01100080 CITY UILD c DINISSIONPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1140 HOLLYHE LA CAL-PAC ROOFING 01100080
OWNER'S NAME: APPLICATION SUB DATE
SADILEK GEORGE AND PATRICIA T 36 RAILWAY AVE 10/10/2001
HONE: SANITARY NO. CONTROL NO.
[� (408) 369-7444
W O O ARCHITECT(ENGINEER: BUILDING PERMIT INFO
8 BLDG ELECT PLUMB MECH
�i6 O O O L7
LICEN CONTRA 'S DECLA N
„3 JobDescri tion
jNO Ihereby affirm) Iamh Provisions chs r9bmarmancing P
_Cu} with$cc On7IMln) fD' ision3o si s dPr� de.andmyhcenae REROOF.
�ou Isi"ran Tara andyfrc t. �' 2 (T/O PLYWOOD, INSTALL 40 YR.
s w 6 Liar flus Lie.x
Dat -(tea ContraLL DECnnr CELOTEX)O ARCCPSDECLARATIO
- � to
I utMersnd my plans spaho aero as public recd s
M❑
o O Licensed Professional
o,a
OWNER-BUILDER from
m the Con ON
=m 1 hereby.(Sent that 1 eaemnt from the Con Worcs c:Any c law for the
C < following reason.(Section 7031.5.oBusiness and improve,
de o demolish,
Code:Any city or county
O which requires a permit m construct,open improve,demolish,or...l any owners
grimmiuissueirce,also requires the applicant For suchpermiuo fileesigttea satertsnt- -- - - - ---- -- --- --- -- - ---_-.--_ _ __ -.. -
--
IlioilaiRiceni�Pdisuinj ldihlialsoionsofd¢Conu8aa�cm�tieys Liecrooaw(chapter 9 ,S ,F F !3g'Area'- t , nation
(swnmrncing Mob Section']")a Division 3 of the poor ionsi code) t,7)_a L•f{�StQ i J a�°reY t:e-,1'Cw,!"e l'��i 1: $8 0
or that tic is exempt theiefiom end the basis for the alldged ben Ciba.A y violation
or Section 7031.5 by any applicant for a Permit subjects Ne applicant to a civil penalty
of not more than five hundred dollars(5500). 3 6 APN_Ntunb�r0 •^ .” Occupancy Type
13I,as owner of the property,err my employers wish wages as their sole compenation, 2 2 6 0 2 b
will do the work,and the srructare is not imeaded or offered for We(Sae-]019, ,
Required Inspections'-
-Business and property
Who b Cade imp Contractor's Liccuc Lew aces notapply to 3 0 5 - FRAME
.owner of his Own
Who builds or improves thereon,and who goes such work intended
or
_onredforthrough hiswvn emPevrr.a. holding
that such iernnvemmis am not intended or .•,30.7 - INSULATION.. ..._..
offered for ale.If,however,the Wilding or improvement n that
within one Weir of t .n
completion,the owner-builder will have the burden of proving that he did not build or 601 - ROOF TEAR OFF �
improve for purpose of al.a.
__ _..602 . - ROOF_ PLYWOOD- NAIL OCT_."1_H_ 2001----
El
vmu, he a the pojrompese,aus".1ourvat,.70",H.,mn.and POdoono,Cis ode:)aadCMRaceeral0 - 603 - ROOF BATTENS
c License
the does
n(Sec.)094,Business and Profusions Code:)The COmmreon. -
.-
LicataLawdoesnotapplymnjownerofProgeny who buildsor pursuathereon, 604 - ROOF IN-PROGRESS 1� elf
., Cori who eomrmns for such volas.with a.enmrenogs)licenced Pursuant m.Ne - -.-- ... --.. -- _. -. - "-. .— BUILDING -
01 am exempt
lacuna Lew..
