02100164 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRAsCTOWINFORMATIOW
Bu11D0o640EsZTASTINE AV TERESA & JAMES CHAPMAN PERMIT N02100164
GwgFM&SA & JAMES CHAPMAN APPLICATPn1
(„EZD3Tg2002
SANITARY NO. ` CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
= (� 0 t=
�00 LICENSED CONTRACTOR'S DECLARATION lob Description
s ty 1 hereby affirm that l am licensed worker provisions of Chapter 9(commencing REROOF p
with Section 7fXXq wf Division Sof the Bwore r mul PwIcsswm Code,and my license is
W. in full fo¢and effect.,zVVLicense Class 0 ” Dam Contractor C IN
A LE®
F=
ARCHITECTS DECLARATION q ']
0 U IundcrsmnJ my plans shall Mused as public rccnNe MAR 3 L�OJ
FLLO� Licensed Professional
qygOWNER-BUILDER DECLARATION
Fiy d li<f I hereby a1Tren that I am exempt from the Contract...a License Law for the BUILDING $4841
t Sa p O following reason.(Section 7031.5.Business and Professions Cndc:Any city or cnumy
a<$(L which requires a permit to construct,after.improve,demolish.or repair any structure
WZT pnW In its issuance,also requires the applicant for such permit to file a signed mammcnl
that he is licensed pursuant to the pfnvisiens of she Contractor's License law(Cha trio 3Sk16At31FJ1�3'7 Al@Q Valuation
(commencing with Section 71100)of Division 3 of she Business and Professions Code)or
Nat M is exempt therefrom and the buis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of PN NUME Occupancy Type
net more than five hundred dollars(550)7. 3 07 — INSULATION
Q I,as owner of the property.or my employees with wages as their sole compensation,
will do Ne work,and the stremure is not intended or offered for Ile(Sec.7W,Business
and Professions Code:The Contraclors License Law does not apply to an owner of 602 - ROOF PL
nfMeltiLons
property who builds or improves thereon,and who does such work himself or Borough his
own employers provided that uch Improvements are not intended or offered fors ale.If. 603 — ROOF BATTENS
however,the building or improvement is sold within one year of completion.the owner. 604 — ROOF IN-PROGRESS
builder will have she burden of proving that he did not build or improve for purpose of
sale.).
Q 1,as owner of the property,am exclusively commuting with licensed contractors to
construct the project(Sec.7M,Business and Professions Code:)no Contractors Li.
cense Law does not apply to an owner of property who Wilds or improves mewed.and
who contracts for such projects with a conlractorfsJ licensed pursuant In IM Contractor's
II
1nce Law.
am cxcmpl�cr gee. ,B&P C far
�this
�rc�ssogn
Own DIUTION nI tl_r�
WORKER'S COMPENSATION DECLARATION �l r
1 her by affirm under penalty of perjury one of IM following declarations:
I have and will maintain a Certificate of Consent to ulginsum for Workers Compete
station,as provided for by Section 3700 of the Lahnr Code,for the performance of the
work for which this permit is issued.
Q 1 have and will maintain Workers Compensation Insurance,u required by Section
3711)of the Labor Code,for theAmann ur r of the work for which this permit is issued.
My Worker's Compcnsatinn Insurance carrier and Pal icy number are:
Cartier: Policy No.: _
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thisscooprecd nosMcompleted ifIM permit isfnrnnehundreddollars( INd .
it,lass.)
1 comfy that in the performance of dm work for which was permit is issued,1 shell not
employ any Noted in ;stoma sm time subject the Workers'Compensation
Laws of California, tr
Applicao
NOTICr O APP IC :If,after making this Ceri fica ,of Exemption,you should
became sobject he Workers Compensation provisions of the Labor Code,you must
OO forthwith comply with such provisions or this permil shall M deemed revoked.
z .^ CONSTRUCTION LENDING AGENCY
No
[—I 1 hereby affirm that there is a construction lending agency for Ne performance of
Cil me work fur which this womil is issued(See.3097,Civ.C.)
UJQ Lender's Name
z Lcnder's Address777���-----
V 0 1 btnee that 1 have mad this application and nam that and
above information nelatiun is
I. U building l agree we comply with all city and county consumers of and stem laws relating a
L)TJ abovengbotioned property
hereby audience representatives tivcs of Nike cirymcnmrupon the
Its
above-mentioned gree a aw for inspection add keep hie
(We)egmc to cast,indemnify end keep harmless the yes of mCupertino id Ctagainst
h inewties,judgme mecausing expenses which may in anyway ettme against said City
tj 7 APPLIC colo-RSTANDS this permit.
