02080129CITY OF
CONTRACTOR INFORMATION:
J.
DIVISION
PERMIT
BUILDING ADDRESS:
PERMIT NO.
19133 ANNE LANE
020801129
GE(�iEME O'HARA
APPLICATIONTE
PHONE:
SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: I
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
r - lJ 1_:J L.J
LICENSED CONTRACTOR'S DECLARATION
Job Description
I hereby.aRrm that l am licensed under provisions of Chapter 9(commencing
REROOF
IIwitM1 Section ]IIIXI) of Division 3 of the Busiucsy.y¢I Professiws Cade, and my license
ire In mu�andfertaZ9 tea 5`2S R?Q.
I License ��rnnaaoosf//
' Da �-�� -ARCHITECT'S
(�n _
�8�����
DECI�YRATION
� I uMersuM my plans shall W used u public rccoNa
SEP 1 8 2002
Licensed Professional
OWNER -BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for me
following reussm. (Section 7031.5. Business and Professions Code: Any city or county
i which requires a to communist, alter, improve, demolish.
1 g `1' a �� $6800
(e a
BUILDING
Permit or repair any structurt
l prior to its issuance.alsoryuinesNeapplicvufwwchpemtiltofikasignedsutenoent-
.-p., ��a,�t�
;, 3 YJIV'FIYV�. A� r.tt0,4
{„+�' YJIV</`lYV 1111 \YY
Valuation
tat heil' ted pursuon, 16 he pro xiom of the ConvacllWces License w(Chager9
(co w gwi@Scnio ]OW)of Division lot the Bin ssaadP f<ssions Code)
or that is eiempt mercfmm anJ the bass far the alleged Any Imam
io e03 than Fiya undredieant for ollars(pe,nsubjens lheapplicam loacivil penalty
applicantto l p
-of Section more
of mol mart than Five hundred Dollars ESW.
p.N I�
305A TI�r11E
•,_ Occupancy Type
❑Laanwnerofthe propen,ormyemployer,wimwages amthem some compens Fon..
307 - INSULATION
- will Eo. the work: and the structure isnotintended or offered for sale (Sec. ]Dian-
'Business and Professions Code: The Contractor's License law does not apply to an
6 01 — ROOF TE AFetl feE' Inspections-' -” •"
owner of property Who Wilds or improves domon, and who does such work himself
602 - ROOF PLYWOOD NAIL____
or through his own employees. provided that such improvements are mol intended or
m
building - .,..in sold within one rear of
or impmvcmcn y
compleion a the:affhowuilder
_ _ _ _ .. ..
.._ - 603 - ROOF BATTENS ,
will
will have the burden of proving that he did not build or
...
improve for Purryaseofoalle'r
604 - ROOF IN -PROGRESS
_ ._..__._ _ a.__.._. _.._..__.
O l: am mwner.P
7v 1 sensed connaams to
property, am ex sines
.. ---- --------
r .,� r .
Project
construct the project (Sec. ]loan Business and Professions Cade:) The
a d Professions
si ns Co
. , I ,
License law does not apply wan owner of property who builds ea improves thereon.
improves thin.
'" "" -
and -who contracts. mmclse such Projects said, a commclarts), licemsed.punuanl.m ,hc.
..._.._.__.__.._ _._.... ._____ ._. ...._. .__.._... _ _..... ... _...._-___.,
Contractor's License Law.
Law.
❑ l am exempt under Seclt '' ;B&PC fonhis rcasan
_.—__ _"._,.___._...__._.—__'__..
Own Dam'
WORKER'S COMPENSATION DECLARATION
1 hereby aRum under penalty of perjury one of IW following declarations:
I
1 have avid will maintain a''Ceridcate of Consent to self insure for Worker's
Compensation, as provided for by Section 3]11(1 of the Labor Cade, for the
prtfonnbnce of 0e work for which this permit Is issued. I,
01 have and will 'maintain Worker's Compensation Insurance, as required by Section
37M of die'Lease Code, for the Performance of the work for which this permit is
Comperdidim Insumnc c cr'atW nli<y number e¢ -
Issued M,y�W�
`k=_ss
Carte�]itM' �.ys .1 Pol'cy No. Zt 3.
