03010197 a CITY OF CUPEWrINO - a.
a BUILDING DIVISION PERMIT M ,bNTRACTOR INFORMATION a'-,
a BUILDING ADDRESS: LOS GATOS ROOFING PERMITNO.
10388 BONNY DR 01010127
OWNER'S NAME: 1771 SMITH AVE. APPLICATION SUB DATE
DELGADO DAVID A AND PAULA E 01/30/2003
IFONE: (408) 298-9399 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�00 LICENSED CON`RACTOR'S DECLARATION F lb Description
I hereby affirm that I am licensed under provisions mo
of Chapter 9(co
mencing
,=.
with Section 71X10)of Division 3 of dm Business and Professions Cole,and my license is
in full fame and effect. REROOF
zo'gb License Cliffs C 39 I.mtracION« 067 -
oz-, Dow L a Contor - REMOVE SHAKE, INSTALL 7/16"OSB &
ARCHITECPSDECLARAT
Iunderstandmyplans mail the used a30#FELTrpublicrecorda , CERTAINTEE r}��4IDEeNTIAL TL SHINGLE
Licensed cssinnal
Y®�9AL ED
Pntl'
Oat I am exempt
from
DECLARATION
u� 1 verso affirm that 11. cBcmpt from the Contractor's Ca License Law lin the MAR 1 2 2003
O following reason(Section 703 omm guineas and Professions Call;Any city or county
a�$ which requireaapmmit wanes the Ams,improve.tfor such
Permits ore.repair g any
tatement ,
=i< pnnnn its issuance,also
tion to the
thovisiappo s;of for Contractors
License
ic nse signed(Chapin
NOIhot est beinnwJpursuam7000)pmviviomofNeContruessandensclaw(Chapmr9 Sq.F[. Floor Area Valuation
(commencing with Section]IXkI)ofDivision3nfthe BusinessandProfessions CoJe)nr B. ILDIiVG
that 0)te exempt therefrom and the buffs for the alleged exemption.Any violation of
Section]031.5 by any applicant for a permit subjects the applicant to a civil penally of APN Number SO&OftUcy Type
not mom than Bre handled dollars($51)(1).
O I,as owner of Ne papery,or my employees with wage u their sole compensation,
will dothe work,and the structure,is not intended or offered for sude(Sec.7044,Bustnesf Re aired Inspections
and Professions Code:The Contractors License Law does not apply 0o an owner of q p
properly who builds or improves thereon,and whodoesauch work himself or through his
own employees.provided that inch improvements are not intended or offered for side.If. 305 — FRAME
however,Ne building or improvement is sold within one year of completion,Be owner,
builder will have the burden of proving Nal he did not build or improve for purpose of 307 - INSULATION
sate.). 601 - ROOF TEAR OFF
01,as owner of the property,am exclusively contracting with licensed contractors to 602 - ROOF PLYWOOD NAIL
construct Ne project(Sec 7044,Business and Professions Code:)The Contracrors Li.
cense Law does not apply to an owner of property who Wilds or improves Battle,and 603 - ROOF BATTENS
who contreea for such pmjecm with a contractor(s)licensed potential 70 the Conlrwlura'
License Law. 604 - ROOF IN-PROGRESS
E]1 am exempt under Sec. .B&P C for this reason
Owner Dat
WORKER'S COMPENSATION DECLARATION
I hereby af0mr under penalty of pe jury one of the following declarations:
1 have and will mainuia aCenilcam of Consent to self-insurefor Workers Compete
astinn,u provided for by Section 37701 of me Labor Code,for dm performance of me
work for which this permit Related.
1211 haw and will maintain Worker's Compensation Insurance,u required by Section
��l of Ne labor Coda,far Be performance of the work for which Nis permit is issued.
My Workers Compensation Insurance center and Policy number am: n'
Cartier. .S7X77� 6owA PolicyNn.: ZDSZZ7f=nZ
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not M completed if me permit is foronc hundred dollars($101)
or less)
1 certify Nal in the performance of the work for which this Permit is issued.I stall not
employ any person in any manner in as 70 become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cer incane of Exemption,you should
become subject to the Worker's Compensation provisions of the ISMr Calc.you must
OO forthwith comply with such provisions or this permit shall he devoted revoked.
z CONSTRUCTION LENDING AGENCY
[r r I hereby anion Nat Nese is a construction lending agency i or the pmfoorommeof
di > the work for which this permit is iasucd)Sec.30197,Civ.C.)
U 0 Isendcr'1 Namc
z lender's Address
V Q1 certify Neo I have read this application and sum that Ne aMve information is
f+ correct.1 agree to comply with all city and county ordinances and sate laws miming to
O V buildingconsuuelion,andherebyauthons,represenativesofthiscitytoenterUponthe
W above-mentioned property for inspection purposes.
(We)alphe to ave,indemnify and keep harmless the City of Cupertino against
yliabilities,judgments,emu and expenses which may in any way accrue against said City
t„)Z in consequence of the granting of this permit.
�-+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date _/U
SOURCE REG /Z? 03
Re-roofs
Signature of APpicahate
HAZARDOUS
MATERIALS DISCLOSURE Type of Roof
Will me applicant or future building e,Chap r J.1 or handle IRabb ier and Safer l
u defined by the Cupertino Municipal Code,Chapter J.12.and the Ileallh and Safety
Code,Section 35532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes NtNo
Will the applicant of future building occupant use equipment of devices which If a roof is installed without first obtaining an inspection, I agree to remove
it h...miles air condominium u defined by the Bay Arca Ail Quality Management all new materials for inspection.
DimricR
C]Yrs 1)Q4r /7
Ilive&Sidws Che IMaerdnusmaarialsrequiremen534.1 understand Chaptefh.95 ofoe holding /�;(' A J /�O/
ria HcalN&Safety Gxk.Scaitms15W5.4553J end 2533J.1 whyOBat if tlr Mil Jing sJry1�^'1 \ O3
does rot currently hoe a coram,But it is my responsibility w notify the cupen0 of Ne
myuimmenu wh; tpn; issuan nfaceniGcam n�e«lmry./G3 Signature of Applicant Date
Owner ur eulhnriuJ egcnO / Dam All roof coverings to be Class"B" or better
r
Building Division
•, 10300 Tom Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CUPEkTINO 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.
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) Preinspeclion 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 W 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: yr)�I' u 2 f) �A j Q
Address: _ 1G 3
I;eroofmg Company Name: `- s Ga 6S
Applicants Signature: r — Date: J0 3
Joe AntDnucci
(Chief Building Official)
6W101