02110007 ctTV of CUPERTINO CONTRACTOR INFORMATION:DIVISION BUILDING nlsmN PERMIT
IBUIL1)16GM4EsALDERBROOK LA WESTSHORE ROOFING CO PERMITNL02110007
' WI IpMYRT MCQUEER 5869 WINFIELD BLV APPLICATIfIN1SlM®f 2002
ONE (408) 629-2100 SANITARY NO. CONTROL NO
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
{O^uC0cc LICENSED CONTRACTOR'S DECLARATION
yj I hereby Orion shat I are licensed under provisions of Chapter 9(commencing REROOF Job Description
with Section 7l(1IB of Dinaon 3 of the Emanation!Profcs trot xk�tinp my Tense is
mmBmrearendeffire. � I'M T/0 & INSTALL COATED STEEL TILE
ZOr��.Licensee + Lic.N
O III Date Contractor public r iii
^SYgyp CHITELTS OECLA,YCA•FIf1IC
`3K IundcrsmnJ my pions snail beuud as public mcnNs
G L.cnmd Protectionist V
OWNER-BUILDER DECLARATION
'ua N X I hereby affirm shat 1 am exempt from the Contractor's License Law for the
m p O following reason.(Section 7031.5.Business and Profesoom Code Any city or county
which requires a permit to construct.attar,improve.demolish,of repair any structure $10780
u+ point m its issuance,also regmres the...Incur,for such proud to file a signed comment
ptZZ that he its licensed pursuant m fire provisions of due Corsmciors License Law(Chapter 9 Sq. Ft. Floor Area I Valuation
y�$ (ommencing with Section 7000)of Dinnon 3 of she Business and Professions Cove)or 36920045 . 00
3r 9 that he is exempt therefrom and the basis for to alleged exemption Any violation of
Section 70315 by any appl¢ant for a permit subjects the applicant to a civil penalty of APN Number Occupancy Type
not more Nan five hundred dollars(SSW). 305 — FRAME
❑1.as owner of the properly,or my employees with wegm as their sole compensation, ,y..
willful he work,and Neawnure is not intended oroacred for sale(Scc.7040,Businem 30 — IJJJjLTA$'@Ipvylly p�
and Professions Code.Tfie Contractors License Law does not apply to an owner of 601 — ROOF TC.HK TrIP .actions
property who buildsor improves thereon,and whadms rich work Interstellar through his
own employees,provided that such Improvements art not untended oroRered for sale.If. 602 — ROOF PLYWOOD NAIL
however,the budding or improvement is sold within one year of completion,the owner. 603 — ROOF BATTENS
budder will have due burden of proving that he did not Wild or improve for purpose of
mla). 604 - ROOF IN-PROGRESS
❑I,as owner of Ne propeny,am exclusively contracting with laenud mormal s to
construct the project(Sec.701 Business end Professions Cook.)The Contractors Li-
cause law does not apply ro en owner of property who builds or improves thereon,and
who contracts for such projects wife a contractors)licensed pursuant o the Convectors
E)Iam Law. F'�a . a� LE
❑lase Law. under Sec. ,B&PC for this remora 'VA
Own,' Date
WORKER'S COMPENSATION DECLARATION NOV O 8 q 2002
I hereby abut under penalty of perjury one of the following declarations. V
❑I have and will maintain a Cenifcate of Continuo self-inure for Workers Curran- x}11 p�
satiom,u provided for by Section 371.of the Lalwr Code,for the Performance of the BUILDING
Y G
work for which his permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
37W of the Labor Code,for the Performance or due work for which this Not is named.
My Worker,Cpm.ensahnn lasugnre comer and Palwy+nyi�ber are.
Camcr: c]�Wl\�•. iC"'.`s••�•VYN Policy No.;
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This seconn need nits be complered Uthe permit o Imone hundred dnlim(g I(g))
or Iem.)
1 candy that In the performance of the work for which this Ferran its issued,I shall not
employ any Nixon in any manner sit at In become subject to the Workeri Compensation
Laws of Cahfotma Dad-
Applicant
NOTICE TO APPLICANT:If,armr making this CemBcatc of Exemption,you should
become subject to the Worker's Compensation provisions of she Uber Code,you must
O 0 forthwith comply with such pmv,xm ,or this fiction shall be Treated revoked
z CONSTRUCTION LENDING AGENCY
Ihereby affirm Nun there IS a construction lending agency for the Kammeoce of
p$ > due work for which this permit is issued(Sm.3097.Cry.C)
fy Q UnderiNam-
2 Lender's Address
U C 1 candy that 1 have read this application and smm that she above information is
U. f' correct.I agree to comply with all city and county ordinances and state laws mining to
OU budding mostmmmn,and hereby auNOrine mpresentapves of this city to enter upon the
a ,mentioned ProPCny for ms.ccuon purposes
(We)agree tu cast,indemnify and keep harmlcts the City of CeNrimn against
y( habili es,judgments,eosuandexpenxs wlmch may m any way accrue against said City
U z APPn CA 1W of thER NANDSIA IDrW t MPL) I ALL N0N.POINT Issued by: Date To
SOU CF. ULATIO _
<H' b�— Re-roofs
Signature of AppincandContractor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future budding o capers scare ur handle hazardous material
ex defined by the Cupeninn Municipal Cube.Chapter 9 I2,and she Health and Safety
Code,Section 255321.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
Will d¢apphtanwr fuwm uilmng occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
tit hvardnus air contaminants m defined by the Bay Area Air Quality Management al ew materials for inspection.
Orono?
❑Yes No
(have read the lommod sr,moats mquiremcnu untkr Chapterh95of the Califnr-
n FkaINS etyCuvk,Lions 2551)5,25533and22S S,Muiacrsmnit Nmif'0 building
d not c a y ha re nit,that it is nsibilitY to tl(y turic upenl of Nc
t nitw a tistwm nirm ennracenificrenftfu` For'
Signature of Applicant Date
1.
Owner mr,timnnad scent Dam All roof coverings to be Class"B" or better
Building Division '
10300 Toga Avenue
Cuperdao,CA 95014-3255
�• ` Telephone: (408)777-3228
F= (408)777-3333
CUPERTINO
]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 musthave a minimum of 1/4"pei•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: t J �z✓ F Al c. �-L^
Address: ° 4 `+ 14 I j�- Y b`` �—
PeroofngCompany N e: ��S kS\-4P_. �On rl✓
Applicants Signature: v / �� 13 ate:n�-
Joe Antonucci
(Chief Building Official)
6/25/01