02110161 CITY OF CUPERTINOmat
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION r -_
BUl 1 1@ESGARDEN GATE DR ROOF ROOFING PERMrrN(02110161
owr(gZrsr A&Ep :DON N. 5577 VASSAM DR APPLICAT1NTr2`A7F 2002
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ONE: --R—o 8—T-265-9270 SANITARY NO. / ` CONTROL NO.
ARCHITEC(ENGINEER; BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 O O O
�00 LICENSED CONTRACTOR'S DECLARATION Job Description
�u F I herehy alfrm that I aro licensed under pavilions of Chaim,9(commencing REROOF p
with Section7fl(IB)afDivision3ofNCBusinesamdNormal...Cear,mdmm
yliernis
< in full forte end R t. /�
Z O g Liccnm C Lic. es-I Sb
0z"
HDam Contractor
qq9 ARCHITECT'SD. �R
W 1 undersand my plane shall W used a ublic rccnrda
aOyU
LL G
Licensed Professional
Oat I an exempt fr DECLARATION
C I hereby affirm that I oto exempt from the Common's Code:
's :Any c Low for tW $3000
x.00 which
following..an.
Permit
703 L5,Busher, and improve.
de as Co de:Any city orcounty
$ which mquims a permit re construct,alar,impose,demolish, file
mash any ttmewm
FI< prit W islissuance,amn to the Ue applicant for amhPermit toienseLaw(rtatemen0
NarWulimnwis paramount 7Um of Division 3 theeBusines and Pre Law(CWpter9 3�6F3.ffdhb6Al0� Valuation
SFO that M is exemng pt Sections and of basis
of theegeircssmton.Any viCourt m
dr'$ Nm io u Bump U"apli and the bud for be cts ft exemption.My violation of
Section]031.5 by eery applicant for a permit subjects tW applicant to a civil penally of 3 UXPNNZWE Occupancy Type
not mom thin nes hundred dallua($500). 307 — INSULATION
❑1,aownefor Ue property,ar my employee with wage as Uev sols compmiatian,
will do the work,and the sudcmm u nm i nosed or offered for sale,(Sec.76W,B usi mm 601
and Prefessiotu Cade:The Convector's Licerve law data rot apply to an owner of 602 - ROOF P T 1V V nSnLCt ns
propertywho Wilds or improves fiction,and dammed work himself orthrough his LVH1 L
awnaroployeee,provided fair such impravements tae not ntnded in offered forsale.If. 603 - ROOF BATTENS
hasteve.Ne Wilding or improvement is said within one year of completion.the owner. 604 - ROOF IN-PROGRESS
builder will have fie burden of paving fiat W did oar Wild or imps.far purpose of
alsj.
❑1.as owner of the pmpmy,am eaclusivcly contracting with IlcemW contractors to r-- -s .,-
consider dte project(Sec.7044.Business and Paliammus Code)the Convmmfs Li.
cease law does not apply to an owner of propeny who Wilds or impusv thcmon,and,
who contracts for such pajecs with a contraonds)licensed pursuant to Ne Contractor's5 II I t
License Lew. `�
❑I am exempt under Sec. ,B&P C for Nis reason
Om A YL/I/ -�
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby aRrm under penalty of perjury one of fie following declarations: u
1have ad will maintaineCmnf37M of ft" eCalf-iaumforWorkeriCampn-
workf a pro h thi for mi Section 3]W of Ue LaWr Code,for dm peHonnancc of Ute
work for which this permit is issned.
❑1 have and will maintain Workers Compensation Insurmce.u required by Section
37(18 of Ute LaWr Code.for the peRormance of de work for which this permit is named.
My Workers Compensation Insurance carrier and Policy number am:
�sG-'.... D Policy N J ZZ�OZ•Ou 01 1
CERnFICATE PION WOFRO7X RKERS'
COMPENSATION INSURANCE
Crhu secumu need not W complemil side Permit is foram buMrcddullas($101)
or lesj
I certify that in the performance of the work for which this Permit is ismN I shall not
employ any person in my manner so m to become subject o fie Wmsge Compensation
Laws of California.Dare
Applicant
NOTICE TO APPLICANT:If,strict making this Certificate of Escreption.you should
Wcame subject to the Workers Compensation pavisians of the LaWr Code,you most
OO faMwitb comply with such provisions or this permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
I hemhy M.Nm there is a conswetinn lending agency to, prfa rnmec of
gS,a dre work for which this prmir is issued(Sec.30097,Civ.Cj
W 0 Lender's Name
jz Lenders Address
U C I certify thm 1 have mad this appliatim.and sum that the salve information is
W (~' emaret.I agree to comply with all city and county oNinmas and stare laws relating to
O U building construction.and hereby malwam representatives of Nis city to enter upon the
W atmve-mentioned papery for inspection pulpsms.
LL (We)agree to save,indemnify and kap harmless the City of Cupertino against ,f
„y H liabilities,judgments,toss and expenses which may in any way mama against said City
U Z in consequence of the granting of this permit.
�••� APPLICANT UNDERSTANDS AND ILL COMPLY WITH ALL NONPOINT Issued by: Dale
SOUR NS.
F77 Re-roofs
i
me of ApphcmVCammct.r Dam
HAZARDOU9 MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle harsNuus memrial
u defined by thc Cupertino Municipal Code.Chapter 9.13,and the Health and Safely
Code,Seeaam 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes VNo
Will the applicmi or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
cank haeandous air conteminans as defined by the Bay Area Air Quality Management all new materials for inspection.
District'?
❑yes
I have mad the hazards smamrials munremems underChadoti.95ifthe Cardin.
iiia HesIM&Safety Cadc.Satinns25505,25533.d25534,1.n&c and Nelifft Wilding
does rot currently have a tenam,Nat it is my mspieihility to ratify the mcupant of W
requimmems w oh must cl brlaimuuccafacerlireamrd Occupmcy' .b atureof Applicant e
G
to authorized sem ate All roof coverings to be Class "B"or better"
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f
Building Division
10300 Torre Avenue
R
Cupertino,CA 95014-3255
Telephone: (408)777-3228
1 0 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
Wand 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 V"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: D-4 o
Address: 6 O
Reroofing Company Name:
Applicants Signature:
Joe Antonucci
(Chief Building Official)
6125/01