02080043 CITYu.owc DIVISIONNO CONTRACTOR INFORMATION:
' PERMIT
BUILDING ADDRESS: PERMIT NO,
21559 EDWARD WAY ALL SEASONS ROOFING SERVICES 02080043
SUB DATE
TE2640 PACER LN APPLICATION
OvjN6ls'$ AR 08/09/2002
PHONE 4089724455
4089724455 SANITARY NO. CONTROL NO,
Q ZO ARCHITECT/ENGINEER: BUILDING PERMIT INFO
U BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
S„? Job Description
1 hereby aRrm that 1 am IicenwB under provisions of Cnaptee,t(commencing REROO F
F w with Section )of Division 3 of the Bit sand Professions qcode,and my licenx
Y to J is ce _/
¢i 6 Littn I
K O Q Dale ConitbOr
'°3 LL iii ARCHITECT'S ODFeIL.ARATI
'I undcrsmnd on,plans shall be used az public
tuz 0 0 Licensed Professional s
a' o OWNER-BUILDER DECLARATION
1 hereby affirm Nal I am exempt front the Conlmctor's License law for the
t E a following reason.(Section 7031.5,Business and Professions Cade:Any city or county $5825
E F O which q e. permit I consumer.alter, p demolish, r rep any structure
it. that tie
prior t also q N ,Tic tfo ch permit re fl g dstatement
Nat heslicensed p t.unt to the provisions ofN Contractor s License Law(Chapter 9� r, Valuation
(co m c 8 N Sect ]000) f '-' .3 f the Business d Professions- Cale) �(r��R4,
or that hes exempt donefirdm and the basis for the alleged exemphan.Any violation i
of Section 70315 by any applicant for a prodit subjects the applicant to a civil penalty,
ocnor mare than rive Honored douars S500). 3 0 5APN 1� Occupancy Type
❑1,as owner of Nc property,or my employms with wages az Neir sole comwnrnion,
-will di Ned Prof ssi the strucode:The C not intended Lice aoffersendLaw for sale apply to a;' - -- --- --- -- — — ----,--------.--------.------ — --
Business aro Professions Cope: int roves tcmr's Lkna Law d«s not apply m en 601 — ROOF TE1B@glfLt}:l;~InspeCtiOns' ``t y
owner of prop whn buildloycx or improver d such i and who does such work intended
or 602 - ROOF PLYWOOD NAIL
or throughfohis own employers Provided Nal men improvements ere not intended or-
oBeredforsale:wner- itdewiffic llhaveteburdenofprovnverecrit mmhedidnotWildor 6'03-----ROOF BATTENS a• '.. ;,., „_�_, -----
idmpledan.the owner-wiener will have me barren nr proving that he eta not Haim or .. . . .
mprove for purpose of sale.l. 604 - ROOF IN-PROGRESS
Q I f Ne Pmpeny,am exclusively contracting N licensed o f t 1: 1,17:1sl'
cont t o P a t face7067 Bus nes d,e f z ons Cad .)mp C t t s
License Law dues not apply loan owner-with,
property who) Ida or sed pur ua thereon, t -
:; .,and vekens for such.projects with.a cnmmcmrfs)..licensed.pursuanl.to Ne _._._ __ ..... _._._ _ .._ __.._.. ...__....... ... .. .._._.. .. ._.......__ ___._..__...
