02110119 4 CITY OF CUPEW11NO
BUILDING DIVISION PERMIT CO NTRACTOWINFORMATION
BUIL DRBRIN WY APACHE ROOFING PERMIT N®2110119
owtSIglOTO CARMERLO 5829 EL DORI DR APPLICATITN1s1MS"Y2002
ZONE: 4 O B 3 63—0 2 0 5 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0
r00 LICENSED CONTRACTOR'S DECLARATION
<u� 1 hereby affirm that 1 am licensed under pmm.ions of chapter i am
nmenenb Job Description
G<z with ScedionTXXI)of Division 3 nl the Business and Professions ode ars(myliccnseis REROOF
imfull fo=and cr 413 9 Vy
=Fs
�= Li.en� s �ay—wm �rs-3 `m'ae�
- ft�OG�IIal�GDD
ARCIIITECTS DECLARATION
aoQIundcrsunJmyplanssnagbeuudaspuM1licmcnNs NOV 2�U2
SO6D
to LL�j Licensed Professional
OWNER BUILDER DECLARATION
rc <Y 1 hereby alftm that 1 am exempt from the Contractor's Liecuse Law for the $6500
¢OO following reason.(Section 7031.5,Business and Professions Code:Any city or county
°'w�2� which mimics a permit to construct,alter,improve,demolish,fir repair any structure BUILDING
I—ia
prior it)its issuance.also requires the applicant for such permit to rite a signed statement
that he is licensed pursuant to me provisions of the Contractor's License law(Chapter 9 .$q 962.ffBo1DBA1@� Valuation
.Wa (commencing with Section 7000)of Division 3ofthe Business and Pro or
.. sCode)or
c. $ Nm he u exempt themfrom and Ble hands fur Ne alleged exemption.Any violation of
SeNon 7831.5 by any applicant for a Permit subjects the applicant to a civil penalty of
POccupancy not mom than fire hundred dollars(SSW). 307 �NPNWE
P y Type
❑ L 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 auto(See.7064.But inccs 6 8 1 Reep T
.it gp
Professions Code:The Contractor's License law does not apply to in owner of 602 — ROOF P Z YVU nWfkof ifms
,,.,,,ywon builds fir improves thereon.end who doessuch wort himself fir through his s L
own employoes.provided that such improvements arc not intended or offered for sale,If. 603 — ROOF BATTENS
however,the building or improvement is sold within one year of completion,the owner,
builder will have the burden of proving that he did not Wild or improve for purpose of 604 — ROOF IN—PROGRESS
soled.
❑ I.as owner of the property,am exclusively conuarting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li.
rinse law does not apply to an owner of properly who builds or improves Ihercon.and,
who contract%for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
❑I am exempt under Sec. B&P C for this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the following declarations:
1 have and will maintain a Cenifcate of Consent u self-insuro for Worker's Compen-
sation,as provided for by Section 37W of the Labor Cocc.for the performance of be
work for which this permit is lamed.
1 have and will maintain Worker's Compensation Insurance,aw re,ored by Section
71 Of the labor Code,for me performance of the work for which this Permit is issued.
My Worker's Com dn%adon Insurance
t carrier and Policy number arc:
Carrs _� ( Policy No.:�--/9`X"�Z° J
CERTIFIC TE OF EKEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This.scetinn need call be completed if the Permit is for one hundred dollars(SIM)
Icssd
I cenily that in the performance of the work for which this Permit is issued.1 shall nut
employ any Person in any manner set as on become subject m the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT.11,aIle,making this Crm icam Of Exemption,you should
Wernew subject to the Worker's COMPenesminn provisions Of the Labor Coca,you must
OO forthwith comply with such provisions or this Permit shall be deemed revoked.
z N CONSTRUCTION LENDING AGENCY
[-+ I hereby affirm that there is a construction lending agency for the Performance of
tY the work fur which this Permit is issued(Sec 30D.Civ.Cd
Ia10 Lenders Name
11 Lender's Address
=1z
V 0 1 cenily that I have read this application and some that the above information is
OF building 1 agree to comply with all city and county ordinancesisof and stye laws relating e /
V building construction,to on,and hereby authorize representatives city to enter upon the
Ct1 .Mw-mentioned property for inspection purposes.
F t1 (we)agree to save,indemnify and keep harmless the City of Cupertino against ,
UN failhis,judgments,costsandexpcnscswhichmayinanywayaccmcagainstsaidCity
z A consequence UN UNDERSTAe granting ofNDS
thisFermiWILL
Issued by. Date
^Z APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
SOURCE REGULATIONSAc��L&
.
urtmatur Srgnamrc of Apphn'AZ^ Re-roofs
HAZARDOUS MATERIALS DISCLOSURE Date Type of Roof
Will the applicant or future building rweapant store or handle hazardous material
as defined by(be Cupeoinn Municipal Cade.Chapter 9.12,and the Health and Safely
"MILCodc.Section 2533200?
❑Yes Py"_ All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or Idiom building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit harallous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
Disoict? P
❑Yes 9ald1 _
I have mad the Worrous materials requirements under Chapter 6,95 of are Califor-
mia1huhl SafetyC,lc.Sado.255115.25533ond25534.1 undcrsmnd mat if the building t /� 02.
does bol currently have if that it is my resWrviM1ility to notify IM ace p m of the 1 .�./;
mquimmdnts wh p met dmel rlo issuam"d cemRram or ae�� Signature of Applican DateSignature of Applican Date `
Owner oraulhoriAdagent Ddd9�2 All roof coverings to be Class "B"or better r
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
4CITY0 Telephone; (408)777-3228
CUPEI(TINO Fax (408)777-3333
Building Department
Subject Reroofing policy for the City Of Cupertino,
I. Prior tOpem-dtissuance,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 inspecti6n can be performed.
IMPORTANT:
1. Flat roofs must have a minimum of IK"per foot slope and demonstrate that
there is no ponding.
2. An LC.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:
Reroofing Company Name: q_e�-
Applicants Signature:
ate:
Joe Antonucci
(Chief Building Official)
&25101