01100112 TINO
` CITY UI DSI G DIIVIISIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0,
22445 CUPERTINO RD A B C 01100112
OWNER'S NAME: APPLICATION SUB DATE
SUNNY VIEW LUTHERAN HOME 10/22/2001
PHONE: SANITARY NO. CONTROL NO,
O O ARCHITEC(ENGINEER: BUILDING PERMIT INFO
<U� BLDG ELECT PLUMB MECH
<i E=
S N Z LICENSED CONTRACTOR'S DECLARATION Job Description
5 z_e 1 hereby affirm that I am licensed under provisions of Chapter 9 heorrmencing P
m)=w wimsmion7WO)ofDivisionJofineBuzincssandRoressionsCode.aitemYliccnse REROOF. (BLDG.A, B C)
I m , is in full forte and t r
:� Lmen. emhh uc.a / REMOVE SHAKES & INSTALL COMP.
a.
i 3 O N
Data
Contractor
ARCHITECT'S DECLARATION
I understand my plans shall h used as public records
en Y
d O O
Licensed Professional
o�
OWNER-BUILDERexempfrom the RATION
I hemb)affirm that 11. exempt from the Coairms C e License taw for the
(_?0 following reason.(Section]071.5.Business and Pmfewions Cade:Any city or county
D pnwhich mqu ms a perm t t t a alley.t t firr o dcmoluh reps onY stmnure - -
m _tha t to.s al m9 .the iammmfor Commrm's faun g� ummem __ _. - ..
e - mithdsl -udpunAmtBinepav,mmormecomramnr:u Sa (Chapter 9onsCide) (e tt » Sq- [11 -loor-Area auation
(comma 8 tiller 170on) The iasis Jofthelaicidisadiati. �s ns Code) t \3Je k (' r'ar>_ t,/y\ 1"'I ,_t
,I .Itf?''�.
or that he rs exempt m y aufli and the bass for me alleged eaeicart m Any violation
-ofBecdon9031'.5 by any applicant for a permit subjaks the epplinm m a evil penalty- 2(mast mamma.five nandredaoners($50)). APN Number sr':) Occupancy Type
❑1; 1,
as wner of the property.or my employees with wages as their sole compensation, _
will'do'
the work.and Jae shnctma is not intended or offered'for'eale'(Sec.7044,'
'Busineis'ao 'Pri fessiotu Code:The,Canaanor's License law dors not apply to an 307 - INSULAT IO*ired Inspectionst"`- '"'ll
owner of property Who Wilds or improves thereon,and who does such work himself
or through his own employees.p sea that such improvementst intended or 601 - ROOF 602 ROOF PLYWOODFNA
Bereafm halo If,empl til ti Iain improvement old Nn one -' "'TEAR
(Completion,she owner-builder will have the burden of proving that he did not build or NAIL!f,,,)
Imprnveforpurposeafsale.). 603 - ROOF BATTENS .
1;as owner of the progeny,am exclusively contracting with licensed contractors m -
s 4 - ROOF IN-PROGRESS - - ...__7i
- _ License
the project(Sec]094.Business and Pmfwhob Cade:)The improves
du 's
License Taw does not apply m ro owner th Property,who builds ax improves thereon,
.,-•_.� ..arta
omracm focmch..P..m..m..rs.w.i.rd.a..comracmex').l,cmud.pusus. .me __-__-_
, conratemecm
❑l em exempt under see B&PCfrNisreaon
1
Owner.:.l .til': it..,.l,..oate i. ...
WORKER'S COMPENSATION DECLARATION
Jhemby aRirm undo pctmhy of perjury orifi of the following d¢Imetians
e ❑ 1 hbde and will mainlain'u'Ccnifica¢of Cim,iem to self-insure for Worker's
Compensation, as provided for-by Section 37W of the labor Cade, for the
'perfommnce of the'wah for which this peamit is issued.
