01040109 IWIL FcuPEN
KTNo
. N
PERMIT CONTRACTOR INFORMATION:
BU I LDING ADDRESS: PERM IT NO.
OWNER'S NAME: APPLICATION SUIT DATE.
PHONE; SANTT PARY NO. . CONTROL NO.
stARCI I I'fECTIENGINEER: BUILDING PERMIT INFO
w BLDG ELECT PLUMB MECII
N4
Ihcreh IfICi'Nl];at, ue...dc 1dle, om Ri Chaps )mn.m..f-in Job Description
o z—o r ..t a proarsmas o per' g
F mtac.a with section](X10 f D 1 the Btran.,.s anal P fewwiuns C,de,and my aemse
Y firm full loan uB Cf4ct.
K`-- firm„`ecJffec, __ ' L;e.Y O� Z REROOF COMP TO COMP.
'x a u D;ua�r '��ap 'tJ� Convenor
_O¢ ( ARCher licr'S DECI,Nt PION
I d 'r l y til 11 h, J I J
�aCOLivenwillV t. ' '1
o OWNI R f1UILULN DECLARATION
W
fz–pF dC h,trillion chat I -pLII C i l lI r the
olhoin, .se,fion
703ISE_ IProf Cd Auy,iOu,county
which requiresa e.nm re construct.eee,..timve.demaluh,or repair n structure
prior to issuance.alw requires The aPplicanl for such ltmiva file
asgned wtalemem,w
Z
ate— that he is licenced pursuant in the Provisions of the Cormcco'sLiccnsLaw(Chapter 9 Sq. Ft. Floor Area Valuation
(conu..encing with Seetinn]0(X1)of Division 3 of the business and Points.......Code)
o.r thio he is c -ntpt IhereRmn..... the Ami,fat the alleged a riphnn.Any violation
fSection]031.5 by any applicant fora fefile s.bjee,,meapplieent to a civil penahy
nfor.momthamfive haddreddollars VENS. APN Number Occupancy '.9
01,n...wner of the property,or my employees with wagi their sole urn wrisntion.
will do the work,,fid the.Imdme is rot inen ild nr ntYcrrtl I'nr Talo Sec.7044,
Basand Pme. ,,Code: IheC..ntru,mr:,Liven-Lawour,or),appl,to �, i— equired Inspections
`of prapnfy wan build.,,, n,pn,u,lheeon,and who dnc.with work him¢Ii
forceful
his oxm employeew.'po,vi&d he,...If impmvonce t,are no imc ut d of 305 — FRAME
offered ha wale.If,however,the building or unpafvemurn is%old within ane year of
yoaon,the ow..er.hw ,cul h
l have the oiden of pmvhtg mal he and..oI hada o`
L,mnpmve Tor,u,00,of,a e.1. 307 — INSULATION_
01.a,owner ofthe pro,ti am c.aclusively connecting with licenwJ caatm.nT to 601 — ROOF TEAR OFF
m,tmer the Project(See.nu<.Euwine...and Procession,Codc:)The Contractor's 602 — ROOF PLYWOOD NAIL
License Law Joes no
ot apply to owner of pmpemy who huilJ.c or improves tharon,
rd who<aatrath n„sash prycmw with..toatmnor(,) neca,ed pusmOI In the 603 — ROOF BATTENS
Comecmr',l teen',law.
01 am exempt under See. .B&P C(of this rectom 604 — ROOF IN—PROGRESS
Owner Date
W(IRKI:R'S COMPENSATION UECLARAI'I(1N
I hcrehY alliin,under penally of perjury ane of the li,llnwing Jednrminns:
❑ 1 have and will maintain a Cedificam of Conserv R)self-insum for Worker',,
Compt m pmvided for by Section 3700 of the Labor Code. for the
purl........nee nl list work for which tbir,ennit is issued.
01 have and will maintain Worker's Compensation Insurance.as eyuiml by Smuon
37M of the Labor Code fur me fonnance of me xvrA Int which this permit is
is,ned.My 'arks/s Com_nwu normo,earn Policy number mer
cuff...: P..pcY n'„�� 3
CERT H:CAI ION OF E%F.MN11t N -- OM WORKERS'
COMPENSATION INSURANCE
('This section need not he completed it the ler cit is for one hundred dol%.'
(81001 or lc,$)
1 mm y that in the performance of me wod,for which this pecoul is issued.1
.hall not employ any tier..in any manner m as a lite....suhjecl a the Workers'
C..n,Rn.mion Laws of Califam a Dae
Applie tin
NUI'ICE TO APPLICAN E IL atter making this Ccnukatc of Ii,nmp(in r.you should
bee on a wbject to the Worker',Compensnibo
un provisions of the lar Code.You coast
O Q forthwith comply xith such runs mon,.,,his permit shall M:directed revoked.
z
F~'I CONSTRUCTION LENDING AGENCY
H
a 4 I hereby alliri,, ( lherui ucnnslmcri..n lendingugency for the peThountnce s
of me work for
which this permit its issued(Sec.300.Co.C.)
S Q Lender',Name
= z IsnJer',AJJms,
U O I”'ifr mal I niva read Ihl.appllcadn c and since mut the above ire Dna int i,
.or.0.11 It,comply aitb all city i I anmty orstrmncc,and ,are laws relating
O U
it)Wilding conswcuon.and hereby authorize representatives of this rnrm enter upon
>. k7 the aMwomcmmned pmperry for inspection purpose..
F„ 4 (We)agrec o,cave,indemnify and keep horer,nithe Ci ty of C.,ri inn ugaina
V) linhilitie,ludgnem..u,a aid e,lxmc,which icy in eery way accrue against said
U7,.y Chy incune.yucnceof rbc gr;nn ingollhiwpermil,ist,
APAP` CANT UNDERSTA SA D WILL COMPLY WITH ALL NON-POINT Issued b Date
S OR y:
Y'
sig atnr�rplicmn/C mruct [)areRe-
roots
IIAZAIt DOUS MA'1'HRIALS DISCLOSURE
Will the appl"I'll elm lmuemg,ertm:..n.tore or nanme naaattioac,aaedal Type of Roof
as declined by the Cupmino Miturt ipal Code.Chapter 9.12,and the Health and safety
CWc,Scctiun 25532(..)'
O Ye. ❑No All roofs shall be inspected prior to any roofing material being installed.
Will the appucaut or ltrace building occupant use eyuiprocnl or Jcvlec.which If a roof iN insialled without first obtaining an inspection. I agree to remove
emit h...Nou,air.....trimmed,m defined by the Bay Area Air Quelily Mmegancm
District?
mO Yew ❑Na all new materials for inspection. Applicant understands and will comply with
all non-point source regulations.
I hme curd the haznW.....mwenelw n9n'ucont,under Choler 69,5 of nbo
California Health R Salify Circle.Section,25505.25533 and 25534.1 understand thio
if the Wilding does not cumentty have a tenant,that in is my res,risibility no notify the
eve,I the rayuimmenn w ch must he met prior a issuance of a Certificate of
o tap° eye 1 ' j�' 4 Signature of Applicant Date
own., , r.cJ a•✓, /tI Date
All II roof coverings to be Class "B" c r better
OFFICE
�. Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF 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: F�A /tl Q,,1
Address: �—
Reroofing Company Name: o
Applicants Signature:
Joe Antonucci
(Chief Building Official)
6/13/00