02100156CITY OF CUPERTINO
BUILDING DIVISION PERMIT
CONTRACTOWINFORMATION.""'
TIM„I
BmflUO( g)@HESE;ARRY WY
P AND R ROOFING
PITRMITNO2100156
GW$Y1EP1*E:PHILIP C AND FRANCES A
R265 WREN WAY
APPLICAfPeSf'2D211.2002
IONS
408 374-7421
SANITARY NO. CONTROL. NO.
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
0
LICENSED CONTRACTOR'S DECLARATION
1 herehy affirm Inas 1 licensed Chapter 9
Job Description
em under provisions of (commencing
with Section]IXXp nfDwision fthe Buky(egs PryYassiln +d mylicensc is
REROOF
I mfull Ramc an c . ,�V
L Liwa Clue. Lve#:
Dee Con cs
ARCH( C S
e Ipndcrsmnd my plans shall he used as puhlic records
Licensed Pmfcssinnal
3
OWNER -BUILDER DECLARATION
S 1 hereby affirm that 1 exempt from me Contractor's Law me
Any
$8500
C's :
cu
1. i Code: Any city ar county
a. fallowing mason. (Section ]1131.5. Business and c
a. which e. de
improve. demolish, nr repair any dructutool
iss s a pcsmil m construct, plan rat
its for h vornsh,
stateme4. nt
that hosficenance,also uantto dueres lheappnsofthe Contrator'mianse file aw(Chlemenl
to due
thathewith
LicensesionCmic)or
39g6Di2�'Jdo7 AfB0
Valuation
pursuant prmvisionsn
Sec ion of r afire a
the Busiaged vii lation of
(cat
Css
fused and th
Nal he is exempt Eacrefrom and Ne basis for she alleged exemption. Any violation of
he is exempt basis f prim. A.,
PN NTWWWE
Occupancy e
p yTyp
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penally of
net mare than five hundred dollars ($50%
307 - INSULATION
0 I, as owner of the propeny, or my employees with wages as theirsole compensation,
will do the work. and me structure is not intended or offered for sale (Sec. 7W, Business
and Professions Cade: The Contractors License Law does not apply to an owner of
nj�Mcltifns
Property who builds or improves thereon, and who docs such work himselfor through his
ownemployers, provided lhatauch improvementsare amimmindedoroBeredfursale.If.
602 - ROOF PL
603 — ROOF BATTENS
however, the building or improvement issold within one year ofenmpletion. the owner.
6O4 — ROOF IN—PROGRESS
builder will have the burden of proving East he did not build or improve for putpoae of
sal.).
0 1, as owner of the property, am exclusively contracting with licensed contractors to
contract me project (Sec. 7094, Business and Professions Code:)The Comment's Li-
cense Law does not apply to an owner of properly who builds or improves memnn, and
who contracts for such projects with a contramor(s) licensed pursuant to the Contractor's
' cote Law.
am ex (under Sea.,B&PCforhisremon
er Dae/ -ZL
^
WORKER'SC PENSATIOND ATION
1 hereby allinn under penally of perjury one of me following declarations:
I have and will mammin a Certificate of Consent m self inmm for Worker's Coma
cation, az provided for Try Section ]]W of the Labor Gyle, for the performance of the
work for which this Permit is issued.
❑ 1 have and will maintain Workers Compensation Insurance, az required by Section
3'. of the Labor Coda, far the performance of the work for which This permit is issued.
My Worker's Campensarian Insurance carrier end Pol �'y numMr ere:
Cam r. A84v/61TD _
CERTIFICATE OFEXEMPirt�'itOM WORKERS'
COMPENSATION INSURANCE
(Dissection need not M complced if the permit is for nne hundred dollars nlosId
or less.)
1 certify mm in the performance of me work for which this permit is issued, 1 shall not
employany,rcomfIn on turzeussuMrA�rime 0 je ff�iM Workers'Compcasation
Laws of Caf.;a Da !!!! ll
Applican //!!!! �n
NOT7T CANT. If, eller Cenmficale of Exemption, you should
becom su ccl Io the Worker's Compensation provisions of the lahor Code, you must
forthwith comply with such provisions or dais permit shall be deemed revoked.
J
CONSTRUCTION LENDING AGENCY
1 herebyName aRrm seam there is a mnmmnion lending agency for the performance of
' be work (or which his permit is issued Sec. 31191 Civ, C.)
LimilLaralcrs Name
lender's AdJmss
1 cenify that 1 have mad this application and sum mal me shove information is
conect.I agree Its comply with all city and county ordinances and amm laws relating to
building construction. and hereby 3UE06M representatives of this city to enter upon the
ahow-mentioned perpeny for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupenim, against
i liabilities, judgmaa0 costs and expenses which may in anyway accrue against said Ctry
f�
APPLIC NT Uf STANDS AmND WILL COMPLY WITH ALL NONPOINT
Issued by: Date
SOURCER IONS.
Re -roofs
Type of Roof
oz
sign of Apphcant/Contrselor Data
HAZARDOUS MATERIALS DISCLOSURE.
Will the applicant or future building occupant store or handle haurl material
az defined by me Cupenum Municipal Code, Chapter 9.11. and the Health and Safety
Code, Sacc YC525532(a)?J
All roofs shall be inspected prior to any roofing material being installed.
Will me applicant or udre baddingo capanl cquipmcm ordcvims which
If a roof is installed without first obtaining an inspection, I agr?e to remove
emir haxallous air contaminants ax dconed by the Bay Area Air Quality Management
all new materials for inspection. '
D'an
0 Yes
/�y�vp+.'
Lha a thcharard+us ma¢rialsrcyuimmcnts under Chapmr 6.95af me Califnr
nice Hcalth&S' Cul.Suctions25N15.25533aru1255M.lundc thmiflM building
does not c hace a eaanL Ease i1 is my respm¢ihild, to rmtily euparal al the
rey nmum b met prior m IssuancemaceEareaearae ,ay.
Signature of Applicant Date
22 0
All roof coverings to be Class "B” or better
Cr or amhorimd agent Damc
I
LJ
Building Division
10300 Torre Avenue
4 _ Cupertino, CA 95014-3255
Telephone: (408) 777-3228
OFax: (408)777-3333
CUPEIZTINO
Building Deparibnent
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
Wand 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. o
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
Homeowners Name:
Address:
. Reroofing Company Name:
Applicants
JA=%- ^
Joe Antonucci
(Chief Building Official)
on
05101
and will
aw
(,L-
with this policy.