02100103 CITY OF CUPERTINO
DUILDINIG DIVISION PERMIT .CON,TRkCTORiiNtORMAT-tijN:,,—
BUII9DN67AD8bAZINGWOOD AV PRESTIGE ROOFING PERMIT NO 2100103
owORDROKAK TERRY R AND CAROLYN 725 MIRAMAR APPLICATT"05yE1D02002
or1ONF.: (408) 268-8003 SANITARY NO. CONTROL NO.
ARCHITECTENCINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MP.CH
�00 LICENSED CONTRACTOR'S DECLARATION �ry�tt�,
F I hereby affirm Nal I am licensed under previsions of Chapter 9(commencing REROOF FINALP1C
with Section"'Y'ofoivisi..n 3 of the Business and Professions Cute,and my license is
in fullfm ride cl-
='aa `I"" I`'" OCT 2 8 2002
Ddle C INCI 1
ARCf11TE S ATION
I
understa my Planatud� s u toad.
LLo Lice dpmfurimnal ^� BUILDING
)OWNER-BUILDER DECLARATION
Y <I 1 hereby allund that I am exempt from the Contractor's License Law for[be 5 O O(]
00 following mason.(Section](131.5.Business and Professions Code:Any city Or county
$C! which requires a permit Of construct,after,improve,demolish,or repair any structure
Fiy prior to its uniform.alto(esliires the applicant for such permiuo rile a signed statement
x< that he is licensedpursuanttotheprovisionsOftheContmctor''sLicenseLaw(Chapter9 3*92MdogAlafl Valuation
FO (commencing with Section 7000)of Division 3 of the B usiness and Professions Cole)or
y $
that he is exempt lhemfrom and the basis for Ne alleged exemption.Any violation of
Sacuon 7031.5 by arty applicant for a Permit subjects the applicant to a civil penalty ofp�N Occupancy Type
ml mote than five hundred dollars(s3110). 307 - INSULATION
❑ Less.,of Ne Property.0,.YemPloycca with wagesas dpirsolecompermatu ,
will do the work,and the slrunute is notimended oroffered forsale(Sm.7040,Business
and Profession'
m
Code:The Communes License Law dma not apply to an owner of 602 - ROOF P nRjkefitns
property who buildsor improves thereon,and who door such work himself or through his
Own employees,prodded Net such improvements are not intended oroBered for sale.If. 603 — ROOF BATTENS
however,the building or Improvement is said within one year of completion,Ne owner- 604 — ROOF IN-PROGRESS
builder will have Ne humen of proving Nat he did not build or improve for purpose of
sale.).
❑1.as Owner of IM property,am exclusively contracting with licensed co ers mors to
construct the project(Sec.7044,eusimss and Professions CWc:)The Contractor's Li-
cense Taw dims not apply to an Owner of property who Wilds or impntru themon,and
who contracts for such projecb with a contractor(,)licensed pursuant to the Contractor's
License Law.
I am exemp nder Sec. .B&P C for Nis reason
Ow rip/ pate
x
.F=7 ER'S COM ENSA ON T�t.AYkl'ION
thereby aRrm under penury of perjury ons of following declarations:
I have and will maintain a Ceri ficete of Consent o self-insure for Worker's Camper.
station,es provided for by Section 3701 of the Labor Code,for the Performance of the
work far which Nis pc(mit is issued.
01 have and will maintain Worker's Compensation Insurance,as required by Section
31M of the labor Cole,for the performance of the work for which this Permit is issued.
My Worker's panallinn Into ceca "rand Policy numbers
Policy NO.: _
CERT I'1CATE OF EXEM ON FROM WORKERS'
l/ COMPENSATION INSURANCE
ohisseedon need not becompleted fine Parmit a formic hundred dollars($10)
or less.)
1 cenify Nat is the41�11]qnante of this work for which this permit is issued,l shall not
employ any parson itaa7fsrmannerso as
to Masmegghjeat mlhc Workers'Compensation
Laws of California.Data VV s
Applicant
N�IC/�/dr'�0 APPLICANT:If,of r aking this cnilicate of Caemphun,you s null
hecp�efObject m the Worker's C pensation provisions of the Labra CnJe,you muss
OO fort wificomply with such provisions or NisPermit shall he deemed revoked.
z h CONSTRUCTION LENDING AGENCY
[-+ Ihereby allion Nn there is a construction lending agency for the performance Of
�. > the work fur which this Permit is issued(Sec.3897,CO,C.)
6Wi 0 Lenders N.
z Lender's Address
U O I cenify that I have read this application and state that the above information is
V. P correct,l agree to comply with all city and county Ordinances and state laws relating to
DU building construction,and hurehy amhonal represenunives of Nis If iy hs enter upon the
move-mentioned property for inspection purposes.
kk. (We)agree to neve,indemnify and keep harmless the City of Cupertino against
f0 liabilities,judgments,costs and expenses which may in my way accrue against said City
U in consequence of the granting of this Permit.
APPLICANT UNDERSTANDS AN ILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REATP ATIONS. r
Re-roofs
ignamrc of Applica130 nocouARDOUS MATERIALS DISCLOSURE Dctc Type Of ROOF
Will the applicant of future building Occupant store or handle hanNuus mateual
as defined by the Cupanino Municipal Code.Chapter,9.12,and the Health and Safely
Code,ovf5 2553260? Nn All roofs shall be inspected prior to any roofing material being installed.
Will the appticantor�building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit If
air commandants as defined by the Bay Area Air Quality Management all new materials for inspection.
District'/
❑Yes
Ihave&Safet Node,S"ll nt 25%5,n533mmenu under understand
of the C.IWit ary �� r �� O^
doesOuth&Safay haves,amonnsortiti,25573 and 35534.1unMrsundeoccup buof l
does not currently have a amount Naz it is myy responsibility dfy IM mcupmt of N /f
reyuimm ,which muss hum prim to issV, Ofd Cenifreateo ' ancy' Signature of Appl' nt \// Date
wnmmaamn agent D{ All roof coverings to be Class/"B" or better
Binding Division '
10300 Tose Avenue
Cupertino,CA 95014-3255
` Telephone: (408)777-3228
p Fax: (408)777-3333
CUPERTINO
Building Depaeut
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.
S. 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 Vi"per foot slope and demonstrate that
there is no ponding.
2. AnI.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: v,
Address: OLZtL40 (.4
Reroofing Company Name: . • - Cc:
Applicants Signature: {e;
Joe Antonucci
(Chief Building Official)
6MI01