Contractor's mp eLa
❑1 me PI underStc. Da l C. x' ` PCfar Nis maxedII•IYl9�A@sE®
0 er Dat " -I
WORKER'S COMPENSATION DECLARATION
I hereby alarm order Penalty of peiju'ry oneor th. fol lowing declamtions:� AUG 2 3 2002
i• O 1 nose and will'miintam z'Cenificae'of Conant to self insum for Worker's
Compensation, as provided-for by Section 37M ofthe Labor Code. for-Ne
wiformance of the work for which Nis permit is issuM_ BUILDING
❑1 have ill and wmainuin Woikcr's Compelixtum.Insurance,ax req iircC by Section
W f the will
Code fo Ih pcTnn c of th work f h h ih 'wan i
u dMy Wo rsC w t Isumn aadPol y tube
__
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f ._._.__.�....,,.._„
t., t
„ L SCLRTIFlCATION OF F,XEMPTION FROM WORKERS L'": � :.. i. ., !. IL n h ,
,r
—a
'1 (Th tion need nm be'cnmplemd if the permit is for one hundred dollars
(5100)or In,
1 mu y mat n the perf ce f Nc work for which this
pc 't _Q,
I t-..:.,L.'• :I„. Ltl k 3 �— - __ —
ihall not miploy anywren Yas m beemne subject 1 the Wo kers "'
Cowonlawsof Cabforn Dri
mnsaie`ne
. APPlicani'�.' .. ..
NOTICE subject
theW :16 after Compseking this Ccsinins fof Exemption. ,yc;aiuldl ;6:.1i -
Z become suompy thesubpr Colons or this Permitinnsiledthe tabor Code,you must "
z
forthwith comply with iu<h provisions or this Permit shall h deemed rooked.
t - '•r'C°NSTr _•Nu LEN.D.ING AG.:E..N.cCY
IM1byrNcisiteoveIon ending agency
for e performance
of the rk for which this Permit 11 issued(Sec 397CvC.)
Oa 'Leinder Mame
,
.7. Z
GL I cert fy then 1 have read Ihts application and stale that the above'nformahon is
'emoict11 agree ro comply,with all city and coum undinances and date laws relining
I to building mnsmiction,and hereby huthodweepreanwtives'of i^iscitym emer upon
W the move-oventioned property for"n w ti
Eva L f We) g Its save d m 'fy d k ep forms 1. IM1e City of C peR i-,'agatnnt
V] I ab I hes 3udg oro t ed pc which y any y against said
U Z City con seq nn'fth grant g of ths - `
PP 1 AVTU ^, TA\DS AVDWILLeCOUPLYN'RHALLVOV Pt)L\7 ®' /
RCE RE n �_ Issued by: Dale v
aignamm of Appfc contractor,;; , . '�; Re-roofs
RDOUS MATERIALS DISCLOSURE
Will We t f t ba Id' g cpwm n n me na:ard ,mat a T e of Roof ..
a.d f neo , N pen M n PSI Code Ch pt 9 12 and N H IN a d oaf ry yP - ..... .—_ ..d......,.,.. ,.,..........,,,.,... .
Code Sen n2531a1 / v'w +•- t -J !
, Ixii rt Tat bks ` at t'. 1a) Fj : h :?a
All,roofs shall be inspected prior to,any,roofing material being installed.
P ' equipment, ° ion ^ If a roof is insialled1without firs[obtaining an inspecuon,`I agree to!remove
P
Will the ppli I future Id '^
it has J -ant n t 'J ed by th BayA aA Q ItyM '-ge t
°" "aY `_ all new materials for inspection,,Applicant understands and will comply_wlth
° all
non-point sMcerlattons . - -
p be'read Neh xerhm,mmeriah requ rcmenti and Chapt 6.95 ofmefomit Health'&Safety'Code.'Sections 25505,25537 and 25536.I undemand that
ifmc building don nomnnendy have a«nam.Nal it is my mswnsibila,ro nmifythe - — - - - -- - — s�
cupevt oht mems which must be met pari to i:xuarc'e of a Csrtificam of - -_ _ _ ,�✓�+. - _
rc rt rc
.Qcupanty
iF �.�. Signature of APP( nt_ ate
... Owners aaN ed agenr ' -. ',','f.- Date All roof coverings to be Class"B"or better
Building Division
10300 Torre Avenue
OCOF
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Pax: (408)777-3333
CUEkINO
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 fust 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 Name: A a/ -SG( 10—
Address:
Reroofing Company Name: ��
Applicants Signature: Me, I Date: e-,2
Joe Antonucci
(Chief Building Official)
6/25/01