❑1 h -d will mai t Worker's Compo mon 1 i...a a required by lection
37M of the Labor'Code,for me ifetfommnce of the work fo'r which this permit is
Carol aQ�l _ pen uonl suranc carrier and Policynumbe
ssu d My Worker's C
x cc ( yy ``
i1<7 IWORKE ll'4 Ili k�I 1y tit /1 t J t i} i.,ll'
✓,. -- i • C
COMPENSATIONOT1. 1.INSUpR�NCE, vr. ..-------
,
,dot 1'1lisun on eednotberom Iced eche for one hundred sonars
IS 100)m,less.)„_ ., P.m
.... ...--., __..-_.... .... .,..-..,....... .... --.,
t 1 mfy that in til pert a t Y,hork f hich til pe ui issued I .. -'- •-• -__-.
,hall n t Irl n,pe In o y morin so as to be come s bl t t the Workers
Compensation Taws of C bf rale.Date"
,'APP( t .-..
NOTICETOAPPLtC after mad,hrig this Certificate ofEa pis you should
Z roes b7RIeW k 'C ions t pro s of the Labor Cade youu must
fmh '
� Q forttil comply
y 'til s h provisions ns toy m perout shall bed reed revoker.
(CONSTRUCTION LENDING AGENCY -
-� o '1 h by affirm that there is a inci o i led g agency for N perfoniunce -- - FI
r� Iti - ch this Permit - -d(See 3097 C C) "
of til okf �h '
Z LaMar
Ianda s Add ss
v gt, r,s. I cemfy thin 1 have mad this appbcauon ens Sete thu me abov<mformadon is
[r sneer.1 agree to comply with all city and county,ordinances and>me laws relating
to Wilding construction;and hemby 9uthimsercpresentativea ofthis city to enter upon
the b e s( ed fmipe.,far ix,farri.mp rTm i. r.
L L (W)ogre sa a de Iarta k p harm) the Cry f Cu penins against
LLLL z
liabilities,judgments,costs M expepe nses hmh y,in any y true against said
�.) ti Cityy c_nssce of ih gram g f This perm t.
APPhICANT UNDER N 4ND WIL o1 LY Wfl'HALLNON-POLYT " Issued by:
SOURCE REGULA'f •t' '; ;i)i:` S Date 62- 2-2--
c
as isomer]by mac pert MuOna ICodl iA rS� OSU '.
Sr Signals. (APP( anUC t t Date.:: Re-roofs
o"� M11 me (cent hope Wes SURE t .. / n
PP Cade, rhalB Iuaanan safety. of Roof.fCemDde.ShGt.�2.. OdC4.. L)Ilrp ,
arta me Health arta Safety --". - --
Code Section'25532(1) yyi , -,y stir!!YYj n Yet St ),i, a v t9 a'. . ...' .- _ ...
❑Yea v1- ex* No - y 'st t ) at ( � +P 1i_diC 161 1:.
` t.,;, s All roofs shall be mspec[ed prior to.any roofing,material being installed-._,_._____
Will the epphyq t frame 0drug«cupemasacRlipmensordevices which If n of Is installed without First obtaining an'ins action;Lagree'to.remove
emit h vrdou a contaminantsh5 fed by the B y Area'A Q al ty M ge m g p
Imo, a�oYes-I all new materials for inspection. Applicant understands and will comply-with .
C "I all PP non-pont souice regulations:,
I have
moi 411m hamrdo malenals¢gmremen¢sense Chapmr 6.95 of the -•` ' '
Calif0 in Heafth&$aretY Cod Seci trs 25505;25533 and 25534r l inoodeosmaidninitt
(thentita,ngdN note dyM1 e mount,Int t'. 1maw bltyt, tify the
o up t f til reg t h muni be t p o'io iisua tt f 6 Ceri(care of
Signa e of Ap 'cant Dale
s
Ownr ,manse :I,. Date• ,. All roof coverings to be Class"B" or better '
ti i {-....r a'�( 1" _ . -t -' OFFICE-
a"aom
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
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 policy on reroofing and will comply with this policy.
Homeowners Name: _ �anh✓o11 /r'P>,L/l�� )o y (4p� mun�jL5/
yi
Address: o� L/Ll� C� /��n o Jr7 / p /`OGCI
Reroofing Company Name:
Applicants Signature: r d Date:
Joe Antonucci
(Chief Building Official)
6/25/01