02070183 t CITY UILDING DIIVISIONVOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS, PERMIT NO.
1 22366 HARTMAN DR. 02070183
OWNER'S NAME: APPLICATION SUB DATE
DAN LE 07/29/2002
PHONE: SANITARY NO. CONTROL NO.
O O ARCHITECffENGINEER: BU11 ING PERMIT INFO
BLDG ELECT PLUMB MECH
Z5 y Z LICENSED CONTRACTOR'S DECLARATION Job Description^
O Z- I he«by alrum that 1 am licensed under provisions of Chapter 9(commencing 1
F41. withSection7WO)ofDlvision3ofthe Bo ine a4(md Protcons Code,ane my license REROOF
< is in full orce and e(f 1, / --f
Y s License VT- Cq Lic.M l 5-0116-7
3SDECC
555
ARCHITECT'S DEC ON
t''j O e I undemand my pl...hall be used as pubbc rtcoNs ,
O O Licensed Professional ¢ i
OWNER-BUILDER DECLARATION
1 hereby.(Sero on 1 am exempt from the Connector's C License taw for to
Z< (allowing upon permit
t 7onstru Business and e.dersuch Code:Any city m county $12500
F C which mquius e v sort to conswct,alter,improve,e�lish,or repair any swemrt V -s
3 of that lie ii"pu me«ffo'ms,p the basis foie C elle to e«Etc s Law(Charter
- ---
$ paorm its issuance.else requirtsthe applicant far sura pemutm
featlleisline rsu,0nt to the provisional of ae CmI loss Lianulewmt,Ouse) Valuation
(c0mlI ha'ing wish Swimn:IWA)of Division 3 of Ne meu.ead Profevrions Code( h. :t1 i°.�(J .3`7 Z 1 t 1� Y(1.'S,'
mpthat Any violation
-ofSecuon 7031.5 by any apPlicad,for a pemtit subjects the applica,to a civil penalty-
m
;of We room than eve hundred dollars($5W). 3 0 5 APNPWyM 4,1P111. 1-1 Occupancy Type
❑1,as owner of the property or my employes with wages as their sole compensation.
--will do'he'work. ad th,-irmacmu is not lhtenaed'or ofered for We'(Sec.70Se.
M
Business a 'Profeasiom Calc The Contractor's License sew does not apply u w 601 — ROOF TEARec!9#0 ='-'-
orthrofpropertyWhoWildsorimprovesthereon,endveoeoessuchwoehimself 602 - ROOF PLYWOOD NAIL
or through his own emploInewc, .the
provided that such improvements memR arewi not intended m ,-_._. .._.___.. ...._-_..._-._____..- _ __.____..`t
-dRemd'for"iele:wner,bevei,'will iavemeiirden of mem is what wit did one YeS of ""_.._
domplmion,the own<obuilaer will have the burden of proving that he aid not build or 6 0 3 - ROOF BATTENS - "�'"°"'
impmaaforpurposeofwla.). 604 - ROOF IN-PROGRESS
._ .,_._..__ - vm exdu rvel.-.. __..... __ ..._.�,._._,__.,_...------ ._.- _ -- _ -_. _ ., _
.pnWnerof the prapeny y contrxung with licensed comrnci..to -... .. __. It,.•:,. '>' ;
construct the project(Sec.7W,Business and Professions Code:)The Conwcmr'a i r.'int .., L
License Law does not apply t bu an owner f property who Id improves thereon, l
7. _and lm Wntmcts for Such.projects with a conuactons).licensed.pursuant to the.. . �f. __ ._.... .._...-._._.. _. .._ .._
Contractor'slIaept under
Law.
