02100128 rr
CYTY of CUPEBTINo z;�-
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION."''
BUlll)CX4A3"ESS BLANEY AV LINDY ROOFING CO INC PERMIT N®2100128
OwVABBIIS LAN F AND ANGELA E 5554 HARVARD DR APPLICATIJr�y qp / 2002
Ah
IFHONK: (408) 269-2025 SANITARY NO./ 1 CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MELD
OCZ0 O O
a00 LICENSED CONTRACTOR'S DECLARATION
l Iherebyarfmmtheir Iamlicensed under previsions ofChapter 9(commencing REROOF Job Description
ri,aa with Section AMM))of Division 3 of the Buslneas and Professions Code.and my license is
FO,r, infullfmcand,ffdn FQrt�o����
O Zpz license Class Lic.x IIII @�''I
t- Contractee
CHIlELTS DECLARATION
� �< I understand my plans shall Be used as public records OCT 3 0 200'2
Xp u
X 3 a F licensed Prmessionm
t—LL O� OWNER-BUILDER DECLARATION
aP 1 hereby ullirm that I am exempt from the Contractor's License Law for the BUILDING $10130
00 following reason.(Section 9113 L5,Business and Professions Cook:Any city or county
$ which requires a permit to common,alter,improve,demolish or repair any swesm
Id
r Z< prior(I its issuance,also toquires the appliam for such permit to file a signed statement
that he is licensed pursuant to the provisions(If IN Common's ubense Law(Chapter 9 3Skl9R.]FkS)OAIQl0 Valuation
FFG (commencing with Section 7000)of Division 3 of the Business and Professions Code)it
bat he is exempt Iherefmm and the baso for the alleged exemption.Any violation of
Section 7131.5 by any applicant for a permit subjects the applicant to a civil penalty mf
not mom thanOeeDaraC five hundred dollars pof)(p. 3 07 pN-N INSULATION
Occupancy Type
I,ss owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec. Business 5191 — ROOF
-illy}{
and Professions Code:The Comm uchn's License Law does not apply to an owner of 602 - ROOF POn Y N V nSBC( IO.DS
property who builds or improves thereon,and who does such work himself or through his IVH L
hoemployees,provided that such Improvements anchor intended ororcercd formic.[1. 603 — ROOF BATTENS
wever.the building or improvement is sold within one year of completion,the owner.
builder will have the burden of proving deal he did not build or improve for purpose of 604 — ROOF IN—PROGRESS
sale.).
❑1,as owner of the property,am exclusively contracting with licensed earnestness to
construct the project(Sec.7W,L Business and Professions Code:)The Commuctor's Li.
terse Law does not apply to an owner of property who builds or improves thereon.and
who contras for such projecs with a commucmr(s)licemed pursuant to the Contractor's
License Law.
I am exempt under Sec. ,B&PC for his reason
Owner Das
WORKER'S COMPENSATION DECLARATION
1 herchy affrn under penalty of perjury one of the following dhelarntions:
I have and will maintain a Ceti ficare of Consent to for Worker's Comp,m
7017'�flk)
rion,ca provided for by Section 370()of the Labor Code,for the performance of the
rk for which this pmmf is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
of the lar Code,for the performance of the work for which this permit is issued.
y Worke<r's Co sagtinn lnsuru/��e(arridranit Policy numhemm: __ k_/�[-rL///L Policy No.: sem feat
CERTIFICATE OF EXEMPTION FROM WORKE S'
COMPENSATION INSURANCE
(This acction need not Be completed ifft pmork is forms,hundred dollarso l(M)
,it less.)
1 cattily(but in the performance of the work for which this permit is issued,1 shall net
employ any PrOam in any manner to as to Become subject o the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
Become subject to dee Worker's Compensation provisions of the tabor Codc,you..in
O z forthwith comply with such provisions or this permit shall hd deemed revoked.
z O CONSTRUCTION LENDING AGENCY
I hereby affirm that them is a construction lending agency for the performance of
the work for which this'nort is issued(Sce.3(197,Civ.C.)
Ir LinName
� ,z Undm's Address
V C 1 emoly that 1 have read this application and tinformation il a that the above infoation is
ly F builc,,.ding I agree
nstr w comply with all city and county nNlnantta and sure laws r Pon
e
OU shovengcmnonan!pnand fombyautnonprepresentatives of this city lasneerupon the
r 04 shove-(We)are in save for Inspection keep ha
fy Wc)g ctosave,indemnify and keep harmless dee Cityof ntc against
oagainst
H res inconsequ consequence
of the
gassing expenses which may in any way accord against said City
VZ mconICANTcofDERSTAN of this Permit, I/ (/
�-^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by: Date
SOURCE REGULATIONS.
Re-roofs
HAZARDOUS
Signature of APPlicaDam
IIA2ARDOUS MATERIALS DISCLOSURE Type of Roo(
Will the applicant ter future building sx'cupam tore or handle hararJuua material
as defined by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
Codc,Section 85321x)?
❑YcaN„ All roofs shall be inspected prior to any roofing material being installed.
Will the applicant Or future building neenteno use equipment ordcvjc s which if a roof is installed without firs[obtaining an inspection,I agree to remove
'mit hatiffJOUS air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yo„
c
I have read the haraNOus materials"discounts under Chapter 6.95 ofthe Califon. t
ria Ilcxlth&Safety Code.Scctims 25505,25533 and 255141 umkmand thou if the building
does
Js not currently have a moral othat it is my raftersm ibiliry notify the occupant mf IN Z
mummerv hichmuvhemetprito Risuancenfa rufcateo cuancy Signator IIC Date
Owner ort L ag Date All roof coverings to be Class "B" or better
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
` Telephone: (408)777-3228
CITY40 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 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:
Applicants Signature: T� �/✓ Date:
Joe Antonucci
(Chief Building Official)
6/25101