02090121 CI BUILDING OF DIVISION t PERMIT CONTRACTOR INFORMATION:
IT NO
MiN4GF@EgsRIANA AV INTEGRITY ROOFING PERn50209019q21
ff"M�ERIANTO AND YONG ING—HL1537 CASA DE PONSELLE APPLIC0T9/19/2002
PHONE: 408) 225-9263 SANITARY NO. CONTROL NO
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g OZ ARCHITEC(ENGINEER: y BUILDING PERMIT INFO
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,8=i LICENSED CONTRACTOR'S DECLARATION Job Description
O Z- l hereby affirm thvI lam licensed under pp,roovmons of chapter 9(commencing - RE ROO F
Pe�3 wnh Secti�^J )of Divizion3 of the BusineKgnd Profesvons Code,and my license
gKg g L'censelC d effect. yA Lic✓✓« 76oss F1 N A t_E 0
n7 3 C Date 4M ••/C cammc O s
ARCHITECT'S as VRATION MAR 2 1 2003
rV O 1 understand my plans shall W used as publm records ,
N
s o O Licensed Professional OWNER
5d R BUILDER DECLARATION $7700
W 1 hereby e(Rrtn that 1 1. exempt from the Cessions o License Law for the BUILDING
following reason.(Section J..L4 Business npr,mfeasmns Cale:Any city structure
--and
:] which its requires s n perms re cares the alien improve,de armut t file repair any suucmrt
pdortnilicensdpifsn reyomrenopyismasoffar Concratmtmicense Law n - Nmihei;hanled'prgsdbnugnhe'pipriaons of the Conwcmis License law lChapter9 �1 f ,m O e 2 g � VaIUBIIOn
fcontmnncis winot thereq70WAafhe basis for the aaamp Pmfesnyvi COde) F.t�i,Y k3 O!9 alL�i tt�a§:I
or Sen.7liempl any ppl andthebasisforthealleged axemptlw Anyviolation! tY"• k` 1 t Y
of Seevon than 5 by any dreg d q Ira perms sub)een the applicant s...ivil pmelry-!
,of.not more than five'hundrcd Joljan(ssnol 3 0 5 App' r_.'r'�.t:r ,G Occupancy Type
❑1,u owner of the property,or my employees with wages u their sale compensation.( _ 307 - INSULATION
-will;do me seokfand'the 141=111.What Intended or offend for sale'(Sec.-7066{' 601 — ROOF TEAlkeq&'rFd Inspections[,,;';'.L Doc
`Business and Profess....Core,The Commuter's Laenu Lew does not apply to an
owner of property Who Wilds or improves thereon,and who does such wok himself 602 — ROOF PLYWOOD NAIL
or through his own employees.provided that such improvements eu not intended or _ _ _
-:offered foTule.IE liuwcvm the buildiii-r im'-ci--mem is sold-within m:e ar of - ------- - - -- - Ni
`completion.the owner Wilder will hose the Wrdcn of prormg that he did not Wild or 6 O 3 ROOF BATTENS .., r.:%^:+t, •:,.
improve for private ofrale.). 604 — ROOF IN—PROGRESS
— — --- --" --- — --------- a;;mWF ------... .-- — — ----- — — —'------ r----.-- ------
_ OI•aact due ofshe p(Sm.7(nm Businessland Prunngwi Codenudwnuxmrs's At!I I'!��1'E'r'..:,
_ - oarWdaw does ($W, to an owner o anderty who Wilds Theves thereat (�•.r .r.-, F,:,Lr 'li:a
License Law lines not apply man awrr of a conarm who W lids seimproves thereon, '
'i<__ .,and-whoconacm for such
.... witha canvxmr(sl beemed pun,unt...the. _ _.__...._-
_-- Contractors License Lew.
❑1 am exempt under Sea "� - B&P C far this rtawp
"WORKER'S COME LNSATION DECLARATION v
�1f Ihembya?nn under pertly of' one ofIatollowingdeclarauons
--
❑ 1 have and'will'.mmmin'o'Cemrmxte or COmnm to self-insurc for Worker's
Compensation, eo provided for by Section 3700 of the labor Cade, for the
- \pe_rfarmvn,e'of the wrkfor which mi}pennitiz ias�edi
PJ I hvvdund•wdl'muisiiein Wrrker's Corrp riuilisn losmantt,as requime by Sandra
>. ��,//1is(Aped of My Cabo sComprnimon Inn one thnlerund.ismiry nuhmcbenirc permit is _.__ _e...._ -:...-...,..-.. •..�.................•.-
ode fu the
Worker's
_ _ (hu�ert! ! >q:aPoli y o:� ,ZQ1fJ .,. s ar L,,,he .•.�.�_,x i �•'.:iV sll.'r
R
1 t CEIITI ICATION'OF,E%E ION FROM WORKERS a �A.t ,d'.'t�. R b„l(. ],•} �_�4a.n
1 .COMPENSATION INSURANCE °- _y Y'” _. _..........
f'01d"(Thia1 secidohecJn6! '6mplemddthe peman,sforonehundrcd dollars •!+iii'. itiOF.1' Phe%'a ',, 01 cil,; {,
,
151001 or l., c. n,r,e,.,.,r r.,: q..., r,,,,.u• ,....
