02110141 CITY OF CUPER'I'INO
r BUILDING DIVISIONPERMIT CONTRACTOR INFORMATION
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BU1LJI1JG&@DRGARDENSIDE LA DAN ELLIOTT ' S ROOFING CO PERM)FN(02110141
OWsT69iZ DAY Y AND SHARON 2669 COIT DR APPL1CAT14"TS Sy 2002
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ONE: 408 559-7327 SANITARY NO. CONTROL NO.
ARCHITELTIENGINEER: BUILDING PERMIT INFO
FILING ELECT PLUMB MECH
0 0 0 0
Ppp LICENSED CONT
nsedFACTOR'SDF.CLARATION
�� lhereby 0(sof
of Nall:Im Geeeseeuexx andProusanftC.dc, nd my license is REROOF (1/2 ObJol $P�r'i�jJ[ion
�i
with Section]dXp fUivisionJal the Business and Prufessians CnJe,ana my license is
In f..111t wand osct.
G �z Liccnsc Claza / Lica CQ
y t-p Date — [.aonmcmr
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ARCHITECTS
dGLCL ATO
8 1 understand my plans shall W used as public records
a.pm0
Liccnaced Pr..trainman
F' OWNER.BUILDER DECLARATION
u� I 1 hereby affirm that 1 am exempt from Ne Contractor's License Law for the $3624
S p O following reunn.(Section 703 L5,Business and Professions Code:Any city or county
x$ which requires a permit to couxtrucl,alter,improve,demolish,or repair any income,
F—y poor to its issuance,also requires the applicant for such Permit o Glc aligned statement
x3x< the hcialimnscdptax
it Or,provisions of the Contractor's Liwase Law(&pmr9 3Jrg2F3.MMA60 Valuation
F$ (Um a is exc rra therefrom
ec from and th Dlvlalnn 3 of al a ed exemption,
Any
Cndc)or
y — that io is exempt Iby any applicant
p li and or basis far the alleged mremant to Any l Pennon of
Section thm03 SveaundredicanarsTS501iermilsubjecutheapplicannoacivilMnaltyof N-N Occupancy Type
not moreman eve hundred y,dollars employees
307 - INSULAT.ION p y YP
❑I,u�wner of the propcny,or my employees with wagnuNeir sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Rusineu A �pq p
and Professions Code:The Contractors License Law does not apply to an owner of 602 — ROOF P Z YV� n 1VHq Lns
property who builds or improves Wood.and who doessuch work himself or through his
own employees.provided Nat such improvements are not intended oroffered for sale.B. 603 — ROOF BATTENS
however.be building or improvement is cold within one year of completion,the owner
builder will have the burden of proving that he did not build or improve for purpose of 604 - ROOF IN-PROGRESS
sale.).
❑1,as owner of the pimpeny am exclusively convecting with licensed contractors to �'N
construct the project(Sec.7)94,Business and Professions Code:)The Contractor's Li- A LC
cense Law docs not apply to an owner of property who builds or improves thereon,and
LJ
who contracts for such projects with a contractor(s)licensed pursuant the Contractor's DECC]I em
law. 0 3,2002
❑ I am exempt antler Sec. B&P C for Nis rcuon
Owner Date
WORKER'S COMPENSATION—DECLARATION BUILDING
1 hereby affirm under penalty of perjury one of the fallowing declarations:
1 have and will maintain a Certifical,of Consentto self-insure for Worker's Compete.
scrawn,u provided for by Section 370g)of the Labor Code,for the performance of the
work for which his permit is issued.
re and will maintain Worker's Compensation Insurance,as required by Sectio
3700 of the Labor Cade,for the performance of Nc mirk for which Nis permit is issued.
My Workpr;SCo�sa'onlnsurance carver and Policy number ant /1,,
Carver. ,�rtl 1✓If0 Policy Nt�U 'J W
CFIOIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not M completed if Nc rcrmit is foram hundred dollars($1110)
nr Icss.)
1 Unify that in the performance or the work for which this permit is isand,l shall not
employ any pecan in any manner at u to Wrom,subject to the Workers'Compensation
Laws of California,Date
Applicant
NOTICE TO APPLICANT:If,aIle,making Nis Ccnilicate of Exemption,you should
become subject m the Worker's Compensation provisions of the labor Code,you must
OO forthwith comply with such provisions nr this permit shall W deemed revoked.
z CONSTRUCTION LENDING AGENCY
I hereby omrm Nat there is a communion lending agency for the perrmmence of
RI the work for which this permit is ist(See 3097,Civ,C.)
DQ Lcnticr's Name -
I Z
Lenders Address
agrees
V 0 1 certify Nat I have read this application and state that the shout or ormation is
0U coned tonne taco.plyand hith all rebyadtyendc unty phareaNinencessof and stain innws er
gto
V abovengcationed propend herebyaction preoses. Ives of Nis city to corer ufam the
}' above-(We)a agree
,,soy fhadcoueatian keep purposes.
(We)agree to cast,Inde expenses
and keep harmless the City accrue
Cupertino against
U ,0.A indi cosequnce of th,he granting ex this phwhich they in anyway accme againstacid City L7 �'
V z A consequence
ICANTCUNDERSTAmg ol SIhtND WIL COMPLY WITH ALL NON-POINT Issued by: Date
CE RF.£ilJLA ON _
a! 1-9 Re-roofs
ig arc Or Applies HAZARDOUS MATERIALS DISCLOSURE tractor Dine Type of Roof
Will Nc applicant nr future building wcupam stare or handle heaaNaus material
as defined by the Cupertino Municipal Code,Chapter 912,and the Health and Safety
CnJe.$ Yrsion 255J21a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yea No
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
omit havardnua air contaminants as refused by Ne Bay Arco Air Quality Management all new materials for inspection.
Uisuict?
❑Yes 0 N
Ilow afet Node Stdnons 255ialsmquircmends 534.1 understand Chat if e,Wilding C
riaknor urSafety Cock.$akar, 255,15s myoUd2551LllondlmyIfup Wilding
Nws not currently base a wnan4 Nat it is my rcspomihility m noGly IM wcuparit nl Oct,
tWujrtmcn h' h uslM�t,pnn,miasaante a fa cenincme or Decorumey. Signature of Applicant Date
CS+ t�-,t/� � ena"!'/1 J e(JZ All roof coverings to be Class "B" or better
W mm nthnrmeJ nyrnt y Uata
Building Division
10300 Torre Avenue
4 Cupertino,CA 95014-3255
Telephone: (408)777-3228
oo Pax: (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 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: J U e 4 C 0�u� (!a �� C"A V.125�e c r�roQ"�1��
Address: J1
. �O 6iad�s,�le (yi
. Reroofing Company Name: lA NM
Applicants Signature: Date: I I-26'0 Z,-
Joe
Joe Antonucci
(Chief,Building Official)
6/25/01