❑lam eaemq under Sec." �- "' B&PCfar Nis mason
_
Owner Dene
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of Perjury,one of doo following declarations:
1 have and will maintain'a Cenificale of Consent a self-insum for Worker's
ompersmion, as-provided for by-Section 3700 of the Labor Code, for the
- performance of the work far which this pemtit is tented. '
❑1 have end will mimt.la Wooer's Compenatimt Insurance,as mr,imd by Section
37W of the Labor Code for We perfortnamet of the work fm hich'dus Pernut'is
is d M sC nlmumnce ce a end Poly number ere: r
Cartier( Pol yry 7�5 O 6 - ObV Z. -7J.� >> �yy .':.< ff JA 4;' 'r1 qq �•- w.. t,.
s .:."CERTIFICATL NOP,EXEMPTLON FROM WORKERS'..,,,
. ' ..'•CQMPENSATION INS URANCE;e,t
-it't'tCphiiloction need not tie completed if the Permit is for one hundred dollar '_i'V ..L IUs.. V V•--%�;'rl!' "T \ !` `C
($I W)or Ica.) .
y m the perfmmmce of the for which th d
,
Camp
not urian Laws. ..
h Ions( dor i�ct 1.to iauod;l
employ y Person in any atenner�a u to become subject to Ne Woikers'
of California.Dns,'
NOTICE TO APPLICANT.If,after making this Certificate of Eae ph n,you should -
0 O IanhwiN cont 1 with such
tie me subject the Woker,C pcnat provisions of Ne labor Cod You must
Manly � permit shall be dnmed k d
o du
' CONSTRUCTION LENDINGAGENCY l - -
La o��f the Work
for hit that p, o conswn n 1 nil 8 g cy for th pert rata ce ..,
hereby affirm
W h to t ssued(Sec J09T Cie C)
Q Le du'a Name .. ."• _ _
V Z
0�+ I mnify that 1 have read this application and state that the above information is
W:!'+ atllicet.I agree m comply wiM all city and county,ordinances end sate lows relating
0-f) Ao building const ruction;and hereby enumfu irpreamatives of this city to enter upon
f11 the above-mentioned Pmperey for inapec our purpoau. ,
M. (Wa)aMe to sure,indemnify and keep harmless the City of Cup Men'olgwmt
(7n liabilities,judg.,s.toss and e.psnas which may in any way accrue against said
ju•,F7 City in 6nsequence f the giaming oe thi perm t ' "
.APPLICANT UNDERSTANDS'AND WILL COMPLY WITH ALL P&N:POINT
SOURCE REGULATIONS. ' . Issued by: Date
Signatureol'ApplicandC nvacwr .• .."' me ;,t; Re-roofs
HAZARDOUS MATERIALS DISCLOSURE'
. ' Will the apPlic ten.future holding occmpdtato.or handle It",material - Type Of ROOF_ . v. ., •. -/.0. _ O_ / .
as dented by the Cupemna,Mun c WI Code,Chapter 9.12,and the Health and Safety'
Code
.pYe:255320) ka❑No�:,,1 ,4„s.j i'j:y1`J P., i.: ti 1't• S stli!i a E'4ir. s. It
c i•'+ ,. 1;,-3".. ” ',- ";', -__All roofs.shall.be_inspected prior.to.any"roofing.material_being.installed.... .
,..- .Will Ne ipplicmt ter future building«meant use equipment or devices which If aI00f IS IDSlalled Without first obtaining an inspection;'I'agree'to remove
DinHn7 , Bay Area Air Quality Menegemem ,
emit hazardous air urn m Lr fors es defines Gy the
all new materials for rasp tion. Ap licant understands and will comply with
❑Y oNo all non-point urea re tions:.
,-
I l coal the hau dcar materials noiIuvromenta under Chapter fi 95 of the
California Health&'Safety Cade.S10.,S10i.,es MM 25533 and 25534 I understand that
it the building does nt currently have a tenant.that it is my responsibility tnotify the
accupant of thooquircmenn which most be met poor tosuanci of a Cenincete'of
_ Signature of Applicant Date
ti. Owner oramhonzedagent + - �, ,, :Date All roof co -ngs to be Class "B"or better
i,
OFFICE . . "_. ...
Building Division
p noTorre Avenue
Cu ertino,CA 95014-3255
sk Telephone: (408)777-3228
CITY Of Fax: (408)777-3333
UPEkTINO
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: /��(Xq�e
Address: f ( J f l b L�� Y�P, . �Q L z / ( f-D I
Reroofing Company Name:
Applicants Signature: Date: v ° GL
Joe Antonucci .
(Chief Building Official)
6/25/01