes prenladvas or But City to enter upon the J+I1.1above-mentioned property for inspection purposes. y (WA)agree Io save,indemnify and keep harmless the City of Capcnino against U fA Iiabllities,jolgmcos,costs and capcnms sate' may in any way accmc against mid City ..)z inaaseq nccoflhegmmingufl 'aper 1. ^t APPLI NT UNDERSTAN N ILL COMPLY WITH ALL NON-POINT Issued by: Date SOU REG 0 A Z, y —/0-' Re-roofs nm eafNp lice Con to Data HAZARDO S MATERIALS DISCLOSURE Type of Roof Will the applicant or fines-building occupant start or esodic havarJous mamtlal u Fined by the Cupertino Municipal Code,aspect 9.11,and the Health and Safety dc.Section 135]3(a)? All roofs shall be inspected prior to an roofing material being El Yet P p Y g g installed. Will the applicant Or future building occupant use equipment or devices which If a roof is installed without fir obtaining an inspection,I agree to remove it havardom air conuminantA u RncU by the Bay Arca Air Quality Management all new sacrists for inspect. n. via? Yes 1 vereadthehmeNnusrmaeials uimmentsunderChapmr6.95oftheCalifor- niaHea &Safry Code,Secdmu 5511 . SJJ aW25574.1 undersuM Nai(mc Wilding /g/O l,� does vmemly have A to a s my rcapamihiliry m notify the cupavt of Nc 7 - V m toe sate' muWin issumccofaCcNBcateo!Occupancy. SD omep ica Date -0 n All roof coverings to be Class "B"or better w rum aul mimJ Agcnl Date g Community Development Department Building Division City of Cupertino 10300 Torre Avenue CITY OF Telephone: (408)777-3228 C U PE RT 1 NO 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) h1-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 l/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 compl with the above stated policy on re-roofing. Homeowner's Name: 24 G Job Site Address: _la ZZ 3141 frnse, 6VC, Roofing Company Name: _c, r A plicant's Signature: Date: �J Greg eel Building Official Revised 1/30/03 CITY OF CUPERTINO REROOF o 3 7/ CUPERTINO PERMIT APPLICATION FORM APN# Date: Building Address: /DLJ v Owner'sName: Phone#: �n C - 9a3 Contractor: Phone#: _ License#: Contact: hone#: Cupertino Business License#: 212 0 Type of Roof Covering: Existing: Proposed: ❑ milt-Up Roof ❑ uilt-Up roof Wood Shakes t Shingles Or sphalt Shingles Wood ❑ Wood Shakes O Wood Shingles ❑ Wood Shingles ❑ Other(Specify) ❑ Other(Specify) Number of existing coverings ❑ 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: C— Job Description: QvlaP Residential Commer al ❑ e Zone: es ❑ No,2' Confirmed with PI g. a t. if there are an restr 'ons: i o Project: 5 Type of Construction: Occnpanc:Lgrou / A lic Fee ID Fee Descri tion Fee Group BPERMFEE Bld Permit Fees BUILDING ,BENERGY Ener BUILDING BSEISMICRE Seismic Fee Res BUILDING BSEISMICOM Seismic Commercial BUILDING BP CHK Plan Check Fee BUILDING BUSLIC Business License BUILDING z3 � ��