1 ❑lamcx rept and r5¢i +r :� B&'PCfor thi reason
0 Her •''Data
WORKERS COMPENSATION DECLARATION
f thereby elErin uM7 penalty of peqry uone of the following dalantions: O
❑ 1 have"aad'will Werst In a Cerilfiaie of Consent to self-insure for Worker's
Compenaetion, u bo
provided for by Section 3700 of the lar Code, for the
'Wart uhre of the woe for hlch this pcmut is Iss ad /�f-
r ❑1caveand wIIrC u Wbhaef mance of
In work
rkfas req and bySeenron C '/--
3700 of the Inbar Code for we perfoml tits of am oh forewhich sou y n ts
t a u N My Wallace,Compensation 1 sum ee and PoI'cy numtier are _- ^••N�.• m F!
c Fro 1k. p� t�t 3al�o o.,-T`1' vatuari,.,:'
)i+ sC61yTIPICATION ON FRO WOR—
COMPENSATIONINSURANCE �
"'"^'T(Thii wcddn"Beed not be'cmn,linecl if the pennhia for hundred dollen 6-cui'w1c.-V T1 PK'
11 11 f em tomeaner .. :. -._.
I c mfy,lhil m elle a in of eh h f i which th perm t o
p y'any,pe son t hcome i"the W rkere''
A licad.' • L""of,CvhfomD
,u: eu '
Compentaho
NOT ICE TO APPLICANT If etierm kat eh1 C hfeat fExemption, o Rho Id -- - - `
pp
becaeiublact1oth Worker pro
C mpereati ot ton of the LaboCade st you mu
Q Q f mnh lie comply with such provisions or this Permit shall be domed resulted.
y - CONSTRUCTION LENDING AGENCY W. '
diet them n e conxtrvcuon IetMmg agency for the peifomort _
f the work for which dis pefm f is issued(S 3097,Civ C.)
1
1 certify that I ova read this sty and n and sum mm the above information is
'k+.E,1 correct I gagree con t9 comply with ell city and countyoNinerueo and state laws elating
Pru !In be al0mgceationed pr perk for
sutho «rtprcu raises ofthnenymemer upon
}-sg] the boame gree 161 pant( fy mud purposes.
Lay (Wjudomerot s,findsminify keep hamd `ra Cryoftruemaoagmnat /
LLti V]
liabilities,Igegmems costs Id xpoft ht h may in any way rve agarose said
U Cn m co sequence of that gmdung of this perms" - !'�
'Ap DERSTANDS AND WILL COMPLY KITH ALL hON-POLVT' f
' soHRrE Rev�r'�: � y5 � Issued by: D
on sur f Applic n onfmctm.; W5 Re-roofs
HAZARDOUS MATERIALS DISCLOSUREf R f
W II eh opph t r future Ming occupant sem �
handl hazanl t rut • +. -+ .
-as me,db th Cu ren MumE1 al Cade Che mr912 andm He Ith end Safm peO 00 I
_. Y ppp55)
C616:OYa 2553 Le1,.
r All roofs shall in
be spected prioridsto. any.roofing material-being installed
Will lea aPplueneo fum rtbuildn occupant use eq ipmant or de Ipgsnnnl If a roof is installed without first obtaining an inspectionI''agree`toremove
bya, Management,
.. -
all new materials for inspection. Applicant understands and will comply with
ems haurdWS e r contain ts R defru by theBay Area A Quality
District? _ _ ,__ -_
0
- all'hon-point-source regulations._, I n,• 11 ,, „ ,
f 1 have«ad�me hags nus mimnals requirtmmu under Cheptei'6.95.af dm
CaliforniaIin do s Safety Cody,Sections 25505.5533 and 25511.1 understand that /� - , .- _- /—1 4•—U
j s6mtiude ng dna nm curtendY have a mount.meat u my responsibility to notify the
occupant of to regw«menu which musfbe,met prior I.Waste,'of a Ceniflcau of f
'<' Ouup ncY ., 1
r Wnature of Applicant �_ e _
rare oar an dagegt All roof coverings to be Class`B or better
OFFfCE
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
ociclo Fax: (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 V4"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. . � _ r>A-N L
Addr
Reroofing Company Na
Applicants Signaturg: ct-�_ —Date:
Joe Antonucci
(Chief Building Official)
6/25101