03010001 CITY OF CUPERTINO »'- =r "� "-"' `' x
BUILDING DIVISION PERMIT CONTRACTOWIINFORMATION
BUILDINGADDR17SS: EASTMAN CONTRACTING, INC PERMITNO.
20298 CLAY ST 03010001
OWNER'S NAME: 1418 DOUGLAS ST APPLICATION SUB DATE
TOKUDA HARUO AND FUSAKO H 01/02/2003
BONE: (408) 971-9000 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�00 LICENSED CONTRACTOR'S DECLARATION
�u I fie chy elfu i lmo l ien iemsed under prJ}�tvisiom of CoPmf 9 morno ernmg Job Description
with Sation 71%Mq of Division 3 of Nc Boxin.;prl0mfcuinnsCak,enJ my littnu is
slum n ZSbS l REROOF
o no ° claw Q cunatur c .,Z/0 1 LAYER SHAKES, INSTALL PLYWOOD &
F� l ARCHITf:CTS DECL RATION
UP Iundcraundmyplan shall husedaspuhliercwrds 0 YR. PRESIDENTIAL CO�(����I��.
aU
1���tl
Licensed Pm(essio.al
k'up OWNER-BUILDER DECLARATION
affirm
u� 1 hereby rm Thal I am exempt from the Cunlracmr's Liccnu Law Inr the �pN
w—0 y0 following reason.(Section]W I.5,Business and Professions Code:Any city or county
6%$LL which requires a Permit to consumer.aINL Improve,demolish,or repair any structure
W prior In its issuance,also requires the applicant for such Permit m file aligned statement
1-�6 that he is licensed pursuant to the provisions of the Conuacusr's License Law(Chupmr 9 Sq. Ft. Floor Area BUIL aluation
�$ (commencing with Section 7(100)of Division 3 of the Business and Professions Code)(it
i/r
that he is exempt Nomfrme and Ne basis for the alleged exemption.Any violation of
Section 7031.5 by any application for a permit subjects the applicant to a civil penalty of APN Number cy Type
not...Nen five hundred dollars(M).
0 I.as owner of the property,we my employees with wag.as their.]a compensation,
will do thewohwct
,and the sure is not intended m offered for ole(Sec.7044,Business 3693 915±9 . 01
and Professions Code:The Contmclols Licame Law does not apply to an owner of Required Inspections
propeny who buildsor improves luemon.and whodees such work himself orthesugh his
own employe.,provided that men improvements am not intended oroRcred for sale.If. 305 — FRAME
however,the building or improvement is sold within one year of completion.the owner-
builder will have the burden of proving that he did non build or improve for purpose of 307 - INSULATION
.]a) 601 - ROOF TEAR OFF
❑I,as owMr of due propeny,am exclusively contracting with licensed contractors to 602 - ROOF PLYWOOD NAIL
construct nue project(Sec.7044,Business and Professions Code:)The Contractor's Li.
cents Law docs not apply to an owner of property who builds or improves thereon,and 603 — ROOF BATTENS
who contractsfor such projects with a conuanor(s)licensed pursuant to the Contuctor's 604 - ROOF IN-PROGRESS
Liccnu Law.
0 I am exempt under Sec. ,B 6 P C for this ream.
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following decimations:
I have and will maintain a Certificate,of Consent to self-insure for Worker'sCompcn-
sation,u provided for by Section 3711(1 of the Labor Code,for the performance of the
work for which this Permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,as required by Section
7700 a(the Labor Cade,for Ne pertormumc of the kfar which this permit is issued.
MyW 1n ,,r`x—Compens Insurance carrier an ynumhe,are:
CarrkeVQN�-Q. V1� Fora Iu3q 24 Z
56 CERTIFICATE OF E%EM FROM WORKERS'
COMPENSATION INSURANCE
(Thissoclion need non hecompleted if the permit is for one hundred dollars($100)
n Ices.)