'shell not em oYan In .norm?- a Wo orwhic ,-p�ian•� �•_ °-d 11"':�"°
(ttm that f'the o inrmrencc of the Wa a for wh(h this t e uaurd;I ,;�.!-� ❑':�CCilibl�y 'It'1 L
p1' y,pawn m an manner so es no W2ome'sub"ea to the Workers
Compensation lawcuf Cobfnmra Date"'
,'NOTICE
,'IOAPI'LICANT:If;af¢r making thie Certiftam of Exemption,yogshbuld -''�!"'• •^• •'nT
Z becbme seblcc nottie WOrkelsCampcnsauon provisions of the labor Code.you murt�
0O
:Fs > --rfr , ;�CONSTBUCTIONLENDINGAGENCY;` .••• s.' - .'.ry Lh, 'c'.'10
"' "'I hereby ufrom that dare,ia'eonstrcilmi lenddgagency fonhe performance btf '.a rl •L. sgr
why i @r which fiilP it is mued(See:3097:Ov.C.1" _
.W Landat's — .. _ _ - .. _
Q 'Leh'der'iAddrea9-n......,.... �.,. .. ..• n.._.., ,,n ,.,_.. -._..__ —_._ - s -
V 0 I candy that 1 have read this application sad state that the above information is
••t*W i rimmit.1 agrx!a,5ampl$wnh all city end county mcimmort end sate laws minim, t
•m W ilding cannim'ion,and hmby authorize mpretiAmoves of this city to enter upon
due WvcanentianeJ ro n forim coon purposes
/• /
W P. errantly M p too �_
CA eWjoldioceldscosts ral exile.addkeep ihdmay in(tie way creme ago id
CA liabilities,judgnunss,costs and espI f hi which may m any way accrue agaimt mid r.T'V 'Cityy in'tonseyuence bf the rdminggof,lilt ernm.;,
., jApp in or TUNRR$TA DSA..0WILE"C PLY'WiTH',;2L NON80INT'
G .
Dus'M Issued b _ Da
!SOUR( tGITI' o acmr,ri,,, D 4
Jll f or fmch'".tldin rcu r
t -.,' ';.-vnie Re-too f R 1
m
drifted b the Cupertino Municipal Coo smrc r m „y
y,-, xAZARD wATE pe r
�(BL,: A ISCI:OSURE°, Typ
p a pen handle Htulth sea Safety e O OOf-...._, ....._
:.. gCha r9.R end the Hevl[h and Safety x'3,1. `t L' r'I" 1P ,r r; s.v, ' --- �-+`;li'I::1"r'�
Cdde.Suuon 333J2(bC;Ll,i), .r_;(,Yy R,q',,:,J�fa;i';i ii 'y' �'{ •. •••{; 1 l;rs' :S .fi As Jh.":j:
_All roofs shall.be inspected prior.to any_roofing,material being installed.,__......__
.,,Will the apphcenl'orf umrc Wilding wcupantuse equipment or dev¢es which If a roof is insialledrwitflout first obtaining aTiinsp8etion;I'agiee'to remove
'emit hamrdous air conmmmams is defined by the Bay Arca Air Quality Management
District?,,",' .,:,: i -r. r : ' all new materials for inspection. Applicant and tands and will,comply with_
a.Yee;1.:-•r"F :rio :., r„•'. Y';. '; ";,'� °” al]non=point source rag ations..; - -- --
v 1i 1 Wive reed she hmardous mammal rtg iremenn u d Chaps 6,95 of the
Cmdomm Health&5 feiy Cade.Seeuom 23505,255ll a d 536 I dcrsmnd that
Ifft Wildmgdoesnr currently",an tenant,a but n is pomrb,Lrymns py the• - - — - - w
;rccupam of she 'mrc nuh¢h'muni M t issuance ofof eme a
unit
,' :;.. .. raa - cant - -- --- - -
' to i t
0 -
All roof cove o be etter
/p�'r
nt. . �Yia �•, , nag Class
.-.�r'a.:,G! :•>':'..:. . ,. ._,-,.. ... _ __ ,. _. . . --- OFFICE,
st 1 ss"B"orb '
Building Division '
10300 Tom Avenue'
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Fax: (408)777-3333
CUPEI� TINO
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 1/4'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 of inspection.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: _�'P�: 1.A k, 40
Address: 418 Ad r; q,r, Av 6
Ieroofing Company Name: 7u7 icGi2;�v o��� n
Applicants Signature.
Date: 9/9 z.
Joe Antonucci
(Chief Building Official)
6/25/01