02080104 j BUILDING urvESSION O CONTRACTOR INFORMATION:
PERMIT
BUILDING ADDRESS: PERMR NO.
O�1V86S8N0 HANNA DR 02080104
HLER i1 A"9,YDNOR APPLICAT'IQN$I)s pA 002
qqq PHONE: SANITARY NO. L U CONTROL NO.
Lu O O ARCHITECTENGINEER: a BUR,DWG PERMIT INFO
BLDG ELECT PLUMB MECH
<6 ILJ
Z 8 i' LICENSED CONTRACTOR'S DECLARATION D O
O Z 4 1 hereby afiimt that 1 am licensed under provisions of Chapter 9(commencing RE
F r3� with Section]DOD)a ivisian 3 of Ne Business and Professions Cade,and my license
is cfull force and effect,
a Liceense Class Lia tl
Data
ontractor
ARCH S DECLARATION 1 understand my plans shat[be used
as public rtcords
m O O Licensed Professional
ass�h OWNER-BUILDERexempt
DECe Connector's
I
a 1 hereby arfmn o that 1 1. exempt from the C ssions as License Law r'ar the
C Z< following reasua erten t 7031.5.Business and Professions Cole:Any city of county $8000
5, ❑ which requires a permit m construct,alter,improve,demolish,or repair any structure
dam ,pis t I t uancePurlso reg the applican[fa such perm tmfl esigitW stet ent - - ..._. ..._. ..._.__ . .,..._ ....._. .._
88. gg3
Nat3seuhtensed -ubmtlbeprovisionsoFNeComrncmrL nseLaw
(Chpter9i3 akT(]9�T//p/�ppppa p ] q y��a Valuation
(comnumq ng„a non-]0007 of Division 3 of the Bys3nes and Professions Cade) 1.`i N I _w;
m that he is'exempt therefrom and the bans for the alleged rLcemDdpn.Any
violation
oTSection]0313 by any applicoin for a permit objects
the applicant b,a civil penalty
ar not more than five hundred dollars(55001. 3 0 5APN AiLtt�tDCE' Occupancy Type
❑Las owner of the proper,or my employees with wages as their sole compensation. 307 — INSULATION
-'
will do the'work,and the"structure-is not intended'or offered for sale(See."]044.- 6 01 — ROOF TEAj� Inspections
Bti mPro
ess and` fessions Code The Commctor s License law does not apply man q ^
0
w rofpropertyWhobuildsorimprovesthereon,and who does such work himself 602 - ROOF PLYWOOD NAIL
or through his wn I employees.ye provided in N t such improvement
menu are m tended or _
g � P -' sold within one year of -�--��� -
-
IDR"-df_-1 Ifh --e the building em — BATTENS' , .
completion,
efarp owner-build, lhavetheburdenofprovmgNmheJidnotWildor 604 - ROOF IN-PROGRESS
p purpose o )
_ ;as owner of the progeny a Business
and
pram ng w N licensed o Cmucmn m ..
_ - onswn the project(Sec.]044,Business and Professions Cadea The Comrecmr's I,
Ic
euse Use does not apply to an owner of prepeny who builds or improves Hereon.
_.and who contracts..for such pmjems.with-a contractions)licensed pursuant.to the -----
Contractors
_.._Contractors License Law.
_ ❑1 pt undl�S� � ^/(B&PPf C for this rtann
ates
�u1te MP TION DECLARATION
�1 -1 hereby inf irrunde penalty of pepury one of Ne toll w ng declarations: ((( J /
CI ❑ I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation, as provided for by Section 3700 of the labor Code, for Ne �l i
performance f the wok for which this permit is issued.
❑I have anL ill oma nm Worker's Compe at 1 urance,as rcgmted by Section
! 3700 of the Labor Code,for the performance of the work for which this permit is
ism d My Workers Compensation Insurance smer and!Palo,number arc
Cerner CERTIFICATION OF EXEMPTION FROM.WPR�RRS['
_. . ._.. .., - ._
COMPENSATION INSURANCE_
(This section need not he completed if the permit is for one hundred dollars
($IDD)or less.) ,
1 c employ
an m the porn any m of the work b which ub e permt s issued,'
shin)not employ any prison d any ma as m become subject m the Workers'
Compensation Laws of California.Dine'
APPlicani'. -__. r .._._. _-..._. . .. .._ . ..
NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should 77
�
Q 0 become'subject to the Workers Compensation provisions of the Labor Code,you must
forth
Z
with comply with such provisions or this permit shall be deemed revoked.
- _._....... .. ._. ._._._.
F: ^ CONSTRUCTION LENDING AGENCY"
a-� I herem N
tiy affirm there t construction[coding agency for the performance
jZ Leader's Name
�, of thework for which thispermit issued(Sec 3097,Civ.C.)
;z Lmoers Address, +
V 1 certify that I have reed This appl i a d tete that the hoe information is
Iii" co rt t I agree to comply with II city and county on r c s d tate laws relating
�i Ito building construction, ad hereby authors represin...iv of this city to enter upon
:the above-mentioned property for inspection purposes..,
P..,
(We)agree to save,indemnify and keep harmless the City of Cupertino against
'LI rA liabilities,judgments,costs and espenses which may in any way acerae against said
V.z City in consequence of t e grunt of Nispetmit.
AP,PLICANTUNDERS , ND OWILLCOMPLYWITH CL�'ON-POI:
so'Rc ;c ATION Issued by; Date
naturem'Applim wet - 1 Data Re-roofs
HAZARDO S'MATERIALS DISCLOSURE
_ will the applicant 4 future budding occupant store or handle Incautious materia Type of Roof
-as clBned by th Cucan Myyy tnpal Cade Chapter9.12, d theHealth and Safety
t [[
Code,Section.25532(a) I i N .s t 't` t. '. s a k t a �3 E t 9 P L`,i "�Y•. a g sg. I '
.. an�.s e-'.
All roofs shall be ms acted. rior.to anroofin mater al.bete installed . ...,,, .._
w n the or future building qc pant use equipment or❑ Ices which If a roof is Installed without first obtaining all inspection, I''agree'td'remove
Di t ha rdous air conmmrnants as defined by the Bay Area Air Quality Management
onmcn all new matenals for Inspection., Applicant understands and will comply with
Dura . . ....
all non-point source regulanons,,,la
- 1 have .it the hazardous mole rims requirements under Chapter 6.95 of the
California Health&Safety Code,ScI s 25505 25533 and 2.5534 1 undersmnd that G
if the buildingdgas not currently have a tenant that it is my.responsibility to notify the
rommant of the requirements hmh t be mel prior to issuance of a Certificate of o
.. Ogcnpr"ey.
2b' Signature ofQp Icant - Date
. . . .
ntr or ewhinzed agen Date Al] roof coverings to be Class "B"or better
.,.. . . __.__._..... - .OFFICE"---. _ ._ ._... ._ _.... .
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
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 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
opolicy on ofing and will comply with this policy.
Homeowners Name:"'`' `^^'
Address: \ �' 6 h r
Reroofing Company Name: T ��
Applicants Signatmw/ Date
Joe Antonucci ~_
(Chief Building Official)
6125/01