�•' (CERTIFICATION 01' EXEMPTION M WORKERS t
a - I ... y. is s o :Ih.•t
<
- : COMPENSATION INSURANCE'"' a s' L '
' t (Th lion need not & completed f the permit is for one hundred dollars
(SI W) or Icxs.l
:
1 cert fy that in,h pert nm ce of Ih o k f h h th' perm 1's .suW I
rsholl
-
not employ any person n any mano=r so as m become mbject m the Wmken
Compensation Laws of Calititmia.Date' - -
: fcal ynushoulst
NOTICE TOctto APPLICANT, It aompener stionPosng this ions
'.;. r^ C .,r
offEmmpuot
become subject to the Worker's Compensation Provisions tabor Cade, you must
forthwith comply witM1 such previsions or chis pertnil shall W deemed revoked.
nCONSTRUCTION LENDL�G AGENCY '
s'" I affirm Thal there Iss lending agency for the perfommnce
, .. r. r, ✓.. ., - -
work for
sof the work for which @is'cennit is issued (Sm. 109], Civ. CJ
issued (Sec.
•'
-lend is Namc... .... .�.:...-_...�. .. ..,".:... __... .,...... ..
__.......__._.__._."_._. _.._... ._... _. ._.. ...... ..... ..__
Lend Add :.
•, 1 scarify Ihat I h read N application and a, that Ne W information is
confect I B I ti ply ut eri t ordinances ri tat, laws aloud
he b e
authorize ns rcpmscnlauves f N s c it, la enter upon
enter
Wilding construction, andherebyfor
,the property od for inspection p
I
Ne_abo(We)
altroned
(W 1 gme harmless
ra slhnCity fC pertnu
sa dcmxpens
skeeph
t, t. and expenses which y n any y m<agains, said
,tid
CLliabilitiesjudgment,.
City inconsequence of theg t gol'thi permit, '_
APPLICANT UNDERSTANDSAND WILL CO IY WITH ALL \ON INT
5 RCERF
Issued by;
K?
ULAT _ ,yam
Date
togna em,,pponsom -ontraaor - •-' • , Date
'
Re -roofs
HAZARDOUS MATERIA . DISCLOSURE '
Will Ih ppha tin f t m W Id m sew 1 mord, , handl bazallous reeled
is defined by the C.' pert Municipal d Ch pI 9 12 and theHealth and Safety
Cod S cIo 25532(6)
T e of Roof
yp ' ' ` -
-l., s
roofs
shalCbe inspected pnor.to.any roofing. material being installed.-_
NII Ih pploeteto^�wrc Wld'n pa t se egmp t devices which
emit M1 nrdo n as d f by for Bay Arca A Codify Management'
If a roof is installed without first obtaining an'inspection;'I agree tui remove
Dis oY --
- all new materials for inspection.- Applicant understands and will comply with,.
r, .• . .'
1 h d the
all non -point source regulations.. -- -,
I pals requirements under Chapter.695 of the
Calif Tri H hh&Sof tyC 1 Seeder, 25505, 25533 d25534,1understandthe,
if Wt notcurrently h ten Rett re Efrytbnotrfy
...
�
oftheng the
occupy t f the quirtme t which must be met poorm
biiseti s of a Certificate of
_
LZ o2
Sid
a� panrr
_ o
g`21-
3 �(f/�/(/��'�7�
S' azure of A lean[ Date
\
_._ PP .. — -
All roof coverings to be Class "B" or Better'.
naumnn==eageml' ... ; Data
J.
11
is
W
Building Division
10300 Tom Avenue
Cupertino, CA 95014-3255
Telephone: (408)777-3228
Fax: (408) 777-3333
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.
I. 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.
IWORTANT:
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:
Address:
Reroofing Company Name: _ 1 - (,a L
Applicants Signature:
'Joe Antonucci
(Chief Building Official)
6/25/01
P-a'z-02