02020106 OF
CITY
I BUB DI G DIIVIISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20580 HOMESTEAD RD WATERPROOFING ASSOCIATE 02020106
r OWNER'S NAME: APPLICATION SUB DATE
RITE AID STORE PLANNING 975 TERRA BELLA 02/27/2002
'HONE: SANITARY NO. CONTROL NO.
(650) 937-1299
MOO ARCHITECI]ENGINEHR: BUILDING PERMIT INFO
E rBLDG ELECT' PLUMB MECH
It,ip � L'J L_j L._1
LICENSED CONTRACT'OR'S DECLARATION
• n I hereby aRnn thou I em licensed under provisions of Chapter 9(commencing Job Description
)yCu9 with Section 71100)of Division 3 of the Business and Protessions Code,and my license T/Q $,U.R. r ADD B .U.R.
i m g j is in full force am fc p
O V License CI Lm.M 0 G
Dme�� Cammnor
1 t+-Cn ARCHITECT'S DECLA TION
0 g
[understand my plvns shall be used az public records
T
7 i O O Licensed Professional
OWNER-BUILDER DECLARATION
X'R—in I hereby affum that) 1. exempt fmm the Contractor's License Low for the
nM Z 8 following renssin.(Sectionmdar,70JL5.Business and are,ders.li Code:Any city or county $21000
f F O which rtgvGn a permit m constmn,ahec improve,tle Permit
t,ore asig ed structure,
a32 'W1Or to its issuatte,also requircxthe applicant for such prmdt to 0leeugmd stamens — --- -- --
tgmkis�licehssdpursiyntrpthtprovioonsof me Comracmra License law(Chepar9 ,- Valuation
(commencing withSmion)040)of Division J of the Bujioess and Professions Cade)
or that he is exempt therefrom and the basis for the alligeil exemption.Any violation
ofSection]031.5 by any api innt for a permit subjects the applicant a civil penalty ��eC
,of not mom than five hundred dollars Scalp). n3 0�PN I�yfI�:AME Occupancy Type
❑I,as owner of to propcny,u my employees with wages as their sole compensation,
'will do the work:and the indurate is not intended or offered for sale(sec,7(44, 601 — ROOF TEA�9 P
u sections ^ ' '
The
g nip y rig p p. yWt 602 - ROOF PLYWOOD NAIL „-,-
Bu nes and P ode roar S-d Connector'sf,License Las,does
me h orkIY to an .. .ROOF—
. . ._
ow f P pc hIN mp nd who Jaen such work himself
or th h his n e In ee t e Nat ach tat n intend
offeredfor'uf L'liowcver the builder et nice IJ thione yamAlf 603 — ROOF BATTENS `
'compler n
on
qui Ider will have the home.al proving that he did our build or
'or p" a'J`1' 604 - ROOF IN-PROGRESS
s It
❑ s t owner for
properly,ti.Busiexclusively d Practing wiN b,:)Td canumdi t', • .
conswct the z(S4 76U,Business and Professions Code)The Comrector's ,
i
License Law
ppl}Iden owner of Property who builds or improves thereon,
and who summers;for,such projects witha connections)Insisted pictures to Ne
Contravenes License Law.
O 1.m exempt uadm Sec. ,B&P C for this reason 1" . .
Owner - Dam '
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following decorations:
❑ 1 have and will maintain a Certificate of Consent m self-insure for Worker's
Compensation, os provided for by Section 3700 of the Labor Code, for the
Performance of the work for which this permit is issued.
0 mpc uo Insurance,as reacquired by Section
issued My Work s C nip n niton Insuof the work for which this Permit is '
Ih and ab maintainWok Co
700 nth Labor Cod f the performance
' -ran Irand Policy npmher ore "
Cart Policy N .