1 certify than in the performance of the work for which this permit is issued.l shall not
employ any Person in any manner an as to become subject n the Wnhers'Compensation
Laws.(Celifomia.Data
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Cade.you must
0Z fordwuh comply with such provisions or this perour shall be deemed mvelod.
zO CONSTRUCTION LENDING AGENCY
[-+ I hereby affirm that there is a construction lending agency With,Performance of
0.i 7 The work for which this permit is issued(Sec.3097.Civ.Q
tat A Lender's Name
Z)
z Ic.der's Address
U 0 1 certify Nat I have mad Nis application alb mutation the move information is
Dr F correct,1 agree to comply with all city and county ordinances and stare laws relating to
O V buildingconswetion,andherebyaudimixerepvaunurivesofthiscitytoenteruponthe
W move mentioned property for inspection Purposes.
(We)ague to save,indemnify and keep harmless the City of Cupertino against
Hy liabilities.judgments,costs and expenses which may in my way accoc against said City
U in consequence of the granting of this permit.
APPLI NT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S R EGU ATIONS
Re-roofs
Signature plicaH ZARDOUSMATERIALSDISCLOSURE mitor Dat Type of Roof
Ne applicant or future building occupant store or handle h riardous material
u defined by the Cupertino Municipal Cade,Chapter 9.12.and Ne Health rand Safety
Gide.Section 255320)7 All roofs shall be inspected prior to any roofing material being installed.
DYns .I' o
Will the applicant or future building occupant use equipment or devices which If a roof is installed without firs[obtaining an inspection, I agree to remove
emit havmdnum air contaminants.defined by the Bay Arca Air Quality Management all new materials for inspection.
Dlnda7
a ❑Yes s�plo �G�7�1(\kms \�//I ^/
lovemudC,Aa.Sbnuamacrials3333wde5534.I rChapmrh.95ofre Callingl-�W �14
ria Hca0 ySafety Csolc,S.dnm 25NI5.2553J end 23534.1 undcrsurW Nnifdn building
does nor currently hale a¢rant.Nat it is my mi mosibility to nodfy tM occupant of the
regal lwnienman in iasson a Iaccnificamoluccupmcy. Signature of Applicant Date
Owner or authorized agent Dane All roof coverings to be Class "B"or better
Building Division
10300 Toga Avenue
Cuperdno,CA. 95014-3255
Telephone: (408)777-3228
C Fax: (408)M-3333
CUPERTINO
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 musthave a minimum of YV 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: Js6z" OL-
Address: o>() ��r,Gtv1 c�fiil Ge r
Reroofing Company Name: - 511-2hiAl O VL,
Applicants Signator : Date:
Joe Antonucci
(Chief Building Official)
6WO1
CITY OF CUPERTINO
BUILDING DIVISION PERMIT 'GCo' RACT4ItaI1VFOIiMATION
BUILDING ADDRESS; EASTMAN CONTRACTING, INC PERMITNO.
20298 CLAY ST 03010001
OWNER'S NAME: 1418 DOUGLAS ST APPLICATION SUB DATE
TOKUDA HARUO AND FUSAKO H / 01/02/2003
{ (ONE: 408 971-9000 SANITARY NO. CONTROL NO.
ARCHITECDENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
�00LICENSED DECLARATION Job Description
1ion7 affirmthe1amfe,Buunderpryryt 11censof Chepmr9mylicense u p
with Secdnn]fg0)n(DlvidonJof theBwineu�dOProfeuian,Code.mtl mylicenula
m in fullr feet 25b5 l REROOF
,Ng enmcl ' Q c`�vatnre„ /O 1 LAYER SHAKES, INSTALL PLYWOOD &
S
ARCHI'fELTDEC RATION 50 YR. PRESIDENTIAL COMPO. SHINGLES .
1 understand my plain shall he used u public record,
a U
=t�
Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby moo ,farm that I em exempt from the Conlnclnle :Any c ty o for the
O o whichfollowing rcasnn(Section](171.4 Business and improve,
de Professions Calc:Any dry car county
$(v which in issuance,
n permit re cores el,altee impmw,demnlift t fl came any statement
Z� thatMor in its iensdpurs also requires titeapionso for mchpctor's sense La (Chapter
t < (em anislianmdpursuantmtheprovisionsoftheComncmr'aLken,claw(Cheplcr9 Sq. Ft. Floor Area Valuation
$ Met he's exempt
tSerefor and of basis f r M dee Burow end on.Anion,Code)of
.. Nm he'ns cxcmpl thertfram and the buil for Ne mlcgetl exemption.Any violation of
Searlon 7071.5 by any applicant for A permit m*x3x the applicant to a civil penalty of APN NumberC e
not more than A.hundred dollar n50D). y EYP
I,u owner of the property,or my employee,with unpin as theh role compensation.
