02100042 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BUlI'P4(6AyDRD!E LA FARGE DR ROOFMASTER OF SANTA CLARA PERMI'fN®2100042
pW*1914EY RUTH H TRUSTEE PO BOX 2711 APPLICATI?tU11H9r�T(12002
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lipZONE: (4 0 8) 74 1-4 9 0 0 SANITARY NO.// VV // CONTROL NO.
ARCHITECUENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
ce., LICENSED CONTRACTOR'S DECLARATION O O O O
z u F 1 hereby million that 1 am licensed under provisions of Chapter 9(commencing Job Description
taiw;IhSection7(XX))ofUivision3nlthe Business and ProfessionsCode.and mylicenseis REROOF
in full tome and ff
z0$__ •c�TLi
OZF� t J Gn0lrufIn,
�' � ARCHITECTS ATI
O1 understand my plans shall Be used lie rttvxJs
KyU
w3 w, Licensed Pml¢sinnal
Oa OWNER-BUILDER DECLARATION
ce 2alF 1 hereby allirm that I am exempt from the Conrac ol'x License Law for the
p O killowing reason.(Section 7031.5.Business and Profcsvons Cole:Any city or county 0
x m which requites a permit to container,alter,improve.demolish,or repair any.oructure
F=< prior In its issuance.also requires the applicant ler such permit to file a signed statement
that he is licensed pursuant In the provisions of the Contractor's License Law(Chapter 9 3SFg9h2A:Do1a7A0C Valuation
SII_ (commencing with Section 7000)(it Division 3O the Business and Professions Cale)or
i 3$ Nat he is exempt therefrom end Ne basis for the alleged exemption.Any violation of
Section 7131.5 by any applicant for a permit subjects the applicant to a civil penalty of PAtN
not more man five hundred dollar.($5170). Occupancy Type
307 - INSULATION
❑Lo the work,the property,remyemntendeor d or offered
Roxhev sole 0,14.8 Business
will do the work.and the structure is not intended or offered fnr.wle(Sec. Business —
tend Professions Curie:The Commit Liccnsc Law docs not apply to an owner of 6 02 — ROOF P Cu.Yli nSBCcil S
propcny who builds or improves thereon,and who dmssuch work himselforthrought his
1w
1VALL
ownemployees,provided Out such improvements are not intended or offered for sale.If. 603 — ROOF BATTENS
however,the building or improvement is sold within one year of completion,me owner-
builderwillhavetheWrdenofpeavingthelhe did norWild orimprove for purpose of 604 - ROOF IN-PROGRESS
sale.).
❑ 1,ruuwmfof the Property,am exclusively contracting s with Theedconvectorsm
cars,La the project(Sea o an Business and Professions Cade:) pro Convectors tad
cense law rims not apply to an owner of progeny who Wilds ol;mpro thethereon,and
who amtmas for such projects with a contraction(s)licensed pursuant to the Convector's /
Law.
0 O/
lam exempt under See. ,B&PC for this rcaznn
Owner Dale
WORKER'S COMPENSATION DECLARATION
1 hereby alarm under penally of perjury one of the following declarations:
0 t haw:and will maintain a CeNficare of Comenuo self-insu ,for Worker's Cooper.
swim,m provided for by Section 3700 of the labor Code,for the performance of the
work for which Bis permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of Be IaWr Code,for the performance of But work for which this permit is issued.
My Worker's Crimp $anon nsnnmc tier and Pol her am:
ice ��_,�Policy X.
CE 'nPiCO E SATION10NFRA K'
COMPENSATION INSURANCE
obu section need nut Be completed if the permit is for one hunted dollars fSlg)
or less)
I certify that in the performance of the work for which this Permit is issued,I shall not
employ any person in any manner ser as to Become subject n the WorkersCompensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IL after making this Cenificme of Exemption,you should
become subject to the workers Compensation provisions of the Labor Cale,YOU must
OO forthwith comply with such provisinus of thmit is pershall W deemed revoked.
z' h CONSTRUCTION LENDING AGENCY
[-� I hereby affirm that there is a construction lending agency lir the performance of
a me work for which the'permit is issmd(Sec.3097.Civ.C.)
111 lender's Name
Lenders Address
az
U O I cortily Bat 1 have read this application and ante that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating to
QU building construction.and hereby imitator represcntahves of this city to crime upon the
ahovame judge, property forinspectionexpenses
nses purposes.
F C (we)agree uo save.indemnify and keep harmless the City of Cupertino against
fin inconsequent, ,msis e'mildiseswhich ma in any way accmc against said City
U z in ttinscyucnc it I got this permit.
^` APPLICA U R AND D WI COMPLY WI TfI AI.I.NON POINT Issued by: Date
SOUR
g Applica Cnnvretm Re-roofs
IAZARDOUS MATERIALS DISCLOSURE are Type of Roof
W 11 the Bcanl or future buildingmcupant store or Io rude harmetus material
az define c Cupertino Municipal Crede.Chaplet 9.12.and the Health and Safety
Code.Section 25532To. i
L]Yet; 0N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building ts'cupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit haimu us air contaminants as defined by the Bay Arca Air Quality Management all new materials f Insp ton.
District!
❑Yes ON.
I boom read the of nusmawrialsmquimmenuunder Chaprcr6.95ofine Califor
niallcalthASafelvlc' tions 5,25533and2553d.lu dcrstand Batifthc building O
does not curen haw at
.thm .myses namilit o nnel'thic'sco'cart trimy
mqu'femon inch Iit, a ;ncatenfwcupr' c gature f plica t at
wmfnr illi,. ,gent D All roof coverings to be Class "B" or belt
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Cl 0
F= (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
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 1/4"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: ff' (,-7 DE LPI FA - \ Q li: LN
Reroofing Company Name: - L�r�
Applicants Signature: Date: /4 6,
Joe Antonucci
(Chief Building Official)
U25/01