02090160 TINO
CITYBUILDING DIIVIISIONPERMIT CONTRACTOR INFORMATION:
fidt'§V°L�PP;�2VER DR SUPERIOR ROOFING CO. PERMIbN2090160
ft,fftNftEW 421 BURGOYNE STAPPL141�Pf l99`y-002
PHONE:
(650) 969-3103 SANITARY N0. CONTROL NO.
w ted.O ARCHITECT/ENGINEER: M BUILDING PERMIT INTO
CC BLDG ELECT PLUMB MECH
0�L E LICENSED CONTRACTOR'S DECLARATIOP r 1 , �R•E�R�OOF Job Description
O Z- I hereby )of Nal I nm licensedseiner provisions of Chad 9 commen<in
Fy Fw with full Section7000)Psct.ision lof Ne Business and Pmfeszinns Codc.anJ mylicense
Raia E� is in full force�andTfrc�c (r(,�
c O rc U License Csn Lic,p �'}-
3 Date DECLARATION IO a SEP
ARCHITECT'S DECLARATION
1 umbe omd my plans shall be used as public records 2 7 2002
a ca O Lwcnud Prolcsvoml
� OWNER-BUILDER DECLARATION RATION 11 j
1 hemby.(firm that 11. exempt from the Cocoons Co License Law for the U�LDlfVG $5500
fallowing reason(Section]031.5.Businessland Professions CWc:Any city areaway .V
to D which requires a permit m ennewe ulmt improve,demolish,ore a signed
ig any ffinaum
a. P non ane al rcy N pplicardforsuch.fthe C.a pester is L Jswomem
fled,he I nwit pd tett dk prb sons of the Contrxlol L (Chaper9 _ "-
fro b, 'th5 t ]WO)sfD'vs°nJoftheBusineu tdP fess onsCoaej 'aa O reag•y- f A ,. "Valuation
or that he to esem pi therefrom and she vans for the alleged exemption.Any violation
I' - {"1 i" } s+ ;}]
of S.e1aM 703 LS'bpany applicabt for a permit subjects the applicant m a civil permit,"
of not more Non five M1unJred do art(as(n). Occupancy Type
❑I,as owner of the property,or my employees with wage:as their aide corn,easmion, 307 - INSULATION
will do the work,and he struMam is not intended or offered for sale(Sec.7044:
'Business et;it Professions Code:The Contractor's License Law docs not apply to an
owner of property Who builds or improves thereon,and who does such work himself 602 - ROOF PLY e is cions '"'
or through his own employees.provided that such improvements on,not intended or
uR red F61 sale.ICho the building p vement is arid w N�one yem or '--' -'-6 0'3 -'--ROOF-'-BATTENS -- ------ ___
completion,the owneb liter will have me burden ofMoving that hedid not Wild or
Imp forp 604 - ROOF IN-PROGRESSO
purpose of'.1c.),1 ).
.. usivelc...-___...__tomo
coLaetthe of n, ,Businiss .__..._._._. .__....._.__..____._._._._..._____.__ _.
- _ propsay. exclusively with licensed conracmrsm t 2i.1! .s )
connrvet the project(Sea]no Business prop Professions Codep The Commuchor's
nomr,
License law tact not apply to an owner of property who) hoseor improves t to do, ).B
._opd_wctor's icer ,Law. projects wah.n.conlmaurtsl Iittmesl pursuant to Ne
-.: CommnolsLc<nwL toot. toot.._.___._ ._ toot.moot moot __ _ _ __. __.__— . ._.__.__.. ._.
❑lamacmpt underScc" B&PCfor this
reason sUi c , 1
Date
WORKERS COMPENSATION DECLARATION
Ih ny Rom d pe airy of pcjury of the following declaratiatiV
'. / ` and Ill' is t Cenif to t C stet to 1f rker's
fm Wo
C1 hom« t s powided far by Section 37W of the Labor Cade, for the
_ _ _ Inrromwn«or mdwnd,oar wrier Nit K"r�t ct iat,ea.
