02050149 OF
- CI BUILDING DIIV��ISIONNOPERMIT CONTRACTOR INFORMATION:
fs B I 1 DR PERMIT NO.
'��'�"3°$ �°UNRADIA CT 02050149
0Nfill PfEDAVID W AND JEAN G "T95cf 235f R2H42
PHONE: SANITARY NO. CONTROL NO.
�00 ARCHITEC-MNGINEER: BUILDING PERMIT INTO
tics U❑ BLDG ELECT PLUMB MECH
�a a a r
s. QQ ao� LICENSED CONTRACTOR'S DECLARATION
.Sy_ 1heg7f UT.then Ia.late...dundyy.r ,gnsofChapier9lcommencing REROOF Job Description
)ytC with genian 00)of Division 3ofthe Buxinbs(and Pro fessmas Code.and my license
x I is i I roe . J�- 3
a,W.O I.ic<nls Maxx Lic.tl
0 vale r� Con�ninyl rVKM
I R µ�TECrg OF}'!1\RA f61
to— undersand my plans shall he used an public records
i�
1?p O Licensed Professional
'a' OWNER-BUILDERexemptDECLARATION
u�3 I herebyca tSect than 1 1. exempt from the Convector's cLicense Ac city
o for the $8000
?< following renes..(genion]031 s,Busincss and Profassione Cuae:Any tiny or county
f F O which requires a pedant I.re conswc4 pme,plic impmva demolish,or repair any swnom
i 3 m that hepoor s lice sed Foliation also uqo theres the app r,o for Ciumuch tm's Lice se Law(stmemem - - u
(commecing itSectSa)0)of Divisinf the Convenors License lsw(Chnpter9 I- af,1t ..e . )• Valuation
(commencing ingwmpt theinn]W3)ofhe basison oof thealegedex and Professions Code)
or that he is exempt zany apo,.and the basis for She subjects
the exemption.to Any l Pennon
—of genion 7031.5 iv any hundred
dam firs a pcsnit subjects Ne applicant m a civil Penalty
.fWt mare than five nanerea aonam(asoo). PN upancy Type
x �,.
D L as owner of She property,or my employees with wages as their sole compensation, -�I 'kTI N I I ).
-will j.'he work,and the sweture is not intended or offered for sale(See,701
Busincss and Professions Code:The Contractor's License Law does not apply to an O CGLIOD I �-
owner of property Who builds or improvesdaemon,and who does such work himself V �' F11ILLtt
or throw h his two employees.provided that such improvements arc nun intendedayear or -O 3 O BAT S
offendor sale.ILhowwldethe buildingorurden ofprosn uW he
one year of -
c prove on,meosseofbuilacrwillhavethebuNcnofprovingthoShedidnotbullaor IN- R
improve for puryoxe of sale J. ,� I
m es sines t S nh licensede Contract m '
_ conswn the projcet(Sec.7094.Business and Professions Code:)The Contractor's .
Limse Law does not apply to an owner of property who builds or improves thereon,
and who contracts for such projects with a commetr g licensed pursuant ro,due
Contmaoes License Law. ,
❑I nm exempt under Set, B&P C for this reason - '-
Owner "Dane
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of She following declarations:
y ❑ 1 have and will maintain a Certificate of Cometh to aeLabor for Worker's
1jLYe Compensation, m-pravided for by Section 3]00 of me Inbar Code. for me
Performance of the work for which this permit is issued. /
❑1 have and will maintain Worker's Compensation lnaumnce,as required by Section
3700 of the Labor Code,for the performance of She work for which this permit is
testa d.My Workers Compensation insurghm carrier and Policy number art_
CERTIFICATION EON INS RANOMOM WORK S - ` I •` f`� _ , a'^� \
TI TION OF
INSURANCE
(Th ucuon need nm he completed if the perm,is for hundred dollars
IS I00)or IezxJ llV//"""
' 1 ormlythan in the,pe6ca m o o,of the work for which dais Fermin is issued,l
shall not employ any person in any meaner so as to'become subject to She Workers'
Compensation Laws of California.Date
.Applicant ._. - .-. :. ......
NOTICE TO APPLICANT:IL attar making this Certificate the
Labor o dyou should
bceome subject coply he suchpr Compensation provisions of the Labor Code,you must
OZ
Q forthwicomply with such provisions or this permit shell be deemed revoked.
a- :'CONSTRUCTION LENDING AGENCY ,t
y I hereby'nffirm than there is'a construction lending agency for the performance
ht.Qof the work for which this permit is issued(Sec.309] Civ.C)
Lender aName
�'-Z Lender's Address _
V-- I certify than 1 have read this application and state that the above information is
(z E^ correct.I agree,.comply with all city and county ordinances and stem laws mlating
0•V to building construction.and hereby authorise representatives m du,city,.emerupon
(� me above-mentioned property for inspection purposes. _
L (We)egree to save,indemnify and keep harmless the City of Cupertino against
W liabilities,judgments,costs and expenses which may in any way accrue against said
V'Z CitY in comequence fthe minp hhia permit. -
isPPCICANT UN RST )S 1 D WILL COMPLY WITH ALL N N-POINT
ou .r .'u .nD Issued by: Date
gnature v A ft i a vconucanor -,,'—'. . Dare Re-roofs
--- HAZARDOUS MATERIALS DISCLOSURE
'-
Will the applic I. f mare, ldm oc pant to . handle heuidousmaS al Type of Roof - - - •
m def ed by th Cupen nu M cipid a CoZ 9 12 d But Health and Safety
Code,Section 255321,` 'S s
oyes No ,," t l`" `.All roofs shall be.inspected.prior to any roofing material being.installed.._.
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection,'I agree to remove
emit hemrdous air contaminants as defrjW by the'Bay Area Air Quality Management
District^ �,IQ/ all new materials for inspection. Applicant understands and will comply with
o
1, ven o p. all non-point sourc regulations.
4-� 1 have read the hazordova mmmitis requirements under Chapter 695 of She
file Se Health&Safety Code Sections 25505 255)3 and 25534 1 understand that
/J / � S /�
ifthebuldmgaoestart currently have alenat that it is my responsibility So notify the
oe pant of She re vire,. ch mus be met prior So,isx once of a Certificate of ,J d 2
occupancy Signature of Applicant Date
wum.l au odaaa agent Date All roof coverings to be Class"B"or better
OFFICE
- Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEPTINO
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 VV 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 Nan300 Irl-Lq7
Address: _.2. (:.-L',4k, Af G 7
>Jleroofing Company Name: - k JAZ
l Applicants Signature: rDate:
Joe Antonucci
(Chief Building Official)
6/25101