02110118 CITY OF CUPERTINo �� rte-. E
BUILDING DIVISION PERMIT e%OONTRAC�TORINEORMATION r,
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BuiCtill0e9csLAURETTA DR GROMO ROOFING PERMITNO2110115
OWWUN@H:UAN-CHENG AND YU-CHU Y 121 W WASHINGTON AVE APPLICATT'3sXH1D9y2002
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ItZONE: (408) 746-2075 SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MEC11
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Top LICENSED CONTRACTOR'S DECLARATION Job Descri [ion
0�I- I hereby affirm that l am licensed under pmvis oats of Chapter 9(commencing REROOF P
with Seeinn 700doof Division Sof the Business and Prnfessinn.Gwk,andmylicense is
66 In full force and crus
"aj� License Cl' a CI-S9 NIC I.ic.. SS�37 y
OZ-0 Das_// /ry/02 Contractar��` T�—
SF=S-� ARCIIITECT'S DUCLARATION ������®
�y o I understand my plans shall M used as puhligrecnrds _
Liccmbd Pmlessitunal ' - DEC 0 2 2002
M1M2tq_uy.0� OWNER-BUILDER DECLARATION
a 2
hereby affirm that 1 am exempt I'rnm the Contmelors License Law for the $6000
i 600 following mason.(Section]1131.5,Business end Professions Code:Any city or county
d�2� which requires a Permit hs conslmeL alter,improve,demolish,or repair any someone
u+ prior to its issuance,also requires the applicant for such Permit to file a signedssalemem
y'Za that he is licensed pursuant no the provisions of the Con
mmois License Law(Chapmr9 3S216L�t5ID61)6At@ Valuation
F0 (commencing w th Section](IW)of Division 3 of Ne Business and Professions Codc)or
is that he is exempt thcrtGum and the basis for the alleged exemption,Any violation of
Section 7031.5 by any applicant for a Permit subjects she applicant to a civil penalty,of Pot N OWE Occupancy Type
not mom than live hundred dollars(ssoo). 307 - INSULATION P Y YP
I,u owner of the pmpcny,or my employms with wages as their sole comNn-lion,
will do Ne work,and the structure is not intended or offered for sale(Sec.7044,Business �pµyT
and Professions Code:The Contmcmrs License Law dons not apply to an owner of 602 - ROOF P i W lJ nWjk_cf ns
prof eny who builds or improves Hereon,and who does such work himself or through his
own employees,provided Hat such improvements are not amended oroffered faradic.If. 603 — ROOF BATTENS
however,the building or improvement is sold within one year of completion.the owner- 604 — ROOF IN-PROGRESS
builder will have the burden of proving Hat he did not Wild or improve for purpose of
sale I
❑1,as owner of the property,am exclusively convecting with licensed contractors to
construct the project(Sec.70 ,Business and Professions Code:)The Contractors U.
cense Law does not apply to an owner of property who builds or improves thereon,and
whn convects for such projects with a emoorm d(s)licensed pursuant to the Contractors
License Law.
❑I am exempt under Sec. ,B&PC for ..on '
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby a(fum under Penalty of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent to self insure for Worker's Comped
-tion,as Provided for by Section 37W of the Isbor Code,for the Performance of the
work for which His permit is issued.
I have and will maintain Workers Compensation Insurance,as required by Section
'of the Labor Code,for the performance of Ne work for which Nis permit is issued.
My Worker's Compematum Insurance carrier and Policy number am:
Cartier: Yr"4 76 xv-Ny0 Policy NoZ-'3- //-5 3
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This union need not he completed it the permit is fortune hundred dollars(10 W)
or less.)
I certify that in the performance of the work for which this permit is issued.1 shall not
employ any Person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,army making His Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Lubar Code,you must
OO forthwith comply with such provisions or this permit shall Ise deemed mvoked.
E N CONSTRUCTION LENDING AGENCY
[-+ I hereby anion Nm Bacon is a consuuetion lending agency l or the Performance of
tai r7 the work for which this Permit is issued(Sce.3097,Civ,C.)
IT]Q Lender's Name
6. Lender's Address
az
U 0 1 certify that I have read this application and soon that the above in onnotiun is
F-' cones.I agree in comply with all city and county uNinances and state laws relating to
�U building construction,and hereby authoim mpresennives of His city to enter upon the
Gia alms¢-mentioned pro"t,for inspection purines.
Q. (We)agree in save,indemnify and keep harmless the City of Cupcninn against
rat liabilities,pollutions,costs and expenses which may in any way act.again said City
in
of the granting of
his permit.
U APPLICANT eUNDERSTANDS tAND WILL COMPLY WITH AL1-NON-POINT Issued by: Date
SOURCE R 111 ONS.
• __5�r —r 7�Uz Re-roofs
Signature of Aiddean tConvanor y Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future budding occupant some m handle humorous material
as defned by the Cupertino Municipal Code,Chapter 9.12.and the Heald and Safety
etude.'red
zs532(a)7 - All roofs shall be inspected prior to an roofing material beim Installed.
❑rex ❑Ntu P P Y g g
Will the applicant or future buildingo,cupom use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
omit hazardous air contaminants as defmcd by the Bay Area Air Quality Management all new materials for inspection.
Unono T)
❑Yes ❑Nu
1 have mad the hammous materials requirements under Chapter 6.95 of the Califor.
nits licaldn&Safety Cod,Sections 25515,23533 ad 25534.1 undershmJ that if the building
dons not currently have a term,Han it is my mad onsihibly to notify the occupant of the
requirements wh' mustbe met priorm-uanAyofa Cenifcaleapancy. Signature of Applicant ate
moi^ /7/9/UE
Owner or authorized agent Date All roof coverings to be Class"B" or better
Building Division '
10300 Torre Avenue
Cupertino,CA 95014-3255
4
Telephone: (408)777-3228
CI Fax: (408)7n-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.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4"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: r7/L I ri tt-S'• ✓
Address: 2 / D S�S l 4 ✓ /t £ 7"-2 ,y
Reroofing Company Name:
Applicants Signature: �— Date:
• Joe Antonucci�'_
(Chief Building Official)
6125/01