02110110 CITY OF CUPER'I'INO
BUILDING DIVISION PERMIT "�CONTRACTOR�INFORM°ATION ,
BUU2)i)d" -ALVES DR PERMIT NO 2 110 110
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Ow8nTRA:RI KONDAPANENI APPLICATP115yBiWY2002
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IFlONli: SANITARY NO. CONTROL NO.
ARCIII'rECl'/ENGINEER: BUILDING PERMIT INFO
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coop LICENSED CONTRACTOR'S DECLARATION
<� 1 nerehy air,.mar I am licensed rade,pmanions ofChapter 9(remmenr;dg REROOF Job Description
�<i wnh Scctinn 7lXMB of Divisinn3 of NC Business and Rnfcssiom Crxlc.and myliccnsc is
zop= �i«�I.a�o rex dee1. 3 J�.3.6
�n ed cea fur ft�ILQI, LLED
r—~W a ARCHITECTS DE rARAT10N
z< I understand my plans shall M u
public
rc[nrdx
Licensed Pndcssinnal OV �j
7 2002
te< OWNER-BUILDER DECLARATION
ce 1 hereby affirm that I em excmp,from the Cnmmelors License Law for the
A
2-L o o following reason.(Section 9131.5,Business and Prufesxions Cele:Any city or county IA1 p1 $6500
x m which requires a Permit w umsvurr,alter improve,demolish er repair any srumure BUILDING
V G
,2- nor to iu issuance,almrcyuires the epplicent lursuch permit to file aligned statement
< loathe is licensed pursuant to the provisions of mcControatins License Law(Chapmri) 3Skl6Bt0ffl(UA@Q Valuation
ex (commencing with Section Wild)of Division 3 of the Business and Professions Code)Or
that he is exempt therefrom and be basis for the alleged exemption.Any violation of
Section 7131.5 by any applicant for a permit subjects the applicant to a civil penalty of PNN Occupancy
not mom thannvehundreddollars(s51n). 307 - INSULATION P y Type
El 1,as owner of the property.or my employees with wages as their sole compensation,
will do the work.and the swnure is not intended or offered for sale(Sec.70akL Business
and gppf;jO
Profusions Code:The Centimeters License Law does not apply to an owner of 6 0 2 — ROOF P n1fA S LnS
property who buildsor improves thereon,and whudoes such work himselfur Brough his 603 - ROOF BATTENS
own employees,provided that such improvements arc not intended orortered for sale.IL
however,the building or improvement is sold within one year of completion,the owner-
builder will have Far burden of proving matIn,did not Wild orimprove for purpose of 604 - ROOF IN-PROGRESS
role.).
❑ 1,as owner of the property,am exclusively conducting with licensed contesters to
cormeact the project(Sea 7806,Business and Professions Code:)The Contractor's L,
cenic law does not apply to an owner of property who builds or improves thereon,and
whir contracts for such pmjcar with a carnations)licensed pursuant to the Contractor's
License Law,
❑1 am exempt under Sec. B&P C for this reason
Owne Date
WORKER'S COMPENSATION DECLARATION
I hereby aRrm under penalty of perjury one of Be following dalvau me
1 have and will maintain a Cenificam of Consent to sel6mithe for Worker a Compen.
.Iien,as provided for by Section 37(M)of the Labor Gale.far the periormame of the
work for which this permit is issued.
❑I have and will maintain Wmkm's Compensation Insurance,as required by Section
370()of the Labor Code,for the performance of the work for which this Permit is issued.
My Worker's Compensation Insurance carrier and Policy number c�
STtgTt '�..�
Policy Nn.; Jgsypntri) I
CERTIFICATEE OFEKEMPTHON FRO ERS'
COMPENSATION INSURANCE
(Tris section need not be eemplehod drive Permit is food,hundred dollars(51(X1)
or Icss.)
I certify net in the Performance of the work for which this permit is issued.1 shall not
employ any person in any mannerse as in become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenificme of Exemption,you should
become suhpa t to the Worker's Compensation provisions of the Labor Cotler you must
O'Z forthwith comply with such provisions Or Permit shall M deemed nevekN.
OCONSTRUCTION LENDING AGENCY
aIhereby allied that there is a construction lending agency fn,the performance of
the work lir which this permit o slued(Ses.3197,CO,C.)
0 Leader Name
z Lender'..,A6drem
U O 1 certify that I have read this application and state that the above information is
a, H cones.I agree to comply with all city and county ordinances and state laws relatingm
OU building construction,and hereby authenm representatives of this city to enter upon the
above judgments.
mentioned prants.c costs
for inspection purpowhich ms.
(We)ague the
indemnify and keep harmless the Cit f Cu Wino a r
liabiliti(We)aree in cuss index indemnify
ad which ho in yo pc gains
h Ix y any attmc against said City
U in consequence of the graining of this permit.
SPPLIIC NT ULDEIO AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
eft-roofs
Signtur
ae APp icantlCmOracm, Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the apphcand or future building occupant store or handle hauNnus material
as defined by the Cupenine Municipal Code.Chapter 9,13,and the Health and Safety
Code,burned 25532fa)7 J
❑Yea (J No All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant et future hooding Occupant If a roof is installed without first obtaining an inspection, I agree to remove
pp g pant use equipment Quality
m devices e which g P g
mit haeaNnus air mmuminunts as dcfincJ by dM Bay Arca Air Quality Managcmcnd all new materials for inspection.
Diudn7 P
❑Ycs IN.
I have mad the lasaAn®materials myuirements under Chapteri,95 of he Califor- e
nosnoth&Safcyyhave Sccun. 2551)5,35533 myms uibili.1undmfify W ur M1uofd c
mal nm caul hcha.c ar it is my respuns;hilidytunnufy dr acupanr of the 4�t �6
1require cots nen mete , ,;s<eanreoracen;firateorae anry. oate
de,or an oriscd agedt ate All roof coverings 10 be Class "B"or better
Building Division
10300 Torre Avenue
Cupertino,CA 950143255
Telephone: (408)777-3228
OCIOF 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 IV"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: Iia.
J
Address: 7 F�)4P
. Reroofing Company Name: ( 0.`' W e V�-- -- ,
Applicants Signature: �_ �Date
• Joe Antonucci
(Chief Building Official)
6/25/01