03030014 CITY OF CUPERTINO CUNTRACT®It INFORMATION
BUILDING DIVISION PERMIT
BUILDING ADDRESS: JIM KRAUSE ROOFING PERMIT NO.
10793 W ESTATRR DR
'S NAME: 2310 DIANA AVE PERMIT6SSSUEDATE
IGNAITIS JOSEPH AND ELIZABETH
NE: (408) 779-0704 SANITARY NO. CONTROL NO.
ARCHITECTIENCINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
uoo LICENSED CONTRACTOR'S DECLARATION O O O O
OF 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
^� with Smon7")of Division 3 of the Buu^r&j!^d Pmlessions Code.and my licence is
in lull torte rad eaecft_, _ -uq 7" REROOF
; ? oZM
,laaroClss ! Co T/O SHAKE, INSTALL 7/16" OSB, 30LB FELT
ON
I ,nden "R �SD,public"moomiti �.=' 30 YR. DIM. COMP SHINGLES
k GLicensed Protc sicna
3 WNER-BUILDER DECLARATION �BtaQa tl N® O ��
.�e f I hereby AMo.that I am exempt from the Contractor's License law for the N G's'q lea
i o o following reason.(Section 703 1.5,Businessand Professions Code:Any city or county
m ff which requires a permit to construct.user,improve,demmish,ter repair any structure
�to
prior m its issuance.also requiros the applicant fnsuch Permit to file a sigmd statement
-e that he isliecnudpursuant tothe pmvisionsOfthe ConuselOel lcen=Law(ChaPW9 Sq. Ft. Floor Area Valuation
,- (commencing with Scedon 7")of Division 3 of the Business and Profusions Code)or
$ that he b exempt therefrom and the bss0 for the alleged exemption.Any violadon of
Section 7031.5 by my applicant fm a permit subjccu the applicant to,civil mnalty of ppN Number Q B&Fp&ay'Iype
not more dean rive hundred dollar(5500).
C]1,as owner of the property,or my employees with wages u their sole compensation.
.III do the work and the smcture i...t intended or oRcreA for We(Sec.7061,Business
and Professions Code:The Commerce,License taw dos not apply to an owner or Required IDSpeCtlOns
property who builds or improv Ne m er.•rad who does.m a wok Idmrelt or through his
own employees,pmvided that improvements arc not Intended or ofrered for We.it. 3055 - FRAME
however,Ne building or improwmem i,sold within am year of completion,the amner.
Wilder will have the burden of proving that he did not build or improv;for purpose of 307 - INSULATION
`ale'1' 601 - ROOF TEAR .OFF
0 1,u owner of the property am exclusively contracting with licensed contractus m
cumwcr the pmjem(Sec.70".Business and Profusions Code:)The Contractors U. 602 ROOF PLYWOOD. NAIL
On.law dos not apply m an owner of property who bund,or improv thereon,and 603 - ROOF BATTENS
who comncss for and projects with a eonuacmr(s)licensed pennant to Ne Conmctoea
uenrrs I.W. 604 - ROOF IN-PROGRESS
0 lamucmptundes Sm. ,BAPCtos delsaccom
Date
WORKER'S COMPENSATION DECLARATION -
6137W
1 hereby of inn under penalty of perjury oro of Ne following declantionsi
aw and will maintain a CenlOnte of Consent self-Ire ure for Worker',CumKn.
,u Provided for by section 3700 of the labor Code.for the performance of dee
for which this permit is issued.
aw and will mumuin Workers Compensation Insurena,as required by Section
of Ne labor Code.for dee performance of the work for which this Permit is issuednrkeescompeuadonl sunnce 'm and Policy numhe'u: Policy NOM
CERTIFICATE OF E%EMPIlO OM WOR ERS'
COMPENSATION INSURANCE
flhis ettvion reed norhe complcte0 if the Iermiti,fmomhundrW dollua(SIM)
._ ._. mleu.)
1 omify that in the performance of the wart for which this Permit Is issued,I shall no - - —e _-----_-� --------- - - — -
employ any person in any manner¢as to become subject in the Workui Compen.tion
Lawauf California.Dam
Applicant
NOTICE TO APPLICANT:If,after¢,king this Cenificam of Exemption,you should
become subject to the Woher',Compeosation provisions of the labor Code.you must
,Z foMwith comply with Inch Provisions or this Permit and]he deemed revoked.
OCONSTRUCTION LENDING AGENCY
[-a Iherehy Affirm that there is a construction lending x,emy for the performance of -
C Y the work for which this permit B Wood(Sec.3097,Civ,C.)
0 Under's Name
a Lander'.Address
U Q 1 sadly deal l have read this application and sum that the abow information 1, t
it, F correct I agree to comply with all city and county ordinances and slam laws relating to
0 U building construction.and hereby aurborie,mpmsenmtiv of this dry to enter upon the
W above-mcndoncd property for inspection purposes.m4
g), (We)agrce ro saw,indemnify orb leo harmless the City of Cupertino against
,n liabilities judgments,cameo lipen swhi may In any way¢cme,gunsl old City
in conxgmncc of the gr Ag o�f�b6 IL
a-r SOULI�� UN E DP WILL COMPLY WITH ALL NON-POINT Issued by: Date
Re-roofs
SPliffina o Pp nVConuactur
aw 7—
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will dm applicant or future building oeeupantsmm or handle hoasdous material
1.jI
dcnmd by the Cupertino Municipal Code,Chapter 9.12,and dm Haahh and Safety
c,$cOc Yc=15532(a)? �� All roofs shall be inspected prior to any roofing material being installed.
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
havardou air mnvorlo.m as Med by the Bay Area Air Quality Managcmem all new materials for i lSpectlon.
rict?
DYe. Nu
Ihaw reW Ne hma a 'shout ' cntsundcrChapmr G95ofdc Ctlifom
Healthg:SaletyC 5: am125534.1 undersmM thmi(de building
tcurrent mym.poruchility 0 nadfy the occupant of the �_re Prior m issuume of.ccruls1 0<upy�y
y Si ature Applicant ate
ter car md.gent °am All roof coverings to be Class "B" or better
t
j g Community Development Department
4
Building Division
1 City of Cupertino
10300 Torre Avenue
CITY OFI Telephone: (408)777-3228
C O D E kT I N^ Fax: (408) 777-3333
Building Department
Subject: Re-roofing policy for the City of Cupertino
1. Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manufacturers specifications on re-roofing.
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 re-roofing
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) Pre-inspection 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 a 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 on inspection.
I understand and will comply with the above stated policy on re-roofing.
Homeowner's Name: L e— �gvLQ rJ
Job Site Address: /d 723 6-J -
Roofing Company Name: yam'
A plicant'1/s/Signature: Date:4��/��3
Greg eel
Building Official
Revised 1/30/03
Printed on Recycled Paper