- CERTIFICATION OF EXEMPTION FRDM Wf1RKHR5'
COMP2NSATION INSURA CET y" ,
(Th s union need not Im completed if the pemut is for one hundred dollars
(S100)in leas)
_.�_t . .. - - - _ .. . ....... .. . .. . . ._ .-
1 certify thanin the pain cry..of the work for which this permit a issued,1 •s
shall not employ any person aro any manner so ss ro become subject to the Worker'
Compensation on Lewa of Coli(omio.Dere
Applicant .. - ._ _...-
NOTICE TO APPLICANT:If.is afterCon making the,C rasions o ofExemption.Laborde,you muld
st
become subjectcoly the Worked Compensation pmvistons i the Terror Code,you mon
Z 0 forthwith comply with such provisions.,,his permit shall be domed revoked. '
rzt. .. ... . . _- _ _. _. _ _ .i CONSTRUCTION is a construction
LENDING AGENCY
1 hereby affirm the,there is a issued
(So..lending agency for the Performance
ai sof the work for which this permit is issued(Sec.J09],Civ.C)
W�Q Lendcr'x Name . � ... ,... -. -._., .. - . . ... ..
Lepder's Address
1 centre that 1 have read this city
and oii and smte that rhe d state
mien is
0 E.x toren.I agree t9 comply with all city end county ordinances and excite laws relating
C.7 .tto he th.ve-mernima,tion,and hear nm,s,km purposes.
erp oientatives of this city m enterupon
pw the abovec)agrenedpropendemify andikepurpnfile
an
(Z) (Wjudgme ts,ave,and a pensesk hi ham y inthe
an way accrue
engainstb. aid
y liabilities,judgments,cons oar expenses which may in my woe accrue again.said
U' City in consequence R the gieming of this L COM WILL COM I 1 ALI NOAOI I —
sOURCE'REGULATION " .147 74 Issued by: [e
Signaturebf Appli`anUCommmor ',' .,Dme Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
`
Will the appllc.t or fucose building occupant ams or handle hazardous mOedal Type of Roofas d6and by the Cupertino lvfimiripsd Code.Chapter 9.12.and the Health and Safety
Cade:Section 2553210
_ All roofs shall be Inspected pint-r-
to any_roofing material being-installed. -
`m '.Will the applicant orfund.building'cecup:nt use equipment or devise which - If a roof is installed without first obtaining an inspection, I-agreeto remove
it haurdom air mmemisi ns n defined by the Bay Arco Air Quality Management
District? . . . all new materials for inspection. Applicant understands and will comply with
Ole °"r-li all non-point source regulations.
I have mad the hazardous materiels requirements under Chapter 6.95 of the
Celifmmie Health&Safety Code,Semions25505,25533 end 25514.1 understood that 2 P--`y
tic phuilding
?dc does not curemly hvveeanam,that it is my rcaponvibility to notify the af'_"'f/�_•�s�.A sN---'mss
/a '2
unt f the requirements which must be mei prior to issuance of a Cent cote of
°""""`oY' Signature of Ae6plicant Date
Ownerm nation.zvill0ligent Is Date All roof coverings to be Class "B"or better
._OFFICE -
4 » Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777.3228
CITY OF Fax: (408)777-3333
CUPEkT1N0
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 Y"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 andel will comply with this policy.
Homeowners Name: Oe � �tJ� A
Address: .20 5 ,Q 0 ��� �
Reroofing Company Name:ed/ _Q
Applicants Signature: lir Date: A0 2
Joe Antonucci
(Chief Building Official)
6/25/01
Building Division
10300 Torre Avenue
Cuperdno,,CA 95014-3255
Telephone: (408)777-3228
CITY40 Fax: (408)777-3333
CUPEI�TINO
Building Department
REROOF TEAR OFF POLICY
revised 6/25/01
1. You must schedule an inspection for the tear off the day before the date you
wish the inspection to be made.The procedure is to call the Building Division
(777-3228)between the hours of 8:00aand 4:00 p.m.for next day
m inspection.
2. When the roof is tom off,the nails removed or driven in,and all of the dry-
rotted wood has been replaced, then you must call the City Building Division.
An inspector will be there within one hour. There are special hours for this
service:between 8:00 a.m. and 11:00 a.m. and between 1:00 and 3:00 p.m.
3. If you call for the tear-off inspection and the job is not ready there will be a
re-inspection fee of$100.00 charged,which must be paid before another
insRection is made.
Joe Antonucci
(Chief Building Official)