02100095 CITY OF CUPERTINO T ` ':" '
BUILDING DIVISIIN PERMIT 4CONTRACTOR INFORMATION:
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BUIL1144,94SS BLANEY AV DAVE SMITH ROOFING - PFRMITN(02100095
owNURINO(A FUNG 1052 KELLY DR APPLICATl4"lY'PTT'r/2002
Ak
ZONE. 408 973-9427 SANITARY NO. CONTROL NO.
ARCI IITfiLTIIiNGINEIiR: BUILDING PERMIT INTO
BLDG ELECT PLUMB MUCH
woo LICENSED CONf RACfOR'S DECLARATION -
s u 1 ncmhy arum that I am licensed ender provisions nr cnaPmr 9(mnmmenming ��� Job Description
w<i with Semion]Igkpnl Division 3nf tc Bosincae anJ Pm(cssioCas-CoNc.and myliccneis ROOF
in i(elle Class
and efr 39 S�J ��®
[)are Class Lic.N
=�o Dale_�Q ,-,_�z amDECI OCT 1
ARCIIITECTS DEChA ATION 7 x,002
9 a 1 understand my Tluns shall he used as public records / C
Oyu
LLo s LiccaeJ Pndcssiowl a�-_
f Y
OWNER-BUILDER DECLARATION
Contractors
t�y'C/IVfp L-®1
e IVG
C C 1 wrcby affirm that I am.Burin from the Comms Co License Low Ino the $10500
w a.X O o following reason Permian]xnstru Business and Professions h.Nt:Any city s county
$ which requires a permit m construct,afro,impurve,demolish,or repair any suuemre
ce
prior Or its ismaoce,also requires the applicant for such permit ,file a ngned.slalchenl
Tomfisc m he is licensed pursuant m the provisions oRw Conoactior License Low(Chapte ]r 9 33gSR. W&I3Atmt0 Valuation
m� (commencing with Section 74b)of Divi.sien 3 of the Business wd Prntessinns Cods)Or
y Nat he is exempt thcrtrom and The basis for The alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects de applicant to a civil penalty of
net mom Than me hundred dmlara(s500). 307 PN N INSULATION
Occupancy Type
C3I,azowner of the propcny,o my employees wit wages as their sole compensation.
will do The work,and The sopcture is not intended m offeed for sale Dec.70d.4,Business �q1 g�e�•,k�g]
and Professions Code:The Conovaur's License Law dors not apply to an owner of 6 0 2 - ROOF PM N V rt 1LHi Lns
pmpeny who builds or improves Theater ,and who dors such work himself or through his
wnemployces,provided thatsuch impmvemenuienot intendedoroReredforsaic,If, 603 - ROOF BATTENS
frost me building or improvement is cold within one year of completion.The owner
builder will have line burden or proving That he did not wild or improve for purpose of 604 - ROOF IN-PROGRESS
sale).
❑1,asr of the property,am exclusively convacdng wit licensed contractors to
construct thprojat(Sec.7614.Business and Professions Code:)The Contractor's Li
se law dors not apply to an owner of property who builds or improves themon.and
who coma css for such projects with a conoacmr(s)licensed pursuant to the Commctnr's
Liver.Law.
0 1 am exempt under Sec. .B X P C for This reason
Owner Data
7C13WORKER'S COMPENSATION DECLARATION
1 hereby alfmn under penalty of perjury one of to following declarations:
I hale and will mount a Certificate ofCOnsenun self-insum for Worker'sCllmpco-
ation.az provided for by Section 3]11(1 of line Labor Code,for to performance of the
ork for which tis permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
7")of the labor Code,for tmo pertaance of TheWomic rk for which this Pert i.s issued.
y Worker's Compensation Insurance cameo and Policmumbo,arcarrico - Policy Na: It2�(p6,t—L
CERTIFICATE,OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be comPletcd if'a permit is Ga one hundred dollars($lap
less.)
1 certify that in the perfimmanee or the work Iia which This permit is issued.1 shall not
employ any person in any manner m at to wcomc subject to the Workers Compensation
Laws of California.Dole
Applicant
NOTICE TO APPLICANT:IL after making this Ccnificam of Exemption,you should
become subject to the workers Compensation provisions of the Labor Coi you mast
OO forthwith comply with such provisions nr this perm it shall w deemed revoked.
ZN CONSTRUCT]ON LEN DING AGENCY
PI hereby affirm That tem is a construction lending agency I or The Performance of
Ri he work far which this Permit is issued(See YN'.Civ.C)
131 Q Lenders Nam.
6. Lenders Address
,Z
U 0 1 cenify That 1 have read this application and some that the above information is
l!. H correct.1 agree to comply with all city and County Ordinances and some laws relating m
0 wilding c...Maion,and hemhy muton a rep¢untmives Of tis city to enter upon the
ill
above mentioned
eriproperty
cost for inspection which ma
H LL (WO agree to save,indemnify and keep harmlees the City of Cupertino against
TA liabilities.judgmif The mmg expenses thispeand. may in any way active against mid City / 1
U �onmyucncc of the griming Of this PCrmio.
'•-� APP NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SO CE ,GULATIONS.
.g t n APPrmanvcnntmetnr UyI 'Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Date Type of Roof
Will to applicant nr lalum building occupant stere or handle harardom material
az defin.d by tc Cupertinn Municipal Code.Chapter 9.12,and the Dearth and Safety
Code.Semen 255321a)2
p res �NO All roofs shall be inspected prior to any roofing material being installed.
Will thea scant nr Marc building Occupant quirt If a roof is installed without first obtaining an inspection,I agree to remove
Pp 6 pant see equipment or devices Management
g p g
emir w,aNnus air tttmaminants as J.IincJ by the nay Arca Air Quality Management all new materials for inspection.
District'
p
Yew C1 NO
I have read the M1amNOusmamfiuls requirements under Chapter 6.95 of tc Calif.,
ng
dosnotc&entlyyhaw aTttdnns2atitis yMe33 Tw25534.1aility ndotify the
md The cupied Of or,
does not currently MuSL he met That it ismyrce Oft Cieitymnoor tw ar'uPant of tc
`�'Imre '')whminn,eslMmetPnnrtnismmnmeerac.mrmaenfaeaPmncy Signature of Applicant Date
1G-I )—a7
ownurur aetnn,edagcal Dale All roof coverings to be Class "B"or better
Budding Division '
10300 Tore Avenue
4
&CITYO
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Fax: (408)777-3333
.CUPEkTINO
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: L f 3.z FF
Address:
Reroofing Company Name:
Applicants Signature: _ Date:'
Joe Antonucci
(Chief Building Official)
6/25/01