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02100105 r CITY OF CUPEwrINO ".wTRsw r �. BUILDING DIVISION PERMIT CONACTOR INFQRMATIO'N RU'rl)1TSSDRORESTLINE DR VOROS CONSTRUCTION PERMIT N02100105 OWIVD'R0,9 DAVID M AND KAMILLA C 1192 CRESTLINE DR APPLICATTVY`114T/�t2002 All IONS' (408) 253-9332 SANITARY NO.// CONTROL NO. ARCHITECT/ENGINEER: BUILDING PERMIT INFO RLOGELFiCr PLUMB MECII E (� WOO LICENSED CONTRACTOR'S DECLARATION amu IherehyafimadeslamlicensedunderprovisionsofChapter9mentomncing REROOF Job DBe/scLription N66 with Sectionndlalec Division Sof the Ousinesa and Professions Gate.anJmylicen¢is FQ9�17lA"vL Intal)(n laand CfffCl. 7 OZ0 Dam Glasse Lie.N —ct Uate 'FS DECLARATION�-=�� As shall be used as pLARATION DEC< 11rademtand my plana anon be used a..rllbhf records L 0 9 2002 W 3`u FLLQ� LiccnuJ Pmlcssional S OWNF.R.RUILDER DECLARATION BUILDING �y ®INpI/� <y 1 hereby affirm Nat 1 am exempt from the Contractor's License Law for the G M0y following remon.(Section 7831.5.Business and Professions Code Any city or county $2000 W m LL which requires a permit to construct,alter,improve,demolish.or repair any smuclule HZs prior to its issuance.also mqu ms,the applicant for such permit to file a signed statement i that he is licensed pursuant to the previsions of the Contractor x License Law(Chapter 9 3WR4f0Qb6A&@aluation WH (commencing with Section 71X(0of Division 3ofthe Businc.ssand Professions Code) nr Nal he is exempt ncc¢from and the basis far me alleged exemption.Any violation of Section 7831.5 by any applicant for a permit subjects the applicant o a civil penalty of not more than five hundred dollars 050% 307PNNOWE INSULATION Occupancy Type ❑ I,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 offered for sale(Sec.7044,Business 681 — and Professions Code:The Contractor's License Law does not apply to an owner of 602 — ROOF P W lJ nLyyLInS property who builds or improves thereon,and who does such work himself or through his a%n employees.provided drat such improvements are not ntended or offered for sora It. 603 — ROOF BATTENS however,the building or improvement is sold within one year of completion,But owner. builder will have me Which of proving mat he did not Wild or improve for purpose of 604 — ROOF IN—PROGRESS sale.!. ❑ I.as owner of me propcny,am exclusively contracting with licensed contractors to construct me Project(Sec.70414.Business and Professions Code:)The Contractor's Li- cense law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contracmr(sf licensed pursuant to the Contractor's Li msec Law, an under Sec. ,B&9C rnr oris reason D KERCOMPENSA NDECLARATIO I hereby affirm under penalty of perjury one of the following declarations: I ham and will maintain a Cer ificasc of Consent to self-imam for Workers Compcm whom.m provided for by Section 3711(1 of the Labor Coale,fine the performance of the work for which this permit is issued. ❑1 ham and will maintain Workers Compensation Insurance.as required by Section 37(w of ft Ichor Cade,for the performance of the work for which this permit is issued, My Worker's Compensation Insurance carrier and Policy number am: Carrier: Pel icy No, _ CERTIFICATE OP EXEM PITON FROM WORKERS' COMPENSATION INSURANCE ,r (This section need not M completed if the pCrmil is home hundred dollars(E Ilk)) IessJ I certify that in she 1�^'',i6i ce of the work for which this permit is issued.1 shall not Employ any t5[mn ns6ny man pcjm !firm ubJec'1 to the WorkCri Ct)mpcnsalinn La ws ofC fo ta' 1/LL Applicayyt NOWTO APPLICAIafterar making Nis Certificate of Exemption,you should beNT:subject m the Worker's Compensation previsions of me LaMn Code,you muss O z fonhwim comply with such provisions or this permit shall M deemed revoked, z O CONSTRUCTION LENDING AGENCY [-+ I hereby affirm that more is a construction lending agency lin the perl'ermanec of Ix the work or which this permll is issued(Sec,31,17,Civ.CJ QLender's Name z Landers Address V Q 1 certify mat 1 have read this application and sore that the above information is D. f" correct 1 agree to comply with all city and county minarets and state laws relating to C) building contraction,and hereby allLhorivc representatives at mus city to enter upon the move me judgments, properly for expenses purposes. F 1 (We)agree to save,indemnify and keep harmless the City of Cufamn,against rn liabilities,ierdgoffileosts and expenseswhimmay inanyway acme against mid City V z in msec uence of me gran sett 's permit. T UNDER ND WILL COMPLY WITH il-L NON-POINT Issued by: Date URGE r:GUTAT ✓7S/ nature of AppfieanUcuntractr,r ©—`Dm�Z Re-roofs HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will flue applicant or home building occupant store or handle haarduus material u defined by the Cupertino Municipal Code,Chapter 9.12,and the Heallh and Safety Gxlc,Solon 25532(x)? ❑Yes All roofs shall be inspected prior to any roofing material being installed. will the applicant or fuwm building onropant useegaipmem or devices which If a roof is installed without first obtaining an inspection, I agree to remove mil hwardaus air contaminants as defined by the Ray Arca Air Quality Management Di.sunct7 all new materials for inspection. ❑Yes apter Ihave mad mchsmaterials uter5is my ureispmdhiliry to onotid 195 of mpoc oCl of tho r. alth&SxlcCtalc'Seednnx2551 .2557t.d25534.1.nde,..Jthalilmeru,Idin,do,,,rotyhivam tll equ e /�(�f C////// \✓Y � ems wl ch muss no Tswana ol'a Ccmncte aol'tX guy, lh' / Sign tore Applicant Date Dan 7tt thonedagent L` - Date All roof coverings to be Class "B"or better Budding Division 10300 Torre Avenue &CMMO Cupertino,CA 950143255 Telephone: (408)777-3228 Fax: (408)771-3333 .CUPERTINO Building Depar' tm' ent 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 Wand 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 V4"per foot slope and demonstrate that there is no ponding. Z 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: aro? Address•. - [q ZZ Reroofing Company Namq,,' ' [16 foS C on Sl' Applicants Signature: Date• /-(C(IO Joe Antonucci (Chief Building Official) 6/25/01