02100125 ' CITY OF CUPER'fINO ,uoy,m -
Ruu,mN 'DtvtstoN PERMIT CONTRACTOR INFORMATION `r'
BUI 1 ES :LIFDEN WY DAN ELLIOTT' S ROOFING CO PERMrrN402100125
1 OWRhOANCHANDRA AND BELLUR GOWRI S2669 COIT DR APPLICATTVYR1%TY2002
1 ANE: 4O6 559-7327 SANITARY NO.77 CONTROL NO.
l
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
CmZ O O O
�tOO
LICENSED CONTRACTOR DECLARATION
Urwit1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing REROOF Job Description
? i
n< Scminn 71xxp r[Divininn Sof Jlc> unU Professions Cndc,and my license ix
in fhull fu ca fie O)'r/rr
ONI.icen.scC
F� �JaN�.
ata drsmnJmYplansshallMubhereenrdx OCT
K�M 2.HLLo� Licensed Professional
OWNER BUILDER DECLARATION
j <F. I hereby affirm that I am exempt from the Contractors License law for the $8400
�a.O OOH following reason.(Section 7031.5,Business and Professions Cndc:Any city or county BUILD NG
%m Y. which requireSta permit in consumer,alter.Improve,demolish,or repair any structure
ptinrtnitai.nuance.al.,eoreyuirespeupplicantforsuchpermiunlileasignedstatement
'-�a that he is licensed Pursuanto me provisions of the Conuachn's License Law?Chapter 9 3� 71MA
9B. FD AL@D Valuation
z�O (cummenci ng with Section 7000)of Division 3 of the Business and Prnfecaions Code)nr
i $ mat he is exempt tWrtfmm and the hasis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of -3 UpN N
not mom than five hundred dollars($500). 307 - INSULATION Occupancy Type
O I,M owner of mese property,or my employewith wages ss their sole compctuauon,
will do the work,and the structure is not intended or offered for sale(Sec.7014,Bus
and Prfessinr Code:The Contractors License Law does not apply In an owner of 602 - R00 F P n cf Ens
m
ppeny who builds Or improves proton,and whodoes such work himselfor through his
owneripinyres.prvided that such impowermnexar nolimmndedoroRered forsals.If, 603 — ROOF BATTENS
however.the building or improvement is sold within one year Ofcompletion.Be owner- 604 — ROOF IN-PROGRESS
builder will have the burden of proving that he did not Wild or imprrve,for purpose of
.sale.).
1,as owner of me propeny,am exclusively contracting with licensed contractors to
convect the project(Sec.7Udd.Business and Professions Code:)The Contractor's Li-
cense Law does Of apply to an owner of property whir Wilds or improves theeon,and
who commerce;for such projects with a contractors)licensed pursuant to me Comnemr's
License Law.
❑ 1 am exempt under Sec. ,B&P C for his maven
0 Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of petory one of the following declinations:
1 have and will maintain a Conflicts,of Consent to self main,for Worker's camper.
syion,os provided for by Section 3700 of the Timor Code,lies me performance of me
work for which this permit is issued.
❑ I have and will maintain Worker's Compensation Insurance,as,reyuirid by Section
,ILMI of the Labor Code,for me performance of pe work for which this permit is i.mucd.
My Wor 's Comine nlnsun wearierand Policy number re: J/jyT
Carts a Policy No.: t-K/
CF.RTIFICATEOF E%EM Fc FROM R E
COMPENSATION INSURANCE
o hi,1 acelion need nut W completed if the permit is utrone hundred dollars(S IN))
nr Icas.)
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 a,m hecome subject m the Workers-Compenxmion
Laws rf Califermit.Date
Applicant
NOTICE TO APPLICANT:11.after making this Certificate of Exemption,you should
become subject to the Worker's Compensation prvisionx of the Labor Cndc,you must
OO Rrnhwi in comply with such provisions or this Permit shall W deemed evoked.
'ZN CONSTRUCTION LENDING AGENCY
[� Ihereby anirm mal there is a wmstruction lending agency for the performance of
C' the work fur which Ibis permit is issued(Sce.3W7,CO,C.)
0.W Q LendefS Name
Z corrects Address
J O 1 lenity that I have read this application and state that me above information is
W F amwl.I agree to comply with all lily and county ordinances and statet laws relying In
0U above mentioned
snedproerl hereby amhonpurporesenutiresofmiscity men¢rupon me
aWveme judgm nt,cost for inspection purposes.
H y (We)agree to save.indemnify and keep harmless the City of Correction against
fp Iiaconsequence of the
granting
expenses which may in any wayaccrue against mid City
V z in consequence ofine r
RSTANDS this permit / 6
NT UND RSTANDS WILL COMPLY WITH ALL NON-POINT Issued by: Date l/
f AprlicaWConomm" / cele Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
l the applicant of future building Occupant yore Or handle hammous material
by the Cupertino Municipal Cost.Chapter 9,12.and Bic Health and Safetyion 25532(a)7 -�'1 cs m \ All roofs shall be inspected prior to any roofing material being installed.
l 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
ous air contaminants ax defined by the Bay Area Air Quality Management all ew materials for inspection.
`/
C]Yea 6ilo
1 have read me hvallous materials requirement,under Chapter fi 95 of me Cvlihv-
niall Ire&Syfly Ctxk.Sectirn met i/son ce"ree53i.1 un ni Ite"str Wilding
Ulcs Ices nRy have enan4 mat' , yrespansiM1ditym city lW rccupanl of We
require ` rd `;rsmnceofacetdfirate:m�.pJtceupanry. ignatureofApplicant ;� Date
/�/1��
ermaamnnmzca agent Dyr All roof coverings to be Class "B" or better
Building Division
10300 Torre Avenue
4 Cupertino,CA 95014-3255
*CITYO
P
Telephone: (408)777-3228 777
f�
CU
f�I�TINO F= (408) -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 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:
Address:
Reroofing Company Nam
c-
Applicants Signa Date: P6-16 6Z
• ,� .� CUA-z�-.�
Joe Antonucci
(Chief Building Official)
6/25/01