02100119 r, CITY OF CUPERTINO it.
BUILDING DIVISION PERMIT IAC- RATORFORMATIONf
BUInj1 (1/9EIRESLAURETTA DR VIP ROOFING CO. PERMITNO2100119
QWMPNERIC AND JENNY TRUSTEE 1555 YOSEMITE AVE #5713 APPLICATq?VyB1Wy2002
IONIi: —7417-822-388o SANITARY NO. CONTROL NO,
ARCHITECUENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
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W^00 LICENSED CONTRACTOR'S DECLARATION JobDescri tion
I hc.by.1111.that l em licensed under provisinnc of Chapter 9(commencing REROOF P
mm wi
it Section 7000 at Dmislon nl the Busincx.and Pndcssions Codc.nndm liecnmis
G=y in lullloreeandefle / Z,
Y
F �Z L c L'
NFO I - Glmracrur
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$ I undersand my plans shall M used as public records
usi3� Licensed professional
F u.0 OWNER-BUILDER DECLARATION
I hereby uBirm that 1 um exempt from the Contractor's License Law for the $14200
w 000y following mason.(Section 7031.5.Business and Professions Code:Any city or county
XLL which rtyuiMS a permit to construct,alcor,improve,demolish,or repair any structure
W prior In its Issuance,also coy.Ims the applicant for sixth Ttlmlt to file a signed statement
qrZx< that he is licensed pursuanuo the provisions of the Contractor's License Law(Chapter 9 3Sk168410da A@B Valuation
aFO� (commencing with Section 70(Xb of Division 3 of the Busi nets and Professions Code)or
that be,is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7071.5 by any applicant for a permit subjects she applicant to a civil penalty ofpAtN Occupancy
not mom than five hundred dollars($500). 307 - INSULATION �Pe
❑1,m owner of the property,or my employees with wages u their sale compensation,
will d9 the work,and Ne structure is not intended or offered fee We(Sec.7044,Business
And Prufcssinm Code:The Contractor's License Law does not apply to an owner of 602 - ROOF P nfjN!lt2ns
property who builds or improves thereon,and who doessuch work himmlf orthmugh his
own employees,provided that uch improvements are not Intended or offered for Aide.If. 603 — ROOF BATTENS
however,the building or improvement is sold within one year of completion,the owner
builder will have the burden of proving that he did not build or improve for purpose of 604 - ROOF IN-PROGRESS
salad.
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the pmject(Sec.7044,Business and Professions Cade:)The Contractors U.
cense law rices not apply to o With
a of property who builds or i.provu Convector's and, /
who emnrscu for such projects with a contractorts)licenced pursuant m the Conuacmri O/
License Law.
❑ 1 empl under Sec. .B&P C for this reason `J
Date
WORKER'S COMPENSATION DECLARATION
I hereby a171m under penalty of perjury one of the following declarations:
I have and will maintain a CeniOcek ofConsent to ml(-into.for Wnhci sComPcn-
satinn,as provided for by Section 3]00 of the labor Cmle,for the performenec of the
work for which Nis permit is issued.
❑I have and will maintain Worker's Compensation Insurance.as myuired by Section
37M of the labor Code,for Ne performance of the work for which this Permit is issued.
M� Work,y'Com nsation lnsurancec mcraW Poli num xrasc: '
cln.l� �i�-tv�r T--u.o Pnncy
II""__ C RTIF TEOPEXE PTI ROM WORKERS'
COMPENSATION INSURANCE
(This czelion need nn1 W completed if IM permit is Intone hundred dollars($Im)
or less)
I certify that in the Performance of the work for which this permit is issued,I shall not
employ any peravn in any manner m as to become subject o the Workers'Compensation
Laws of California.Date
Appl scam
NOTICE TO APPLICANT:H,after making Ibis Cenibcam of Exemption,you should
become subject to the Worker's Compensation provisions of the tabu Cnde,you must
OO forthwith comply with such pmvismax or this Permit shall le deemed revoked.
CONSTRUCTION LENDING AGENCY
[-+ y "I hereby affirm that there is a construction lending agency for the Performance of
(Y. ti the work for which this permit is issued(Site.3097,Co.C.)
{Ta Q Lender's Name
U 0 1 Le Address
PO I certify Nal I have read this application and stats that the above information is
u. U correct.l agree m co,and herth eby
a sty and represounty ordinancef and tam t inn r Pon
m
V above-mentioned roend heeby awhon purposes.represenutives of Nis city ur enter upon the
r u] ahovc mentioned IIIpeny for inspectionkeept
(We)agree ts,save,and expen and keep harmless the City of.agents against l
Uy incoritieajuceofth,ttnuang expenses which may in any wayaccrue against said City i
V APPLICANTcUNDERSnAND�S thisPermit.
WILT.COMPLY WITH ALL NON-POINT Issued by: Date o V
SO LATE S.
OF _
Signal. f U n a Ir Date -
IIA RD 1, MATERIALS DISCLOSURE Type of Roof
WiEdIm.pPlicam or tutor h ilding tccupantamre,of handle hamrdous material 1 _;
as defined by the Capeninu Muni al Calc.Chapter 9.13,and the ll.Ith and S.fery
Code,Selena zss3z(aTt III���/// All roofs shall be inspected prior to an roofing material beim installed.
❑vet ',p Nn P P Y g g
Will the apPlicam or future building Occupant tie equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
not haeamods air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Distrio?
❑Yes' Nn
Ihavcreaddiehetallo sm urialsmyuimmenuun&rChapar6.95oftheCalifor-
nia Health&Safety Crxk,Sections 2SA15.25533 and35534.1 undersand that if dm building
Cdoes not currently have a lactam,that it is my responsibility to madly[be Occup rm of the 1
•idents which must he met prior m issuance nfa Cerilicureo OtAIlipawy. Ignskr@'4-Appl1an ate
onwhod J 1 Datc
II of coverings to be Class "B" or better
'BuildingDiyision. •
10300 Tone Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
p Fax: (408)777-3333
CUPEkTINO
Building Depa ritment
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.
S. 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 policy on reroofing and will comply with this policy.
Homeowners Name:
Address:'
Reroofing Company Name:
Applicants Signature: Date: l ,
Joe Antonucci
(Chief Building Offidal)
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