02120028 CI BUIOF G DIVISION
IV SiONND CONTRr1CT0R INFOkkXTT,ON:
PERMIT , h
pUIL rsBRITTANY CT PERMIT N(02120025
QAWRAOKLIN P LEE APPLICATIgiNgy 2002
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TONG: SANITARY NO.// vv // CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
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One,
LICENSED LICENSED CONTRACTOR'S DECLARATION U Job Description
I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing p
with Section 9agp.f Division3 of the Buesssinnd Professions Crude,and my license is REROOF
�� in fullferccanJ rf 62-& S tr T/O WOOD SHAKE, INSTALL 1/2 CDX PLYWOOD &
ZO{'�� License Cl Lic.
cyF� Dam C;mac or o 40 YR. COMP. CONTRACTOR: LEGACY ROOFING
ARCIIITECI'S DF, ATION
gal 1 understand my plans Nall he used as public records
n OR!U
LLO Licensed Pmfessianal
OWNER-BUILDER DECLARATION
rcI I hereby affirm that 1 am exempt from the Contmemes License Law for the
t600 following reason.(Section 7031.5,Businessand Prnfemions Code:Any city or county
on$� which requires a permit to construct,alter,improve,demolish,or repair any structure
vis to ice issuance,also requires the applicant for such permit to rile a signed statement
Iq-ss< that he isIi...dpimuunttothe provisions ofthe ConlractoO,Lin a.Law(Chapter 9 Sq. Ft. Floor Area $6WI[htion
y'+FO (commencing with Section7000 of Division 3 of the Business and Professions Code)or
$ that he is exempt therefrom and the basis for dm alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of 3 b1VpWPll9WRP Occupancy Type
.at more than five hundred della.(5500).
El I,as owner of the property,or my employees with wages M their sole compensation,
will do Ne work,and the structure is not intended or offered formic(See 9044,Business —
and Professions Code:The Cimanclor'a License law it.OR apply to an owner of 307 - INSULAM*ed Inspections
progeny who builds orimproves thereon,and who doessuch work himself or through his
mvn employees.provided that such improvements arc nor imitated or offered for sale.If. 601 — ROOF TEAR OFF
however,the building or improvement is sold within one year of completion,the manor-
builder will ban this,burden ofpmyingthat hedid not Wild orimprovefor purposeof 602 - ROOF PLYWOOD NAIL
"It')' 603 - ROOF BATTENS
01.as owner of me property,am exclusively contracting with licensed contractorsto 604 - ROOF IN-PROGRESS
construct the project(Sec.704,1.Business and Professions Code:)The Commerce's Li.
cense Taw does not apply to an owner of property who Wilds or improves thereon,and
who contacts for such projects with a contracmr(s)licensed pu.mnt in me Contractor's
License Law.
❑I am exempt under Sec. .B k P C for this recon
Owner Date t�
WORKER'S COMPENSATION DECLARATION p
I hereby affirm under penalty of perjury one of the following declarations: t'r E B 112003
3
1 have and will maintain a Cerifica,of Consent o self-insure for Worker's Compere
soden,as provided for by Secdnn 3)p0 of me 4Wr Code,far the peRormance of me
work for which this permit is issued. BUILDING
1 hale and will maintain Worker'sCompettull Insurance,as required by Section
37W of me Labor Crude,for the performance of the work for which this permit is issued.
My Worker's Somaensatien Inamace carrier and Policy n//Iyy//�g�b,esst��a�rt����v a.t
Ca r: AQ/7,,,2dl SNS Policy Ng7�/3d 7
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thissection needoat McompletediftW pemailisforonchundreddollars(Sllgq
less.)
1 certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner an as to hecome subject to the Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making mis Certificate of Exemption,you should
become subject to the Worker's Compensation previsions of the labor Cole,you must
OO forthwith comply with such pmvisinns or this permit shall W deemed revoked.
z i;nCONSTRUCTION LENDING AGENCY
[-+ I hereby apiren mat there is a conslmnion lending agency lar the performance of
ai the work fur which this permit is issued(Sec.301)1 Cie C.)
Q Lender's Namc
z Lender's Address
(�QI cenify Out 1 ban read this application and sum that the above information is
correct.I agree to comply with all city and county ordinances and sum laws relating to
Ubuilding construction,and hereby aurhoriw representatives of this city to enter upon the
U.1 above-mentioned property for inspection purposes.
(We)agree to save,indemnify and scup harmless me City of Cupertino against
y Iiabiloses,judgments,of the nrsing of this Ps
mit. they to any way accrue against aid City
U z tAnPPL'cy cnUNDERSTANDStAND WILL COMPLY WITH ALL NO N-P INT Issued by:S4(70H Date
SOU EGULATI NS.
IZ b�° Re-roofs
ignamre of Applicant/Con oor Da
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hvaNaus material
as defined by the Cupertino Muni-pal Code.Chapter 9.12 and the Health and Safety
Code,Section 3553](.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes o
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
emit haanNnus.i,contandim s a�defined by the Bay Area Air Quality Management all new to 'als for inspection.
District? m/
❑Yes Nu
Ihavemudmehammou.materials requirements under Chapter 6,95 of me Califon !2
ma llcalth SafetyCook,Sections 8515,35533 vW25534.1 undersmnd motif the building
does o rarely haze a tenant.mat it ix my rtaponsi ily to notify IM scup I of me
requ' cnrwhicyyuslWmel prianoissuanccnfa Cc ate rlkeupan gnature of Applicant aIC
T ✓� I d e
seer or aumontea agent a All roof coverings to be Class"B" or better
Building Division '
10300 Torre Avenue
Cupertino,CA 950143255
Telephone: (408)777-3228
I Pax: (408)777-3333
CUPEkT1N0
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)
pproval3) 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: —FAN V , . P Le-e_
Address: - IO q2- Lf (�llesrnar�5 CQ2.
Reroofing Company Name: LDr-\act, Repflrib
Applicants Signature: Fuz l v Date: �o?z'
..9
Joe Antonucci
(Chief Building Official)
6/25/01