03010150 CITY OF CUPEWI'INO
BUU.DING DIVISION PERMIT CONTRACTOR INFORMATION
BUILDING ADDRESS: PETERSEN-DEAN INC PERMIT NO.
19841 LA MAR DR
NER'S NAME: 7980 ENTERPRISE DR APPLICATION SUB DATE
SUE RANNEY 01/27/2003
PHONE: (510) 494-9982 SANITARY NO. CONTROL NO.
ARCHM-CIVENGINEER: BUILDING PERMIT INFO
BLIK ELECT PLUMB MECH
. 00 LICENSED CONTRACTOR'S DECLARATION Job Description
P 1 hereby affirm that I am li that Bo under and
Pr inns of Chapter i 9(commencing p
� with Satinn 91k10)nf Division hd ase Busiwss end Professions Cale,anJ mylicense is
in full forteanJ�/c j 8�� T/O 2 ROOFS
'nom Liccnrc Cla�: Lic.X_
oZ-o Date_( cnmmeta_ ADD 50 YR. COMPOSITION SHINGLES r�
ION
I understand my plans shall W
ARCHITECTS �bAR cords FUN A�.a{�®
uG
3 u Licensed Professional q '']]
F="<g OWNER-BUILDER DECLARATION OOJ
� I hereby oil!,.that 1 am exempt from the Contractor's License Law fat the Al If-,
l
a ❑ following reason.(Stenon 7031.5.Business and Professions de:Any city or county I's 1, 2
�a
.92 which acquires a Permit to construct.eller,improve,demolixh, it.,at,say structure
t-.ZY prior to its issuance.also acquires the applicant forsuch Permian Ne asignedsmtemem t ,.�
Q�0 that he is licensed pursuant the previsions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area IQ1)I Lv2luatio�nj
a $ (commencing with Section 71kk1)ruf Emilia 3 of the llualnesBt As and Pmlemoons Codefor
y that he Is exempt therefrom and the basis for the alleged exemption.Any violation of 7844
Section 7031.5 by any applicant for a permit subjects the applicant to a civil perohy of APN Number Occupancy Type
ant
an
a., five hundred dollars(a500). 36910031 . 00 P Y YP
0 1,ss owner of the property,or my employees with wages as their sole compensation,
will do me work,and the strvmurt is not intended at offered for sale(Sec.7011,Business
and Professions Crude:The Contractor's License Law does not apply to an owner of 305 - FRAME Required Inspections
property who builds or improves thereon,and who docs such wart himself or through his
own employees,provided that such improvements arc not intended or offered for sale.If, 307 — INSULA'T'ION
however,me building or improvement is suld within one year of completion,the owner-
builder will have the burden nr proving that he did not build or improve for purpose of 601 - ROOF TEAR OFF
sale) 602 - ROOF PLYWOOD NAIL
0 I,as owner of the propcny am exclusively contracting with licensed contractors to 603 - ROOF BATTENS
consumer the project(Sec.7(M,Business and Professions Cale:)The Contractor's Li.
cense Law does nut apply to an owner of property who builds or improves diamond,and 604 - ROOF IN-PROGRESS
who contracts for such projecu with a Canracmr(s)liecrsrd pursuant to the Contramor's
License Law.
❑ 1 am exempt under Sea B&P C for this reason
,net Data
t WORKER'S COMPENSATION DECLARATION
I hereby amren under penalty of perjury one or the following declarations:
71�7.(,"Kmf
I have and will mairmem a Certificate of Consent to self-insum for Worker'sCnmpcn-
on,as provided for by Section 3700 of the Labra Code,for the Performance of the
rk far which this Permit is issued. '
1 have and will maintain Worker's Compensation Insuvnce,as acquired by Section
the Labor Cnde,for me peKnrmmnce of the workfr which this Permit is issued.
Wor h Co pcnsa bn Insuan canicrandPolicyouumMrs ; prier. r 4 Policy Net /O p S -44 9'
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATIONINSURANCE
(This sectiom need not be completed if the Permit is for one hundred dollars(S 100)
or loss.)
I certify that in the Performance of the work for which this Permit is isaied.I shall not
employ any person in any mannerso as In become Subject n the Wormer Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:11:after making this Certificate of Exemption,you should
become subject m the Worker's Compensation provisions of the lsMrt Cale,you must
O 0 forthwith comply with such provisions or this permit shall be deemed revoked.
Z "' CONSTRUCTION LENDING AGENCY
[-+ iN+ I hereby altirm that mere is a construction lending agency fonhe performance of
t:X7 the work(or which this permit is issued(Sec.YN7.Civ.C.)
21 Lender's Name
0. Lender's Address
az
I)Q Icertify that Ihaw mad this ty and ciunyoslateces the druveass Minting is
to
0Ubuildct.I agreeingcontr to comply herebyth lcityandchuntyomves;of and staleentrdramge
0 U building coned construction,and Im, mirumori¢ poses. tivcs of this city ur toter urym me
ahavo-mee)agree
Ina inspection keephs.
in
(We)gemr hr save,indemnify and keep harmless the City of against against
f/] habilin
ncoisegjnce of ths,cusuend oe granting f this Permit.
APPLICANT
they in any wayaame against said City
U APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N POINT Issued by: Date
SOURCAPPLIC NT REGULATIONS. SCD WILL LY ^ /ry27
+ �,,
�7L Re-roofs
Signature of ApplicanVChntramnr Datc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or fours building occupant store or handle hawdous material
as defined by the Cupertino Municipal Code,Chapter 1,11,and the 1kahlb and Safety
tor,Section 35532mfy All roofs shall be inspected prior to any roofing material being
installed.0 rex "IT.-
Will
the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, l agree to remove
emit humrdnus air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
O Yrs QDlor
Ihave.aduc befte,Secnonsly ialsacquiacmcns .under u Chapterfi95 hour our Wilding n �f -7/0-3
fier-
nixs noth&Safety Cnk,SmionOatitV,55Aand2553t.1 to Moody the
octand that cprbuilding \ ' � i
des not currently have a tenant,mm it is my resrynaibiiity.godly the Penney t of the
acgniacmrms wb m.prior.i. arta nracrninralr nr�«/r/panry Signature of Applicant Date
Owner in strummed apart J All roof coverings to be Class "B" or better
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Cl 0 Fax: (408)777-3333
CUPE�TiNO
Building Departmen
Subject Reroofing policy for the City of Cupe o <<
• �\� �q 1003
1. Prior to permit issuance,you must agree to com wj11N1997 UBC ds
and manufactures specifications on reroofing.
2. New roof coverings shall not be applied without taining ection
'and written approval from the building inspector.A final inspe d
approval shall be obtained from the building inspector when the rer fing 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 V"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 p licy on reroofing and will comply with this policy.
Homeowners Name:
Address: l '�F'9 Z-0--
. P
a.
Reroofing Company Name:
Applicants Signature: nate: ? 03
Joe Antonucci
(Chief Building Official)
6/25101