❑1 ban and will inaircum Worker',Co p t ' I saranc yulred by Section
37W of ih 'Labor Code,f 'h'piefoomance of me work for which this permit is
issued MY W A .C pe 5 t 1 ;u a c - and Policy he are
Cam Tg'L..n,/i /iti Pnh N r.Gr( YY - S -
toot_. -_ .�,:.....,...W..........-.
,'CEItTIFICAUUN OF EXtairi JUN FROM.WORRER$ Y,t I(k s 1?.-3� �f rt 1,;' rs„ �s t A ! `' ` .91
COMPENSATION INSURANCE', ...ae
-,.._r s- ,._r...:-toot_.. _._ tomo _. toot_ ..._
g: J .__ ......e
(Th' tin J' lbe c'umpineddthe print nfor ane hutNrtd dollars I
fv
Anil It eml h,i theprim 1Ne k for which this pe ,tit iss. ed 1 tomo ..
P Y y Pe man Joanne,oi a,to heron a subject m the Worker
Compensmmn'Laws at CaliforM&Dae -
_.APPlicnnt'. `
NOTICEIOAPPLIC NT If, fI iU C mf t orE pt you should - - - - - - - '
_ .. .. ._ moot._. _ . .._
Z income subject the Worker'sC ions t p of theL bor Cnd you s, •` " s " u F-' '-
zforth lh mp1,with eh p s ons o th s K not shall be deem ed mvok d.
CONSTRUCTION LENDING AGENCY
a. I h by firm that theor
" s.n.v�m�ato1._ do-g.agency. finite"p "fomaaof Ne ch h permit s siud(Sec led].6sC)Ld oaName,
`-' - -
Isndcr 2 AJdrevs�.
..❑i7r : . :
.1 certify tI have lead Nis appllemion ant that the above informalon is
<�irrect 1 agree ino c comply:with all city sand county ordinances
unc<s and tote I,wx relating
2� U to Wildingconswction.and hercbyewhoneerepra t,. fives nrthif city menmr upon
rkl the ubo(We)6gionea pmpcInkamfar ify and
dkepItI
y inr IWe)dgrcerosave.Indemnify and keep harmless the City of Cupenino'agaimt
Vi li fits . ents mqs anJ expenses whicM1 may in any way arcane against c id
.U.� ry 9 cotheg bf)th.pc n t
S Il C\h7 DP nYkANDSANDWILL COMPLY
WITH L ubI.\'f' ' Issued��� /°Z y Date
' rc.f AppEcaMUCo t ( Dao.,. Re-roofs
W
sf \ HAZARDOUS MATERIALS DISCLOS
11 Ne aypl ca t or pubWilding«<W t tom or handle
hautolim,material T e.Of Roof.
as defined by theCupen Al Pal Cod Chapter 9 12 d d H dth and Sart, yp
Cad S t n255J (a) �./ ! . . ...._.......v._.��.....
❑Y ' a \., dam,,, .J' 7s'.i-ii! y l sA I.r\3,. IlA if ll.l lla 'rr t :I
. . _All roofs shall be inspected prior to.any roofing_material being Installed.___-_... ,.
s'
11.W 11 th applicant fuw e building« p tequipment devices wh ch .r.
'Mir h a m cote t defined by'heBay A Ali. QualityM .tic nt If a roof is installed without first obtaining an'inspecnonA agree to'remove
°""" all new materials for,inspection. Applicant understands and will comply with _
•r Ors -... _ pp
all non-point source regulations ' ' '
1 h e r d'he
if not hfhada'.Materials
ateal requirements
t P mer ntso ndantter CCa a Health k Safety
Code. hofca a C,3c6,m9�5 coaaft he
to,bo J C d Sect on25505 5533 and 25530 Iunderstand Nft
m y have a tenant thI ty t mini the
Occ p t f r w hwhmuablm
)
-
- p`LliicLaan�t
signature Of ....
Date..._ tomo
r °`oath"dma,g ' Dae All roof coverings to be Class "B" or better -
OFFICE_
toot.-
Building Division
10300 Tom Avenue
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 Y"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: A E7 7- f3 L
Address: 105-90 6 j2VII-7Z
Reroofing Company Name: Sv�v7Lio2 112ao%„vim CO _
Applicants Signature: Date: 1?12�1)° I
Joe Antonucci
(Chief Building Official)
6/25101