02050114 CITY OF CUPERTINO °
BUILDING DIVISION. PERMIT CONTRACTOR INFORMATION: -- -- --
BUILDING ADDRESS ,. - -. � - r , „ -, PERMIT NO
10'8;4'9; 'W ESTATES DR_ ; . LOS GATOS ROOFING`__: .:.• 02.050T14___ ,_
OWNER'S NAME:. - - - - "- _ - -' - - ""' APPLICATION SUB DATE
"I GAL ZADKOVSKY 1771 SMITH AVE. 05/20/2002
PHONE: - SANITARY NO. CONTROL NO.
4088650116 SAN JOSE, CA 95112
n-7 ARCHITECT/ENGINEER , - BUILDING PERMIT INFO
w22
<u G REROOF BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
1 hereby alynn that 1 am licensed under rev is ons orenapler 9(commencing Job Description -
iy=c
with Sea,� jOIXry of Division 3 of the Busin, rid Pmrasioni Cndc.andm license
full fo�e anJ effect. p' a Y - -
Ozu Ltlenx Co. f70�
3 LLu y ¢• M Co he
0 RCHITECfS DECL TION /LOoPo N(
1 undemane my plans shall be used as puE is recdrds . . _-
;tyi.Y� ,
3 i C o Licensed Professional t- • ,.
- LL
that I a BUILDERDECLARATIONIn RATION '
m I hcrcby affirm that 1 am'exempt from the Conoanor i License Inw for the
�"Z a fallowing rtuon:IScaion]031.5.Buzinas and Professions Code:AnY city ar county
E x D wh' h rcquu<s a perm t t nwn::hlmi,mprove d<rpobsh' -pair any stmcture
aemmem
that h 1 icd p - t td Ne pro is n of th Co vocro L x Law(Chapter 9 S Ft.,Floor Area
apm a i; 'm sea n]OOU)orD �! -3 nn B m< aMPr resstonaeada) ; ,:.�. 9•, � - _. Valuation
r th t h s mpt themfmm and the ba s fo th II gad ex mpt on A y v In a
_-
d S f ]03P5 by my apPlicam for a pc t b) i. me appl u t t d penalty,
i 'ornam m B�enanareaawlars(ssoo) . -. - - APN Number; , - rr;' .. '�r
. Occupancy Type
❑I as gwnwfthe psupenY,urmYemploYeeswthwegcs ex thersolemmpensfn, -----. _. .... .... .. ........_.-------
r.
_ _e]040- .. _:. _
Bu- es. J P of inns CMc The Cont ao L c La d not apply to an Required Inspections". '
ow
r of progeny Who builJs or'mprove thereon,end who does zuch work himself
or th gh h's o pl Y p -dM N i s h p t rc t m¢ntled or
.... ...... . ... ... ...__.. ..............__ ; .._. ._....... . ...
co d f ale If h l d l i11111 nce t o P t la—within one year is - t-
nmpl lion the owner b,i Ider w 11 hove the harden of proving that he did not build or
mprove for purpose of sale.).
.'i I,Ta nur of the p pentexclusively contracting withre a nnoanorsm
cer'nou
i p an(secBusinessand eono cao.)The a
License Law does not apply to an owner of proposy who builds or improwas thereon,
_and who o rns fo such p ) tswiN aco wn r(s) m
' .
m.th<Contractors L'came Law. _
q :
El am exempt underS . "' B&P C for this reason
Owner : ' Date ,. - U�N pl LT 202
WORKER'S COMPENSATION DECLARATION -
I hereby affirm under pen thy of perjury mie of the following declarations:
p, O 1 have and will'nmimain o cerpfiash,of consent to self-in,me for Worker's Sul
I C'�
N
f Compensation, in To ided for by Section 37W of L,he Labor Code, for he L/ D'p,�
- perfota
mna of the work for which this pe.it is issued. '
O 1 h mb ill mai t Wok Compe ( n 1 mnc required by Section ..
