01100108 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
B INGADDRESS a PERMIT NO.
X11140 HOMESTEAD RD RESPONSIBLE ROOFING INC 01100108
ry sy
D��MAW EULIS P AND MARY V 1
2882 SPRING ST AOc1 2001
PHONE: (650) 969-6151 SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
H Z LICENSED CONTRACTOR'S DECLARATION lob Description
5,4i 1 hereby oRren that I am licased under provisions of Chapter 9(commencing REROO F.
v-{I: raid,Section 7")of Division 3 of the Business and Professions Codi and my liana
ismmllfomentd Rffeet .Z T/O & DISPOSE OF EXISTING ROOF,
3 License Class • Lic,to 7 Qs aI<f p
EEG Date Comrator�a—end.. APPLY NEW 40 YR. COMP.
C ARCHITECT'S DECLARATION i .mis
j I understand my pions shall be used as public recoils
1 a p Licensed Professional
OWNER-BUILDER DECLARATION
R-' I hereby affirm that I am exempt from the Convector's License Lew for the
r
Z I Basiner, and ate, mons Code:repair
cit w
(_ � following reason.(Section 703 3, Y Y county
T, O
which requires a permit to consuact,alter,Improve,demolish,of eating any structure
Ida$ -poor tow vena, l a9 res the�ppl¢mtforsahpemuuofibolgaduatemcm - - -_. ._ •. _ _ _ _ _
Nat he islicameed Panamint to The piorisions of the Convector's License Law(Chapter 9- y c f^[;�']OOC ea' $1D gyWuation
(commencing with Section 7000)of Division 3 of the Buamese ped Professions Cade). ( 1}A, l,1 'wq;yt-i.'. on7lr£t
or that be is exempt Ihemfmm and the basis for the allegei exemptimi Any violation A�p}.,i�7aT h TY
L.
pe Sectio"7031.5 by any applicant for a Permit subjects the applicant to a civil perWty 3 2 6RYs1+l/V `!YD Occupancy •7 P
I of not mom than five hundred dollars(E500. Occu anC e
0 Cu owner of the propeny,or my cmployces with wages as their sale compensmion, 1
,will do the work,and the struerure is not intended cr offered"for sale(Sm'7 Wer, 3 0 5 — FRAME
Busims%end Professions Cade:The Contractor's License law does not apply tom Required Inspections,
owner of pommy,Who Wilds or improves thereon,and who does such week himself 307 - INSULATION
or suou h his own employees.provided that such improvements are not intended or
toff red€r tole.If.lwwever.the building or improvement is sold within one year of 6 01- = ROOF TEAR-OFF ..
completion,the ownervbuilder will have the burden of proving that he did not build or
improve for paryuae of eate). 602 - ROOF PLYWOOD NAIL
._ " .__ ._-. . y. _ - - - - 603 - ROOF BATTENS
construct
I:as ownspr the pope.%am exclusively contracting with licensed conramors to ! ' "
conswmtw does
lately to
ownBuser eand
ertyw Professions or mpgThe Caraerors 604 — ROOF IN—PROGRESS
License law das nm apply f eco ower of property who)dice reimposes thereon, t
"- and who',Liens for such pojms with a canvmmga)licensed pursuant in the - - - - - - -
Cmenscou
ense La... P
' ❑lams exempt under Sec. BkPCfor this rtmon ,
Owner ' • ' Date " .
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
0 1 have and will maintain a Certificate of Conant to.1f.houm far Worker's
Compensation, as provided for by Section 3700 of the Labor Code, for the t7X
performance of Ne work far which this permit is issued. .
El 1 hove and will maintain Worker i Comix mation Insinuative,n required by Section
3700 of the Latton Code,for the performance of the work for which this permit is
ieioed.My Warkne,Countersink,.I. cc artier and Politynumberem.�. f
f`siner 4f��Y FLr:I''t PohcY No. 7I'� 75 /90 LY: if♦)saF�TKs) . i�i3'f4.�;
CEROFTCATION OF EKEMPTION FROM.WORKERS',
COMPEINSATION,INSURANCE.:' __. ...._ ._...._�-v._.-�.__._.._._' '-'-"- .. __ ____.._ ____._.
I
(lTii seniors need am ha completed if the permit is for one hundred dollars
($100)orles")
_I certifyy shot in the.peRwinenice of Ne work fon which this Pemnit is issued,I _ - ��' ",J,
shall nm employ'any Person in any manner in as to become subject w'fhe Work.,a
Compensation Laws of California.Date:
Appliveno
NOTICE TO APPLICANT:If.after making this Certificate of Exemption.you should
z� 0cbeuhjem to the worker's Compensation provisions of the labor Code,you mstu
ome sfins an comply with such provisions or this permit shall he domed revoked.
`CONSTRUCTION LENDING AGENCY s
I hereby ofBmmw
l that them Is a caeo n lending agency for the performance
'mf the work for which this perm t Ii issued(Sec 3097,Civ.C:),
finders Name' .. .. .. - .. .. .. .- .
o z Lenders Address '
CJS 0 I certify that I have reed this application aha ante that the above information is
cortecs.1 agree to Comply with all city and county odivnm and rate laws relating
.D.V to building construction;aid herby authorize repreunmtives ofthis city to emerupon
k7 the above-mentioned property for inspection purpose, ,,,
a. (We)agree to ml
save.indemnify and keep harmless Ne City of Cupertino against
liabilities.judgments,ensu and expenses which may in"ray way accrue against said
V City in consequence of the granting of this permit.
_ APPLICANT UNDERSTANDS'ANDWILL COMPLY WITXALL NNON-POINT' Issued, Date
SOURCE REGULATIONS. y'
5gnmucafApplicanUC rano - Pea Re-roofs
HAZARDOUS MATERIALS DISCLOSURE / �Q
W�Y the applicam in future building occupant more or handle hazardous materiel Type of Roof
u de0ad by Ne Cupenm Municipal Code chapter912,and the Health and Safety L i- f s^,,•f n T ` s• 111
Cede section 255724) yr -.'.t r ,A 4s , , 'r" 1 1 ^. : `.at. is 7;-, ' t#..
ore,, r' „❑xa, All roofs shall be inspected prior to.any.roofing material.being installed.... ._ -.
Will the appliant ar future building occupant use equipment or devices which If a roof is installed without first obtaining an!inspection,'I agre6%to remove
emit harudous ser coataminanti is defined by the Bay Ares Air Quality Mmagement
names? all new materials for inspection. Applicant understands and will comply with
OYes No t all non-point source regulations. ._
I have mad'Ne hazardous materials rcquitementa under Chapter 6.95 of the
California Heithlb&Safety Code,Sections 25505,75533 and 25574.1 understand that
if the building does not currently have a tenon,that it is my responsibility to notify the ��
occupant of the requiremems which'most Water Prior to issuance of a Certificate of
°""°°"`Y''' Signature of Applicant Date
iL
Ownererr auNori edagent Das All roof coverings to be Class"B"or better
:. . - .. OFFICE - .
Building Division
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: (408)777-3228
aCITYF 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.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: Mr. Rn ad ,�hgw
Address: HOM S+2Gd Rd
Reroofing Company Name: A a 5wn Sb�e iGnQ r t/aC
Applicants Signature:
Joe Antonucci
(Chief Building Official)
6/13/00