02100029 CITY OF CUPER'1'INO
ouILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILVI509DR93ARNHART PL CAL-PAC ROOFING PERMITNT2100029
OWNPA891ER RICHARD L JR AND IRMA 36 RAILWAY AVE APPLICAT14W615g 2002
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GNE' 408 874-0784 SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH—
c z 2
p^+00 LICENSEDCONTRACnderp DECLARATION
z F 1 herchy affirm that I em licensed under Previsions of Chapter 9(commencing REROOF lob Description
<� with Scainn]qk)of Division3nl the Business and Professions Cnde,and my license is
< in full forced dial' IN A LE®
Z p z Lice Lic.M &774,2- (- 9 P°'�
O w F Date mcmr
gLFgL ARCI In ECT'g ComDF.CLARA ON
60U I understand my plans shall be used as public records OCT 2 9 2002
LLa. Licensed Prow.,xianal
� « y Oat lam exempt
DECLARATION BUILDING $2s000
1 hereby sfprm that 1 am cxcm t from the Contractor's License Law Inn fee
ad S: following reason.(Section]1131.5,Business end Professions Qslc:Any city or county
s'K S which requires a permit m omsuua,elver,improve,demolish,or repair any suucdre
ad;in prior be its issuance,also requires the applicant for such permit to file a signed statement
.j2< that he is licensed personal to the provisions of the Commons Lia nm Law(Chapter 9 3A1R.ffahbdAl@z0 Valuation
nel-0 (commencing with Section'ngggof Division 3 of the Business and Professions Coade)IIr
that he is exempt therefrom and the basis for B¢alleged exemption.Any violation of
Second 7131.5 by any applicant for a permit subjects the applicant to a civil Penalty ofN-N Occupancy Type
not more man Eve hundred aollam($501307 - INSULATION
❑Lasowner .the pmpeny,o,my.I ployeu orowages r Wei(Sm.70th.Business
will do dm work.and theswemreis not inverted or offered for sale(Sa.]IWd,Business �pyS[ �ng�(�Q
and Professions Crede:The Commctor's Licerne law does not apply to an owner of 602 - ROOF P T W V n LV H l Lns
progeny who builds or improves thereon,and who does such work himself or through his
ownemployas,provided thrtsuch improvements arenotintanaetoroRered formic.If, 603 – ROOF BATTENS
however.the building or improvement is mid withinone purufcompleion,the owner- 604 – ROOF IN-PROGRESS
builder will have the burden burden of ponying that be did not build m improve for purple of
sale.).
❑1.as owner of the property,am exclusively contracting wife licensed contmcmrs to
construct the project(Sec.]1144,Business and Professions Coae:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a comranoord licensed pursuant to the Contractor's
License Law.
❑ l am exempt under Sec. ,B&P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declinations:
1 have and will maintain a Cer ificeu of Consent to self-insure for Worker's Cumpen-
miion,m provided for by Section 3700 of the labor Cade,for the performance of me
work for which this Permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
701 of the labor Code,for the performance of use work for which this permit is issued.
My Workers ns tin/pI�rrdan�omia carrier and Policy number m:
Cartier: Of Policy No.,7 1361- 1-155t,
CERTIFICATE E%EMPfION FROM WORKERS'
COMPENSATION INSURANCE
(Thu section need not be completed if the Permit is forms,hundred dollars(SIM)
or It.,.)
I ceniry that in the performance of the work for which this Permit is issued,I shall not
employ any person in any manner so ra to become subject m be Workers Compensation
Laws of California.Doc
Applicant
NOTICE TO APPLICANT:If after making this Cer ifcam of Exemption,you should
bourne subject to the Worker's Compensation provisions of the labor Code,you must
OO forthwith comply with such provisions or this Permit shall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
[r .�. I herchy affirm met mere is a construction lending agency for the Performance of
Ci the work for which fess permit is issued(Sec.3(N7,CiN,C.)
4 0 Lender's Name
z Lender's Address
U O 1 cenify that I have read this application and state that the above infosnoinn is
D. Fcorrect.l agree to comply with all city and county ordinances and shite laws relating to
V building construction,and hereby amhome mpmsentatives of this city to enter upon the
{iI abovomcntioned property for inspection purposes.
.(We)agree to save.indemnify and kap harsnleas me City of Cupertino against
is faA liabilities,judgments,costs end expenses which may in any way acerae against mid City
V z in consequence of the grading of this Permit. /
^ts APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NO -P NT Issued by:94W�(2� Date o
SOURCE REGULATIONS. ,0 3 j
• Re-roofs
Signature of ApplicaDateHAZARDO
HAZARDOUS ATERIALS DISCLOSURE Type of Roof
Will the applicant or furore bustling e.Cap done or handle Health a dSafrmaterial
as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health end Safety
JDwimrice.Section 15532')'' All roofs shall be inspected prior to any roofing material being installed.
❑Yes QlIpi
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
t?
❑Ye: �-
I have read the hazardous mamrials requirements under Chapmr6.95 of the Califnr
ninllcalth&9maly Qak,Sr+:hons1S545,25533 and 15534.1undemmnd thazlfthc Wilding
do, /�—ry ^/1 �S
dws not earrcmly haw mit is my pomsihilhy to nn dl'y the occup tnl fee L�/� O 'L_
rcgmrcme etnemet norloiss ofacenmcemmr�c�tan Signature of Appficant Date
v s All roof coverings to be Class "B" or better
Owner o euthuriasd• cat Date
Building Division
i. 10300 Torre Avenue
` Cuperdno,CA 95014-3255
Telephone: (408)777-3228
C PEkT'NO F= (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 .
Wand 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 inspectionis 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 V'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: - 7-50 yQL
i
i
Reroofing Company Name: �G��� P
Applicants Signature: Date: ✓0 92, '
Joe Antonucci
(Chief Building Official)
6/25101