3..a f iM1 cwki,Code,for t6 (for !O il work f h'chthis' +
sau d My W ke "C pe t n u m c perm t
nil Pul<y be e
c �710IrF✓ND rP.he o f127� OZI
"CERTIFICATION OF.EX ION FROM WORKERS ]. L ,' !
e
'COMPENSATION INSURANCE'
to+ I ffh s x t n e a nm be complemd if the permit is for one hutMmtl collars 1. ,..,"4 C— _t -
' (g100) )- - -
s al Puri fy tha in the pert rmanc (the work for wmeh u perm i s k? d 1"
" shall of employ ,". • ' - - ~ f
P Y and Pe end man - m become subject m Me Woder% x♦ t -
Cn pe tion Incas of C 1 f 'n:Data
n
.A,,hcimI. ' " ._ -. - - __ _...
NOTICETOAPPLICANT If ft rmakingito C ri fate of Exemption.you should _—
bac uh3 n ii Work provisions
C rope t p it ria of a ame Coda you must
Q fonhwith comply- th h 's ons or this Permit shell be deemed invoked.
wi
pros
""'•CONSTRUCTION LENDING AGENCY "
a"� I
of the work for
aRrm that mere'isconswnion Iagency for Ne performance .. ,,,
which this Pertnih(is
i ed(Set.3
WU9L]'C C' C)
Lend ' Name
." -. .'........ _... _._.. _._ _
..... ._.
z Led AddressI .. ...
agree to c I have mad tinct appl c tion and smte marine above laws
rebating is
.F correct,I agree r comply with all city and a hpoemdatives sand.gate taws relining
to U th,aboveeconamiaionlandhercbyaeection uposes. Lives of this city to enter upon
y,.�, thaabo(we)igionedpropendfor rimify addknp1kdplc.., ,
(we) g t costs nae i,p and keep harm) n anyC a of c peri' i agamin
h cit 1 f j d6 td xppf ibi which yin end y rue against said •'"
U z City m cANT U rice of thegmm yD Ni Permit, -
APPLICA,VI'U T D iD WIL OMPLY WITH ALL CON- NT
Of/RCE L to s,. l Issued by: Dat
0
Sten m p(APPlic ' otmnntT,. =c„ Date., Re-roofs
. HAZARDOUS'MATERIALS DISCLOSURE -
• ' ''' - Wll the til tafw 'bu ld ti rec Type Of Roof
PP an g pant tae haMl haialloua ten 1
,is defined!by the C pen no Municipal Cod Chapt 9.12 d the Health and Safety
Code Section 25532m) It `� `1. "'. h t t s. zh
a i�o,tt C -
• All_roofg shall be inspected prior to_any roofing.matena] being installed.
a Il o ilc ,l t f b fi g occupantcrimper' t d< o ,µn'ol If a roof Is installed without first obtaining an'mspectton I,agree to remove
nth atdu em tasd f'dbym BaYA ArQ 1ryMan.,e em
°i" " all new materials for.inspection. Applicant understands and will Comply with
❑r ono f 1 - all-nori-point source regulations. -
It
i M1 dvhe Naz d llnW r qu nt u de Chept 6,95 of the
Cohnim.Ha.Ith&Saf ty Code Sisclimis 25505 25537 ad 25534.,L understand that
ifthe Im Id ag doe t cumandy h a¢n t that u y po b I tyro notify the -
Occ p ncY M.".
1q f C nificetof J 'r/-Zo d y
Occup m f therequ reme t men most be me ,zaoa \ Signature of Applicant _ Yate
All roof coverings to be Class `•B" or better -
-'OFFICE . .. ... . . .. . .. .. . . . . __ - - .. . ..
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
X8
CITY OF Fax: (408)777-3333
CUPERTINO
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 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>/ ZAbj �tVE"i y'
Addr& s: _ /dJ `/R GrJ,, 65747-3 2
Reroofing Company Nae: L d S &,AIDS
Applicants Signature: Date:�Z o U 2.
• a
Joe Antonucci
�_
(Chief Building Official)
6/25/01