02110132 4 CITY OF CUPERTINO r
BUILDING mvISH N PERMIT CONTRACTOR�INFORMATI0N'
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Bulff3Jj1cbN"EsE=RD WY JIM KRAUSE ROOFING PERMITN(02110132
WbO�NfIoARESH SUDKA 2310 DIANA AVE APPLICA'1'I(pN1Sls�'mTi 2002
INFIONE: (408) 779-0704 SANITARY NO. 7, �L 77 CONTROL NO.
ARCHI'MCI'IENGINEER: BUILDING PERMIT INFO
_ BLDG ELECT PLUMB MECH
0 0 0 0
,00 LICENSEDCONTRACTORS
order IF DECLARATION
C U I heresy affirm that 1 am 1 me Bu under ad Purons of Chapter 9 on,heeme, Job Description
with Section 7axB of Division Jof me6usinesaanJ Professions Crwk.and myliccnuu REROOF p
GLfall tb sande 3q 5 35 FB����
Liccnut Lic.M
Dam r�� Contractor
l'= 1. ARCHITECT'S DECLARATION
Six I demand my Plana shall
is,W used as public mends
JA
2 8 2003
ROyU
w39. License)Professional
0a OWNER-BUILDER DECLARATION
J
0 q 1 naso ,(Here Inut 11. exempt from Be Contractor's Co License law forme BUILDING
6 0
p D following reason,(Section 703 1.5.Business and Professions Code:Any oily or county
x m which myuifes a pcmlil m construct,alcor,improve,demolish,or repair any swcture
w-O+ pnorto its issuance,also requires the applicant for such Permit o File a signed statement
that he is licensed pursuant in the provisions of Me Conceatur's License Law(Chapmr 9 3A.ER.ffT3b6A100 Valuation
,at-m (commencing with Section II01)of Division 3 of the Business and Professions Code)or
a
that he is exempt merchant and the basis for tbe alleged exemption.Any violation of
Section]031.5 by any applicant for a Permit Subjects the applicant to a civil penalty of NrN Occupancy Type
not mom man Ehundred narea dollars($500) 307 — INSULATION
❑ I,as owner ofmc pmpeny,or my employees with wages as their.sele compensation,
will do the work,and the structure is not intended oroffered for sale(Sec.7044.Buse
and Pmfessiora Code:The Contracture License law does not apply to in owner of 602 - ROOF P "� rVAC�ins
property who builds or improves mention,and who doessuch work himself or mrough his
own employees.provided that such improvements are not intended or offered for ale.If. 603 — ROOF BATTENS
lumever.the building of improvement is sold within One year of completion,me owner.
builder will have the burden of proving that he did not Wild or improve for puymse of 604 — ROOF IN—PROGRESS
Side I
❑ I,as Owner of the property,am exclusively conmac0ng with licensed contractors to
consumer the project(Sec.71144,Business and Prolesslons Codc:)The Contractors Li-
u law does not apply to an owner of property who Wilds or improves themmn,and
who contracts for such projects with a contortionist licensed pursuant o me Contractor's
License law.
❑ I am exempt under Sec. ,B&P C for this reason
tuner
Date
WORKER'S COMPENSATION DECLARATION
1 herehy affirm under Pemilly of perjury one of Ne following declarations:
❑I have and will maintain a Cenifcam M'Commruo self-insure for Workers Compcm
satins,as provided for by Section 3]1x1 of the Tabor Code,for the performancc of me
work for which Nis permit is issued.
have and will maintain Worker's Compensation Insurance.as required by Section
J Ixl of the labor Code,for the pefformance of me work for which mix permit is issued.
My Workerr x Cnyr/9p-e ati/nofn Insurance easier and Policynumber
u �Meam: p
Cartier: 1I l�� Policy Nn.:Ld J'��—0�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section nod not be completed if the permit isprone hundred dollars(5100)
or lcsx)
1 certify Nm in the performance of the work for which this permit is issued,I shall not
employ any Person in any manner so as an become subject o the Workers Compensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:IL after making this Cenlfcate of Exemption,you should
become subject to the Worker's Compensation provisions tl the Labor Code,you most
OO forthwith comply with such provisions or this pefmil shall W deemed n,vnked.
z N CONSTRUCTION LENDING AGENCY
[- I hereby affirm Nat mere is a construction lending agency for the performance of
�i
the work for which this Fermi t is issued(See 3(X37,Civ.C.)
QLender's Name
= z Lendch Address
V C 1 cenify mal I have read this application and.aWrc that the Shove information is
f-' correct.I agree to comply with all city and county ordinances and state laws relating to
�U building construction.and hereby authurim mpresentativcx of this city to enter upon the
liarwv-mentioned progeny for inspection
es purposes.
Fr^ a (we)agree to Save.indemnify and keep harmless the City of Cupertino again
h in
egence o Orts,graUindof this csmit. may in any way accroc againstsaid City
U Z in consequence of the graining of this Permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NOry PO NT Issued by: Date
SOURCE REGULATIONS. /� /�Z _A
Signaturenrnpplinnvcnmmetna Dam Re-roofs
HAZARDOUS MAIERIA.S DISCLOSURE Type of Roof
Will the applicant or future building occupant stare of handle harallous material
az deems)by me Cupcnirm Municipal Code.Chapter 9.12,and the health and Safety
lq Scerion 25532(
❑vee m.�- All roofs shall be inspected prior to any roofing material being installed.
00
s c
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
comol mNntitlaous air coamantsinnts a'defired hy the Bay Arca Air Quality Management all new materials for inspection.
int
❑Yes
1 have read the he ardous materials requirements under Chapter 6.95 of me Califor-
niallcalm&Safety Crede,Sec0mts 25505.25533 and 25534.1 undersand the ifda Wilding
does not currently have a tenant,Na it is my resplmsihility to mi Y=t copal of the
requireinen f`aanrus MmetPneau iastanccofaCcNFicareofOcc _cy. Signature ofAppli cent Dale
// z oL
Owner ora ffimi,edlitter „c All roof coverings to be Class "B" or better
' Building Division
10300 Torre Avenue
&CITYO
Cupertino,CA 95014-3255
Telephone: (408)777-3228
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 Y4"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 andwillcomply with this policy.
Homeowners Name: aC
Address: x--15 (- o 1
Reroofing Company Name:
Applicants Signature: 0 Date:
Joe Antonucci
(Chief Building Official)
6/25/01