03010149 CITY OF CUPERTINO
BUILDING DIVISION PERMIT GONTRACTORINFORMATI011
BUILDING ADDRESS: PETERSEN-DEAN INC PERMITNO.
10325 ANN ARBOR AV 01010149
NER:S NAME: 7980 ENTERPRISE DR APPLICATION SUB DATE
SRINIVASAN LEELA V AND GANAP T 01/27/2003
PHONE: (510) 494-9982 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
I� I�
p00 LICENSED ONTRd made,SDECLARATION Job Descriptio �p
U 1 hcrchy affirm thin I am licensed under provisions of Chapter 9(commencing01 C J A Le
with Scminn]Ig1U)of Oivision3Of Ne puniness and Pn cation Crmc,ny mylicense is o
z o g< infulljorreande r. i // T/O SHAKES . RESHEET 1/2 " CDX
5 LMcnm Cla s Lic a
oz-, wa cannxmr ADD COMPOSITION SHINGLES FEB 2 0. 2003
ARCHITECTS DECLAR ION
1 understand my plans shall he used as public records
Au Ok!U
BLicensed
i
OWNER-BUILDER DECLARATION
$ o BUILDING 1 hcrchy affirm on 11. exempt from the Contractor's Co License Law lar the
a p 0 following rcost n.(Sermon IIDI.S,Business and Professions h,nle:Any city onnunre
$ which rets issuance.
a Permit re c ir6w0.alar,i applicant forsu demolish,tar leash any su rmcm
priormslissuare,aim inquires theitioforsuch rofilessigned stammer.
as that(com iratingsedpursuannothe ofDivision3NCConsmcmraLittreLaw(Chtpmr9 Sq. Ft. Floor Area Valuation
� $ (rommenc rating Sermonstand of Division the
the
eged essanJPndAnyvilationor $11904
that he is exempt Ihemfrom and the basis for Ne alleged exemption.Any violation of
Section'/031.5 by any applicant for a Permit subjects the applicant to a civil penalty of ApNNumber Occupancy Type
.at mom Nen five handled dollars(SNI(). 32655022 0 0
❑I,downer olds,property,or my employees with wages a their sale compensation,
will do the work,and the suueture is not intended or offered for sale(Sec.7044,Businem
and Pnsfessiuns Code:The Conuecmr's License Law does not apply to an owner of 305 - FRAME Required Inspections
properly who builds or impmva Hereon,and who does such work himself or through his
own employees.provided that such improvements art not intended or offered furssle.If. 307 — INSULATION
however,the building or improvement is sold within one year of.repletion,the owner
builder will have the burden of proving that he did not build or improve for purpose of 601 - ROOF TEAR OFF
tale) 602 - ROOF PLYWOOD NAIL
❑1,as Owner of Be pmpeny,am exclusively commuting with licensed Comments to 603 - ROOF BATTENS
construct the project(Sec,7W.Business and Professions Code:)The Convectors Li.
cense law does not apply to an owner of property who builds or improves themon,md, 604 — ROOF IN-PROGRESS
who counters for such projects with a conuvctor(s)licensed pursuant bu the Commutes
License Law.
❑I am exempt under Sec. B fk P C for this leaon
net Dale
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury one of the following outstations:
I have and will maintain a CenlECan,of Consent to self Insum for Worker's Camper.
sa'ion.as provided for by Section 3]r.)of the Labor Coda,for the Performance of the
work for which this Permit is issued.
1 have and will maintain Worker's Compensation Irumme,as required by Section
'loll of the Labor Code,for the performance of Ne work for which this Permit is issued.
My War Co Re Brio susanc mer and Policy nu Mra�j [`'
Camcr. �^ x QPolicy No.: �O ES Z. a
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need nm he completed if the Permit is forms hundred dollars(Sla)
or less.)
1 certify that in the performance of she work for which this permit is issued,I shall not
employ any person in any manner m as or become suhjuuo the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject to the Workers Compensation provisions of the Labor Code,you must
C) Z forthwith comply with such provisions or this Permit shall he deemed revoked.
OCONSTRUCTION LENDING AGENCY
(—i I hereby affirm that there is a construction lending agency lot he performance of
LYa the work for which this Permit is issued(Sec.3097,Civ.C.)
GQ Lender's Name
Z Lcndcr's Address
U t7 I certify Nat 1 have read this application and sum that the above aninnation is
F Correct.l agree to comply with all city and county eminences and sale laws relating to
�U Wildingconswction.andturebyamhorimlepmsentatimsOfthisCitytoenteruponthe
W above-mentioned property for inspection purposes.
(WC)acme to save,indemnify and keep harmless the City of Cupertino against
fa'q liabilitics,judgments,Casa and eapensr which may in any way accme against mid City
U in consequence of Ne granting of this Permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N -POINT Issued by: Dat
/W
SOURCE REGULATIONS�. � �l �
/1—'--+w—D 11"7 >3 Re-roofs
Signature of ApplicantlContracmr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant atom or handle remmous material
as;oefined by the CuNnino Municipal Code,Chapmr 9.17,and rhe Ilcallh and Safer'
de.S.Imor 75537(o7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes PPM—
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspectional agree to remove
anvil haeamous air contaminants a defined by the Bay Arca Air Quality Management all new materials for inspection.
District'!
O Ycs
Iban&Safet Cock.Ot Smnons2555.2553ls and 2 tsunderdephan6.95 ofthe Caldinn.
g
nit HealthoSafetyban.Sectionv 75N15.75577and7553a.l understan hit ifdzbuilf the
dins not curtcn0y have a mnanr,Nor it is my esporihility m notify rbc a upanr of the
requirements which re elpdonoom m.ft CcmIIcmcof Qcjt ley �3 Signature of Applicant Date
Owner or aummimd agent / Dam All roof coverings to be Class "B" or better
1 Building Division
�> r 10300 Torte Avenue
l Cupertino,CA 95014-3255
Telephone: (408)777-3228
C
ITY40 Fax: (408)777-3333
Building Departme 11
JA q 2003
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance, you must agree to comply with 199 andards
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. 4
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/"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:
Address: 25 a4t";�-7.
Reroofing Company Name: � �
/ �+ —� re,,✓
•. Applicants Signature: Date:
Joe Antonucci
(Chief Building Official)
6/25/01