will do the work,and the wucmm is not intended or offered for sale(Sec.704,Business 369390t9 . 00
and Professions Cade:The Conuacmr's License Law dors nes apply to an owner of Required Inspections
property who build,or improve thereon,and who dnessuch work himmlfor though his
own employees,providW that such lmpmsementsm not Intended oroffered for sale.If, 3055 — FRAME ,*
however,Ne building or Improvement is sold within one year of completion,Ne owner
builder will have the burden of proving Net he did nal build or improve for purpose of 307 - INSULATION
ink.). 601 - ROOF TEAR OFF
01.as owner of the propeny.em exclusively contracting with llatucd cumratars to 602 - ROOF PLYWOOD NAIL
convect Ne pmject(Sec.7(s44,Business and Profwion&Code:)The Con Wclor's Li-
cumelawdoesnoupplytnanownerofpmpenywhowildsorimprovuthemon.and, 603 — ROOF BATTENS
who convects for such projecu with a contractor(s)lianud pursuant to Ne Contrulori
Lkensa Law. 604 - ROOF IN-PROGRESS
❑lamcscmptunder Sca ,84PCforthisreeson
Owner Date
WORKER'S COM PENSATTON DECLARATION
I hereby aRitm under penalty of perjury one of the fallowing declmllon,:
1 have and will maintains Ceniftcau of Consent to sel6inmrt for WorkeYv Compere
don.u provided for by Section 3700 of the Mbar Code,for the Performance of the
work for which this permit is Issued.
❑1 hew and will maintain Wntkeb Compensation Insurance.as required by Section
7700 of the labor Code,for the pcmormma of de k for which this permit is Issued.
My Wo r aCompc ' Iommocs"no" ynumber m:
cAytB viol Pau '.: Iu3gZc��- 2
J' CERTIFICATE OFF FROMWORKERS'
COMPENSATION INSURANCE
(This auction need not be completed if the permit is forone hundreddellm f$101)
or les.)
1 cenify Net in the performance of the work for which this Permit Is issued,l shell not
employ any person in any manner an as On become subject to the Workcn'Compansation
Laws of Celif ord s.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Workers Compensation Provisions of the Labor Code,you must
0z forthwith comply with such provision,or this Nonkhall be deemed reveled,
p tiCONMUCfION LENDING AGENCY
F+ I hereby affirm that them is constmetion lending agency for the Performance of
the work fm.which this permit is issued(Sec.Y)9],Civ.C.)
0. Q Lender.Name
LD z Lenders Address
fJ O 1 unify that 1 have mad this application and,tau that the above information is
gI.H correct.I Agra o comply with all city and county ordinances and rote laws relating in
O U
building eonsuucdon,and hereby authodanrtpresentativesofthis city toenter upon IN ,
4V abow-mentioned property for immoction purpose.
(We)agree to save,indemnify and kap harmless the City of Cupertino against
pd'g Ilabilitle,.judgments,costs and expenses which may in any way ace=against mid Cityin m
V APPLIconsequence of the granting t
s rmit.
NTUNDERRSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S R XEGU ATIONS
1 Re-roofs
Signoil plicanUConvutor Oet
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
the applicant or future building occupant core or handle hazardous materiel
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
code.Scedet 25532(.)T All roofs shall be inspected prior to any roofing material being installed.
IS��
❑Ycv �NuIf a roof is installed without firs[ob[ainin an ins action,I a Tee to remove
Will the apPllcam or fmntc building occupant esu equipment of devices whichg P gl hazardous air contaminants as donned by the Bay Area Air Quality Management all new materials for inspection.
❑YesIhawmayCodc,SuoOhlWmd Me 5505, SS33m4umdentsundcrChapood Ma o(the GldingHealth ik SmetyCWc,Socti.n.25M)5,23577 and25534.1 understand thcifthc buildings nut courn Y haw an,n,that it is my responsibility in notify 1M occupant of the
uisceniftcmeofoccupancy. - Signature of Applicant Date
Date All roof coverings to be Class "B"or better