02070087 CI BuDIEN DIVIIS
BUILDING CONTRACTOR INFORMATION:
"TOT'Ggp TbREST AV "" 62070087M-Yg25n. RAMAN APPLICAT7/ f�/ C 0 0 2
PHONE: SANITARY
NO. / `CONTROL NO.
r�
e O zo ARCHITEC-DENGINEER: BUILDING PERMIT INFO
v BLDG ELECT PLUME MF.CH
h Z I I
LICENSED CONTRACTOR'S DECLARATION
v 1 hamP,sportier I am licensed under provisions fche n 9(commencing Job Description
i N__ license
REROOF
F with genion 7000)of Disision of tM1e Busies ePmtesno sC pd mylicense
nIn roll fur and t (/ LEM
z,< Licenu v _fir' �e Lip/a n
O O C nor
0 3 ` ARCHITECT' LARA
O 1 undersmnd my plans shall be u. a+publi J U L 2 9 2002
r
3-,M Licensed Professional
y c y OWNER-BUILDER DECLARATION
d=' 1 hereby am tna ffir1 am exempt from Ne Contr000 License Law for the $12000
t?a following reason.(Section 7031.5.Business and Prnfearm Code:Any city m county BUILDING
BUILD
S G which requires a permit to consumer,alter,improve,demolish,or repair any stmeture Ll i V L7
orri.,mt Io.requires,to ,,lucent ion such permit to file a sigtndsmamcma.
(hit he is licensedIt'rsa n7000)to the of si nf the 3ofthBasinComment, andpricense oswonsCork) ii31S�j213.Qlay fika yy Valuation
or
(commencing riser 7000)of Division the Business Any violation
i Code) Ca, 1?R ¢ fu..i4 LYR'. s "'t r:.f Y"r KALA tL,ilS• '
or that hers exempt(anrcGom and the basis for the subjects
the esempuoto Any vin malty t
of Sermon IlhP.5by veanyapplicant opcnnit subjautheapplicam(°acivil Penalty
rornm mrrc n,an five harmed dollars S5k)) 3 0 5APN .. . . Occupancy Type
❑I,asowa,,of the vrepair,or my ampmyacs withvages as than sale compensation, 307 - INSULATION
-will'do'the work.and the'snruaure is not intended or offered for sale(Sec.7644, _
Eusine's'and Professions Code The Connector's License Law does not apply to an ��❑❑ tions
owner ofpropcny Who builds or improves mereen,and who does such work himself 602 - ROOF PLN8NH
or through through his own employees.providedbuilding
that such improvements memo art not unenvied or
"mothe:ICnrwsver,otic building a improvement ofpmo pg the he did'oneW, year of -- - -"-603 - - ROOF--BATTENS- ------
'completion. - -- - -- - - --- - - -
improe ."erwnn-builder will have theburticnof,covingthathedidnotbuild or 604 - ROOF IN-PROGRESS •
improve for purpose of sale.).
❑1:asowner ofthe opmy,-,irii with licensedcontractorsto
omwct the does
n (Sec Ito a Business and Pity who s Code:)The Contractor's
License law d«s no(apply(o an owner with
property who builds se improves thereon, ,
and who convects(or.such,miens wins a.contrumr(s)licensedpursuant to.dm. _...._ ___.... __.... _... -. .-.._....._. .... ........ -------...
mcmrlaw
.El
Licence la .
El I a
- ❑ m exempt udder Sec .,. _ ,B'&PCfor rise reamn
_
Owni, at
WORKER'S COMPENSATION DECLARATION
I hereby aftcot under penalty or perjury one of the following declaraionz
• ❑ 1 have and will maintain a Crnificate of Consent to selr-insum for Workers
Compensation, as Provided for by Section 3]00 of the labor Code, for the
performanee of the work for which this permit is issued.
❑I have and will maintain Worker's Compcnwtion Insurance,as required by Section
3700 of he Entire Code,for the arfarmaince of the work for which this .is is
ss cd My duce,Compania(on cc cards,end Policy number ere
No
CERTIFICATION OF ION WORKERS'� r {Siv"tfa I4i try 'D+" •, rs tin I I
:.,.-,• _, COMPENSA ION INSURANCE' .
" (This section'nad not he'com completed if the - -_ -
(5100)or less.) p Permit one hundred dollars t.. .. .,
I n fy th t in(n perm a of the rk f ninth-a nis issues,I
shall a.(employ any person in any marts,so as his become subrat Ir the Wnrrum
Compensation e Laos of California.Date
:NOTICE TO APPLICANT If.afterCom making r p Cesi n s of the
E e -,urn,you ashould
st
became subject(o the Workels Compensation provisions of(he labor Cade,you run
QSpur, ith comply with Inch plovisiom or this permit snail be gamed revoked.
T CONbTRDs a comnit n LENDING AGENCY
+� 1 h- by Ihi n that(n lending agency forthe p rhinnance 1
of the work for which this permit is issued(Sec,ID97 Civ C)Lendri'a Name '
LandLandi Address
. U Q 1 c=nifY thin I have read this application and stare that the above information is `
P. =roan.I agree to comply with all city and county ordinances and state laws relating
0,U to building crmtmctirn:and hereby authorize representatives of this city to enter upon
�•,._W the above-memiianed pmpeny Por in aterma purposes.,
eFa 0. (We)egrts nr save.indemnify andk ep harmless the Ci(y of Cupcnino against V] liabilitiesjudgments,costs nd penscs hitch may in any way accme against saidV.z City in consequence ofdi ti f nodAPPLIC lT UNDFRS ND ND LL COMPLY N'ITHALL60N- NT"w F rin. s. Issued by: DatOL Signa ore°f Applic ✓ennnmanr Data Re-roofs
HAZARDOUS MATERIALS DISCLOSURE -
p 8 pant some or M1nndle hapromm s mm
me h�an(d,rr(rm brileh, beer d;a Type of.Roof. _
as dafned by a Cupen no M 'pal Code,Chap er 9 l2,and the Holth and Safety yp -
Code Sitcom 25532(al - --
❑Y. it
I� FI'ylk 44 �e .:
_ All roofs shall be mspepted poor to any roofing material being,installed.
venin air ppic
to f t rebut a est A.Aise equipment tdeviceswhenIf a roof is installed without first obtaining an-inspection;I'agree to remove
Di t n dot a r coram osa]SdE♦ ren A Quality Management __-
coedbyN Bay
all new mat ials for mspec o Applicant,understands and will comply with
❑Ye: o roes, , , - all non-p n source raga
1 h i ad,the huardd s irm.1st q nem (s tide,Copan 6.95 of @e '
Cal ,m l H' Ith&Safety Cad S tons 25505 25533 d 25534 I understand that
if c Wil does not c
ace pe f he requi h c un ma pori to issuance f C mfica(e of
citron
_ 7-/r nature of Appli t e
me,oramgonred, ear • Dan All roof coverings to be Class "B"or etter'' -
+ i: OFFICE - -
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF F= (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 Y"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: RAJEE V K / -M nAf
Address: �722$T Ave
—
Address:
Company Name: _ ST
Applicants Signature: i41—t. L'!.i(C [mac Date:
. Joe Antonucci
(Chief Building Official)
6/25/01