02100178 . I
CI'T'Y OF CUPEWrINO -_j +� •••
BUILDING DIVISION PERMIT I ONTRACTOI�INFORMATION�x
BUI *4(DxKRE-,GRENOLA DR A L RESIDENTIAL COMMERCIA PERMIT NO 2100178
owt9ji]"9AY SAWHNEY 14893 E HILLS DRIVE APPLICATITVYU: I'YZ 002
Alk
IONR -4o-87729-6100 SANITARY NO. CONTROL NO.
ARCI IITEC'UENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MF.CH
O O O O
�00 LICENSED CONTRACTOR'S DECLARATION
a U 1 hereby affirm Nat 1 am licensed under provisions of Chapter 9(commenting REROOF Job Description
e¢ with&coon]IMXB of DivixionJof Ne Ou<i sad Profcasin Codc.anderylicenscis
z0=� in full&, a sad efface. �s 3r/7
�z Licane, LLie. `s
G=Fp Da rm cru- L
A I' iCT .CLAR TION
��sa' lundcnund my plans shallMumd es puM1lic records
6()e.WG
FLL c.~ LItCMed linuesuoral
O
OWNER-BUILDER DECLARATION
w a f 1 hereby affirm that I am cscmpl from the Cnmracmr's License Law for Ilse
se
m s p O lidlowin,reason.(Section 7031.5,Business and Psofesxions Code:Any city or county $4800
e' $ which requires a Permit u,CoeslroCL.alter,improve,demolish,or repair any structure
Fi< primor its issuance,also requires the applicant for such Permit to rile a signed statement
that he is licensed pursuant o Ne provisions of the Contmcmrs License Law(Chapter 9 3S?I2IROF (fi)r A&a Valuation
(commencing with Section ApO)of Division 3 of the Business and Professions Code)or
y Nm he 6 exempt therefrom add Ne basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to acivil Penalty of PN N Occupancy Type
not more than Bre hundred delta.($500). 307 - INSULATION p y YP
❑1,as owner of the property,or my employees with wages as their sale compensation,
will do the work,and the structure is not intended or offered for sale(Sec.704,4,Business �{ ((���0
and Profcssinns Code:The Committee's License Law does not apply m an owner of 6 0 2 - ROOF P nLtlHl Los
property who no or The
Ihemod.and who docs such work himself or through his
own employees.provided that such improvements are not intended oroffemd for sale,If, 603 — ROOF EIATTENS
however.the building or improvement is sold within one year of completion,the owner- 604 — ROOF IN-PROGRESS
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the Sec.7 y.am exclusively contracting with licensed contractors i.
consenter theprojectnot apply
Loan Businessand roprty who
Professions or
provesThe quarteridd
cense law does not apply loan with
a of property wce builds or improves thereon,and,
who contracts for such projects wird a conuam.r(s)licensed pursuant m the Conuacmrs /
hiccnsm Lew. /
❑nem exempt under See. Date or But,reason /.2 j
Owner Dam
WORKER'S COMPENSATION DECLARATION �/-��/
1 hemby alTum under penalty of perjury one of the fol lowing declarations: q�
I have and will maintain a Ceniftcate of Conserv R,a df-insure for Worker's Comped.
cation,as provided for by Section 3701 of the Labor Code,for the performance of the
work for which Nis permit is issued.
❑ I have and will maintain Workers Compensation Insurance,az required by Section
371X1 of the Labor Code,for the peefmmaace of the work far which this permit is issued.
M orkers Compensation Insurance adPolicy nu berate:
rticr. Policy No.; `j2`I8-2
CERTIFICA EOF EXE PTIONPR WORKERS'
COMPENSATION INSU ANCE
Thissuction need not be completed if the Mmtil is forone hundred dnllam($I(XB
Its".)
I wilily that in the performance of the work far which this permit is issued,1 shall not
employ any person in any manner sat as a,become subjca to the Workeri Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the labor Code,you must
OO forthwith comply with such provisions or this Permit hall W deemed revoked.
z CONSrRUCfION LENDING AGENCY
[•+ � I hereby al ism that there is a construction lending agency for the Performance of
the work far which this permit is issued(Sec.3197.Civ.C.)
0.i A Lender's Nam.
r7 Z Lender's Address
U Q I certify that I have read this application and state that the above information is
{L, P correct.1 agree to comply with all city and county ordinances and state laws relating to
C) building construction,and hereby aurhorim representatives of this city to enter upon the
r W aMwrmentioned property(or inspection purposes.
(We)agree m save,indemnify and keep harmleca the City of Cupertino against
rF,t h Iiabil ities,judgments.costs and expenses which may in any way accrue against said City
U Z i n consequence of the granting of this Perm it,
r APPLICANT UNDERSTAND AND WILL COMPLY WITH ALL N N POINT Issued by: Date
SO IR GULATI
D Re-roofs
rgnamre nfApplicaHAZARDOU, RIALS DISCLOSURE Date Type of Roof
Willtheapplicanimfulureb IJin&sa'aupam stare or hanJlc ha ardous material
as deflated by the Capetian Municipal Code,Chapter 9.12,and Nc Health and Safety
Code,Senh,n 2553 an All roofs shall be inspected prior to any roofing material being installed.
L]Yes �o
Will the applicant or future building occupanl use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
all hazardous air contaminants as dclincd by the Day Area Air Quality Management all new materials for inspection.
District?
❑res No (/
I have mad the haardnus materials requirements under Chs ter 695of Ne Califnr
niaflcalNgt Safety CsXk.Sadom 25N15.255JJ and2553a.lunders NmiftM MtilJing
d nm currcn ha- tenant,that i l is my responsibility mnndfyl net
of the
viremcnu wlfiM mu mel primmissnance nfa CcniGcatc oftJccu ey. Signature of Applicant Date
u `�Z ` L All roof coverings to be Class "B"or better
O cr ur.nthndzvd agent Dam
Building Division,.'
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Pax: (408)777-3333
CUPEkTINO
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:VV"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: `\6-a
Address (�- 6r (0. r .
$eroofmg Company N ( ,60
Applicants Signature: Date: D &e D Z-
Joe Antonucci
(Chief Building Official)
6/25/01