01110004 CITY YILDNG DIIVIISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
6559 CLIFFORD DR 01110004
OWNER'S NAME: APPLICATION SUB DATE
COOK CLEATIS L 11/01/2001
HONE: SANITARYNO. CONTROL NO.
O O ARCHITECT/ENGINEER: ILDING PERMIT INFO
- BLDG ELECT PLUMB MECH
rn<E
5 y 2 LICENSED CONTRACTOR'S DECLARATION
i Z zi o eby alfinn that 1 am hce' "under provisions or Chepmr.9(commencing Job Desc 1 l0n
.yC' hail onion]WO)orDivision3ofinenisinesss. nessiooh, re.andmy-.too REROOF -
Sms i. nfXnforceand e �7 T/0 FLAT ROOFING & INSTALL 4 LAYER
z cc Cba Lic.p
ILLo� "°
T'S DECLARECLARA BUILT UP ROOF SYSTEM.
ARCHITEC
I understand my plans shall he used as punlic records
I e5 O Licensed Professional
a.
c OWNER-BUILDER DECLARATION
6=�so I hereby aRmr that I am exempt from the Conlmcmr's License law fm,he
t?a following reason.(Section 7031.5,Business and Professions Code Any city or county
$'S O which requires a perm,so ronsuuct,oboe improve,demolish,or repair i ny.lLeturc --
u�3� _vn ,
its issiourco,rifirm"at.,mertists ,for such permtto file a signed..,omen,. _ _ _.- ------
,hi,hd Al cc d poh am tdihe pronsbns of the Conuacto/s Lmm�x lsw(Chepur 9 - - - - �� -
(commencerMSa,on7000) fDivismn3ofN<Bumn`1aPrar(sannnrende) k'(}`'. E }3�Sq:'F[,Floo['Aea 1T T1 31uation
or that he 62:empi therefrom end the wsis for the alligc8 d2mpuod.Any violnudn '
m 0.,
-of Section 9031:5 by any applicant for a penrdt subjects the applicant to a civil Penalty
,of not moro,ban five hundred dollars(550(3. 36912InJdlJ!]i40 `f!t'E,,, Occupancy Type
111.as owner of the property,or my employees with wages as their sole compensation,
-,will do the work,,and the structure is-not intended or"oHcied'for sale'(Sec.'10M
Businese end Profession.Code:The Contactor s License Law a«e not apply to an 305 - FRAME Required Inspections' '• \ -
owner of property Who wild,%or improves merevn,and who does such work himself 307 __-_ INSULATION ,
or,h gh his ply p ided that such mprovem t t imenJ J
[completion,
for sale If.h ,h wilding or improvement a sold ih one) f �--_ "'-- - _._... , „ ...., ., .,_ ,. ....
.._ completion the owner wilder will have the handed of proving met he dm not wild or 6 01 — ROOF TEAR OFF ' .'c:❑ -- --
improvePorpuryoseofsale.). 602 — ROOF PLYWOOD NAIL
'--- -- ._._._chin-----ting` ---- -- mush --- -- — — --- ._.._..-------
0 —
_ 'r l.as owner of me property,am exclusively contracting with licensed mntracmrs,o 603BATTENS"-- - --- - --- - -
_ - -
construct the mustier(Sha.7000,Business and Professions CcA0 The Contractor's
- license Law does not apply to an owner of property woo weds or improves thereon, 604 — ROOF I N—PROGRESS
r' _and.who.coi for,such projec,s.wim.e contmetorfs),licensed-pursuant.to.me__-_____
Contra Lbe d.La ------ ---
❑lam pt under Sec 51' i ',.B&P C for this reason a''' D.
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Own. I_r Duie ar .iv .,r . ...
"WORKER'S COMPENSATION DECLARATION
I hereby eRrm under penalty of perjury one ol.me following declarations:
iI hrve'and wiWli ibiein a Cmificemof Consent'io salf-insure for Worker's
��_ Compensation, as provided for by Section 3700-of-the Labor Codc, for Ne
- performance of the work for which this permit is board, ,
_ ❑1 have and will maimeiriWorker's CompeneaLn inmrance,m reyuimd by Section
li i-rc ]7 ,he lobo'Cob f the performs of theWork f hch thisAero.,is
.. yucd M W kers ompery u Ir,surmce' d.Pal y umbo „
Can sit FIC II NOFEKE M0 FOMWORKEIi I, r �f�' TLi.S+ ? y`lltl(J-R•t+i 1t-e..F G-h.iY(..�. .I.1 t.i
COMPENSATION INSURANCE"' . �_ i
'.CS Ipphs Mtion red Ibet Atoned if pertnit is on<hundred dollars e1Fa8 AL ® �U- �'r s\' i! 442r
rv,.l.•,....
:tha I cert fy th, nth porno d f r no which u ct to
1 �r i1.:l; '•r' ,.•..••.v'••.,.. .• �.,-
shall t emPl Y b y,pc may n to become subject to1n Workers' MAI
Compensm on lie.of Cahfom�n'Dve'
i
.
Applicant'
NOT
ICE TO APPLICAI�T.If.
after_..__- i..g.this
Certificate of
Exemption,.. Y_'should
Znecom Luo me W Co pen' onpoits ofth lawCod yodm t
0 fonh m comply thh poro arm permit shall demands ._p....V- L..