•7 APPLIC NORSTANDS AND WILL COMPLY WITH ALL NON POINT Issued by:94Date
SOUR 0 S.
°2; d'Re-roofs
amre of ApplicanUCuntr'O Uadt
HAZARDOUS MATERIALS DISCLOSURE Type of ROOF
Will the applicant or forum building occupant snore or handle harardous meted)
as defined by she Ca nano Municipal Code,Chapter 9.12,and the Health and Safety
Cngc,Scoot 25512(x)'! All roofs shall be inspected prior to any roofing material being installed.
Q Yes it
Will the applicant of Nturc building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hasardnus sir mountaineers as defined by the Bay Arca Air Quality Management all new materials for Inspection.
District]
QYes lot,
Harm WBoe hvsNnusma¢rials reyviamenb under Chapter6.93of me Califnr. //
ria Realm et Code'.does 25505,25533 and 8334.ImIJatsmnd Bos ifthc Wilding
is Does nun rA
have a mound,than it is my rap risibility m nattily ten cecupam of me /
rc c ustMmelpriormismaneeofacIII aroccupancy. S' nature of Applicant Date
own miumarized cm Dade All roof coverings to be Class "B" or better
Building Division '
10300 Toile Avenue
Cuperdna CA 950143255
' Telephone: (408)777-3228
Oc 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 musthave a minimum.of V"per foot slope and demonstrate that
there is no ponding.
2. An M.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.
HomeownersName:Xca t_irq,oy,g,�
Address:Jl /oG •o G9' sn.�� A%
PeroofingCompanyName;,-4/ SF-LF
Applicants Signatd�q Dag Z� a Z
Joe Antonucci
(Chief Building OfEW)
6W/Oi
,
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family(parent,spouse or child) will perform:
A. All the work authorized by this permit
B. _ A portion of the work
C. _ None of the work
If B or C is checked,complete 2 or 3 below. OCT 2 3 ZOOZ
2. A state licensed contractor will be hired to do:
By
A. _ All of the work
B. _ A portion of the work(complete section below)
Contractor Address/City Phone # State License # Type of work to
be performed
. 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer(see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder
Address: In/foormG/atoio](rev#erse *
Property Own s Signatur Date / 0 2Job
Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build_
,� Department.
alAl
City of Cupertino Building Departmal
CITY OF 10300 Torre Aven
C U P E IST I N 0 Phone: (408)777-3228
Dear Property Owner:
An apocation for a building permit has been submitted in your name listing yourself as the builder of
the property'improvements specified.
For your protection you should be aware that as owner-builder you are the responsible party of record
on such a permit. Building permits are not required to be signed by property owners unless they are
personally performing their own work. If your work is being performed by someone other than yourself, you
may protect yourself from possible liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a
business license from the city or county. They are also required by law to put their license number on all
permits for which they apply.
If you plan to do your own work,with the exception of various trades that you plan to subcontract,you
should be aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family,and the work
(including materials and other costs) is$200 or more for the entire project,and such persons are not licensed as
contractors or subcontractors,then you may be an employer.
if you are an employer,you must register with the state and federal government as an employer anti
you are subject to several obligations including state and federal income tax withholding, federal social
security taxes,workers' compensation insurance,disability insurance costs, and unemployment compensatiot•
contributions.
There may be financial risks for you if you do not carry out these obligations,and these risks are
especially serious with respect to workers compensation insurance.
For more specific information about your obligations under federal law,contact the Internal Revenue
Service (and,if you wish,the U.S.Small Business Administration). For more specific information about your
obligations under state law,contact the Department of Benefit Payments and the Division of Industrial
Accidents.
If the structure is intended for sale,property owners who are not licensed contractors are allowed to
perform their work personally or through their own employees,without a licensed contractor or
subcontractor, only under limited conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder
building permit,erroneously implying that the property owner is providing his or her own labor and material
personally. Building permits are not required to be signed by property owners unless they are performing
their own work personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License
Board in your community or at 1020 N Street,Sacramento,California 95814.
Please complete and return the enclosed owner-builder verification form so that we can confirm that
you are aware of these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
Building Department, .
City of Cupertino
Printed on Recycled Paper