02100051 CITY OF CUPER'I'INO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
5
ml8l8f8)DIBR0OKGROVE LA COSMOS ROOFING PERMITNT2100051
"w"URRIY HELEN C TRUSTEE 1901 OLD MIDDLEFIELD WY APPLICATIJrtF"ATP 2002
IONS: 415 4 93-6 3 73 SANITARY NO. CONTROL NO,
ARCHITECTIENOINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�00 LICENSED CONTRACTOR'S DECLARATION
I hereby afford that 1 am licensed under provisions of Chapter 9(commencing lob Description
�z1 with Section 71XXoof Df,oo..Sol the Bmirootind Profcssiona Code.and my lice..¢is REROOF �"'��"a4LE®
tQ in full force and c
H'n� LILCn. CIr R Lic.M
°Z— Dow Contract.,
ARCIi1TEC`S DECLA TION
I mullocsand try ptons shot]h cold as public record., OCT 2 3 2002
0
F�p� Licensed Pmfcssinnal R'1 I
OWNER-BUILDBR DECLARATION BUIL.DINf-�355
1 hereby affirm that I am exempt from the Conuauors License Law for the
a—00 following reason.(Section 703I.S,Business and Professions Codn:Any city or county
$ which requites a permit to construct,alter,improve,demolish,or repair any structure
'a prior o its issuance,also requires the applicant for such perent to rile a signed statement
£=£Zxx<
that he is license)pursuant to the provisions of the Contractor's License Law(Chapter 9 Valuation
Kf $ (commencing with Section 7")of Division 3 of the Business and Professions Code)or
— that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for apermidsubjecsa the applicant to a civil Nulty ofAtN Occupancy Type
not more than rive hundred dollen(55tH). 307 — INSULATION
D I,as mencroftheproperty,or myempdnyces wish wages as their sole compensation,
will do the work,and the str.cmm is not intended.,offcmd torah,(Sec.7044,Business Opf�yr
and Professions Code:The Conu be ori License Law docs not apply to an owner of 602 — ROOF Pr T 1V V
pmpenywno Wilds orimpowes thereon,and who doessuch work himselfor through his
own employees,provided that such improvements are not intended or offered forsale.If, 603 — ROOF BATTENS
however,the building or Improvement is sold within one year ofcompletion,the owmn 6O4 — ROOF IN-PROGRESS
builder will have the burden of proving Nat he did not Wild or improve for purpose of
side.).
0 1,as owner of the property,am exclusively convecting with licensed contractors to
consumes he project(Sec.70a4,Business and professions Code:)The Contractor's Li-
comem Law does not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a commcwrfs)licensed pursuant to the Contractor's
License Law.
0 1 am exempt under Sec. .B&P C for this mason
Owner Da
WORKER'S COMPENSATION DECLARATION
1 hereby atrrm under penalty of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent to sblBinsure for Worker's Compete
same,as provided for by Section 3700 of the Labor Code,for the performance of Ibe
work for which this permit is iuucJ.
I haw:and will maintain Worker's Compensation Insurance.ns required by Section
7 of the labor Code,for Ne performance of the wad for which this permit is issued.
Camber art
My'errkcr's C cC c xd� Pol cY No num -0/-1( V
CERTIFICATE PEXEMPION FROMWORKERS'
COMPENSATION INSURANCE
Cous section need not be completed ifthe permit is furore hundred dollars(f 100)
,it 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 m ss to Mc.me subject o the Workout:Compensation
laws of Celifnmia.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
OO forshwith comply with such provisions m this permit shall he deemed revoked.
z CONSTRUCTION LENDING AGENCY
[r4 h hereby affirm that them is a construction lending agency for the performance of
94 the work for which this permit is issued(Sec.)IPA,Civ.C.)
W� Lancia',Name
z Lendcr'x Address
V Q 1 comfy that 1 have Mad this application and sum that the ataw information is
Iy correct.I agree to comply with all city and county on inences and auto laws relating to
OV building conswuion,and hereby and i MinicloWtivesOfUnix o4yu,enter uponthe
W ahnvomentioned propeny for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cuporlino against
E lisbihitics.judgments.casts and expenses which may in any way ammc against said City x
V in his XTOOL.
APPLICANT UNDERSTANDSof the granting Of IAND WILL COMPLY WITH ALL N N POINT Issued by: Date rU
SOURCE REGULATIONS.
Re-roofs
Signature o(ApplicanUContractor Date
IIAZARDOU MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building.ccupam store or handle hvuNous material
as definetl by she Cupeninn Municipal Code,Chapter 9.12.and the Health and Safety
❑tea
atlas Seeinr 2ss32(a)7 R''I All roofs shall be inspected prior to any roofing material being installed.
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
Iders
mit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
DYms {LNC
I haverood!the havardous materials region¢.u under Chapter 6.95 of the Califon
ia Health&Safely Qvle,Scctions25A)5,25577 and 2SS74.1 understood Nmifthc building /Y /s Z,
not currently haw a refund.Nut it is my responsibility w unify the rccupant of thev Vquimmc muvhcmclpri oissuanaofacinifwac.fQcup ey. Signature ofApp 'cant Date
wnemambori, seg Date Ti All roof coverings to be Class "B"or better
Building Division '
10300 Tose Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CUPERTINO 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) 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 74"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: alLl >
Address:
Reroofing Company Name:
Applicants Signature: �• , Date: �a 7 0 Z
Joe Antonucci
(Chief Building Official)
6/25/01