.O.__.I—ry._G
.__-
,i 'lr r . 't"-1CONSTRUCTION LENDING AGENCY
or firm h h .'construction t ledg agcy for she 1o;Iorarace
Which his permit is issued(See 3097 Cm C)Unders Nome
ind. s
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,
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Add . .. - .. ._._..._
f^ cal that 1 have red this y said stmt that the aboveformation,
cnirat'Lret to comply,withall Y application
�ountporaioarmes owl laws relating
.0. to buildingconstructrobfand hercb authorize representatives of,his city to enter upon
the w e ,' d p perky for inspectionpurposes.
,
F.,.L. (We)a6 t ve rid. fy ariilk pharMsineCry fC peri'o`a8arn. _.
0 ' judgment, send pe u hch. y n any ay gin amid - ._. . .__._ "" . . _..---
liabilities .. . .
V,Z Cry gore ofth g fg (this Femin .'.
pP h •T NDERSTANDS AND WILLCOMPI. N77fH AL N01'POLN-T 1
s L GpuuTlorvs " I ,�r�jIC?� -- Issued by: - - - - Date
as is r ea m antic mr cmi ) D m: ., ` Re-roofs
s , i HAZARDOUS MATERIALS DISCLOSURE . 1
g pP
dant w Istat building occupant t m handle haurd rat marcnal T e Of ROOF _
r I c
Will the app,
UY pen oM pal Cade Chapter912 dth H lnandsalty - YP .._ .... - __ .. —...-.___._.._ _
codesa z553za3+ . ,., .I.3; t ' .i., _t$(7 l, f'tt�til_4 t,'v. ` ...
F: ! s „tat
v-
113 Yet' I- Sftt QNo t,E ff✓i.a 11,{]sl z il ug,s 7 s. 1
_All roofs shall be mspected.pnor_to any-roofing material being" ' installed.! ;Will eppver Same,wddmgoccupamusecgmp reevteaynmh arooisitstlle' 'withoutfirstobtainin anins ectioo•Iemit h b s air contaminants a f ed bifth Bay AA Q aty Me gement , agree.toTieno
ve
Di""' _ all new materials for inspection Applicant understands and will comply with
1'' ❑y 1 r,h I (Nott, __ -i all non-point source re`gulanons.t .:.�;.. _ I '
V I ha e e d the'haz do credal, requvements and Ch pie 695 of the
Californians'Health&Safc,y Code,Sections 25505,25533 and 25534:4 unders,and,hat
}f Ne budding docs not carendywWribirsm.NatitismYrtsponsibilitytomdfY,the
eupbm f the men¢which must to me,imor,o issuende m Cmi cam of
Occup,; :'
... .. :' Signature of Applicant _ Date _
ow r,n" get, Iate ...,; All roof coverings to be Class "B" or better' '
-.
OFFICE
"; ---' --- - - .. _- -- - -- - - -- -. . ._ __
'f Building Division
aXaw
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
IOCUPEkTINO
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 1/a" 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 pnolicy on reroofing and will comply with this policy.
Homeowners Name: 1 �1�. 1 IPo S ()pk
Address: 5 r
Reroofing Company Name:
Applicants Signature: Date: l
a -.9 aIT
Joe Antonucci
(Chief Building Official)
6/25/01
11/01/2001 12:58 N0.361 1?002
STATE P.O.BOX 420807,SAN FRANCISCO,CA 94142-0807
*OOMPBNSATION
IMMUR^mcs
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
NOVEMBER 2, 2001 POLICYNUMBER: 571-01 UNIT 0001426
CERTIRCATE EXPIRES: 10-1-02
r
CITY OF CUPERTINO
10300 TORRE AVENUE
CUPERTINO CA 95014
JOB: ALL CALIFORNIA OPERATIONS
L
This is to certify[hat we have issued a valid Workers'Compensation Insurance policy in a form approved by the California
.Insurance Commissioner to the employer named below for the policy period indicated. _
This policy is not subject to cancellation by the Fund except upon&days'advance written notice to the employer.
• +nandL,gtr '
.. ._ _..,. . . _ ., .1 ,..,... .., .. . ...,. ....,e„aW:a,;..;„._ _. v+xyt•er.eu�c.,:.c,+.:rw.d,�:::kaea
We will also give you nN days'advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an Insurance policy and does not amend, extend or after the coverage afforded by the
policies listed herein. Notwithstanding any requirement, term, or Condition of any contract or Other document with
respect to which this certificate of insurance may be Issued or may pertain, the insurance afforded by the policies
described hefeln Is subject to all the terms,exclusions and conditions of such policies.
' AU��11 CB NTATIV � PRESIDENT ,
EMPWYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $,1,000,000 PER OCCURRENCE:
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE
10/01/01 IS ATTACHED TO AND FOPM A PART OF THIS POLICY.
....n.�..wY ..:J1L”..�L.uC:'J:.I�.UYavN�•'�Su+++.i•rl.)�%
. EMPLOYER
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'. KAYAR CORP
DBA: K REGEVIG ROOFING OD
2600 MCCONE AVENUE
HAYWARD. CA 94545
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