02070098 CITY OF CUPERTINO '� ° - - - •'+I '�
BUILDING DIVISION PERMIT �CONTRACTOR•tINFORMATION: .-
•J
BUILDING ADDRESS:
18644 LOREE AVE. COSMOS ROOFING ""'N82 070098
ERMITN 82070098
OWNER'S NAME: APPLICA S
CARL MYERHOLTZ 1901 OLD MIDDLEFIELD WY T�°��T'D72002
• PHONE: (415) 493-6373 SANITARY NO. CONTROL NO.
O c Z ARCHITEC IEN'GINEER:
ps O O BUILDING PERMIT INTO
&w BLDG ELECT PLUMB MECH
O I I r-1 L:7 I—I
Zss--O z LICENSED CONTRACTOR'S DECLARATION Job Description
L 0 I hereby afEran that l am licensed under provisions of Chapter 9(commencing REROOF p
;v,t•Uu withScaian 70001 of Oiyision3 of the Hosineu end Prohssions Code.end mylicense '
z.a Li cense force and ea T.O TAR/GRAVEL, ADD TAR/GRAVEL
O c O Date Comractor
u t+ ARCHITECT'S DECLARA ON cbe Lra
I understand my plans shall be Used as public rtcods AUGp
Po Licensed Professional AU
G O 20OZ
o OWNER-BUILDER DECLARATION
m 1 hereby M.that 1 no exempt from the Convenor's License law for the
2 0 which following mason. archon 701.5.Business Improve.
Profusions Co de:Any tiny or county ��I� e940
Cz which q Permit t construct,aline land Pr demolish.C or repair any Structure ,+
u0 2 -pri t u issuance,also q the applicant for such pmmit to file o signedstm m - - LA_..... s..5,9.
th510c 3l ttd pd purs a t 16 she pia lsrom of the Gnmrasinrs and Pr Law(Chapterpt 9
(<o mrnmg�, nh1¢etsm]00,0)q(Dt son3ofthcnUstnasendPrgPopoonsCde) 1 '; ;,n 'i jx Sq�•FtaFloorArea,. 1 .1-`11��, Valuation
nr than he s exempt nhcrcrrom olid Ibe bosix for the alleged damgion Any v okuon -' 3 7 5 2 5 0 7 0 . 0 0 .
"af]eaten")031:]'by my appllram for o permit subjcns the opPlicom to o civil penalty
into knm teed hue nnnarca mnara(asdo). APN Number jdF- Occupancy Type
❑1,as owner of the property,or my employers with wages us their sole compensation, 305 - FRAME
-'Will'do the CvotkT and the stdclum is.-M intended or offered for sale(Set.7W;" _
'Business und'Pmf=svions Coem The Contractor's License law da=non apply to en }[�W,I{{rnspectiaiis"`'°'` "
owner of property W ho builds M improves thereon,and who doea such work himself 6 01 - ROOF TEAR V P L
or Ihmu h his own employees.provided that such impm4emems art not intended or
-offered or tele.If,however.the building m im comment is sold within one- _----- -"-"'------------- ---
g p Wild 602 -'ROOF -PLYWOOD NAIL,.i;;;.;:. , :;T=;d
completion,the bowner am.f.le.)r will have the burden of proving that he did ria build ar I '
improve ra pnrpae orpk.j. 603 - ROOF BATTENS
— - ._..-..._.-... ------ - - -- - - — -'-' 604----ROOF--SN-PROGRESS'----- — _..---
❑1,as owner of'he Praperty,am exclusively contracting with licensed c warner.to I v p'IT"3 rt
convect the projc t(Sec.7040,Business and Professions Cod=:I no Comreaor's •'v :;• `._,_„
License Law does eat apply mow
an ner of Poulton,who builds or improves thereon, ""' '
Li
l
:_EL.
and.who.rontmns-for.suchprojects with a cohuracler(s).licensed puuvenbto.the_ .
..._._.... ............... .__-.._ _ .. -...._,... r
Ol am axes License Law —
l un ote
mPt under Sec "'',B.&P C fonhis rtuon
0oner
WORKERS COMPENSATION DECLARATION
I hereby efRnn under pebe]ny of peijury one of the fallowing dedwtionr.'
,t ❑ 1 hese turd will maintain'e-Certificate of consent to mlf-imure for Workn's
Compensation, as-prwided For by Section 3700 of the Labor Code, fa the
rp�ed.m mm.Uf the work fm. ich thn permit k issued..
Ii l he.and will melnuin Wors:ei'i Compensmoa Insurance,ei requited by.Sation
pjOp of the labor Code fa Ne p=rfo6n nc or to ork Ya wh ch dt s permitIT
u
ssu d My Work Yi C m enumn 1 un a mortar and Policynumber-ere:q
5,.� s ' _
Cemcr ' ' - IcyN ��'��/)���`te7 f. if.. t fix . '11.:.x1 r.
° FICATIONOFMK nIONFROM,WOR s .1. .1.,t si 'L. y . t;i T. :: �.
t I C COMPENSATION INSURANCE' -'
~ frhrsSeaton need not be mmpleieJ if the Permit is for one hundred dollars v "i� ' ICI t (`•.!i !' •( ,.f.,
(SIM)or 1 ,y
p the erfumunc ohl e o k f r veli ch the ......_ . . „._ . ..,.
Y P permtl lsSued l _..__..,..._._..r.._._-.. ..._..
'hall tnot employan ,Person y manner so to become subject to the Worke L tl It"A
CoPPm move maws of Cshfomu Date'-
I Dent( 0 t in
. A Imam
,Ncame sujAPPLeWoracf Compensati Shu[vision of th Labor Code,
you most ,I
Z become subject totheWorit pCompensator provisions the Lebo Code,you most •-
0 p forth rah comply W wch provisions a this permit Shell be deemed revoked. .'
ti - ___. - ._ _ - _. _� II
'f� a' i' y 'h;(CONSTRUCTION LENDING AGENCY ' - _
r.-4
— - -
b:-. "' p
a ' "n 'i herebywhichtIher mereus construction 097"Ch,C) for the performance'
W;-sa tart dmahim.whrth du patten': :sued!Ste 3097 Civ.OT '• .
6r_Q -Lmd<n Name -'tr' .."... - _ r+ -a-t ._- __' . ..__.. .. ._ _
V1 c mfy Ili he,1 hove W this application and nine Nen the above (onion a 1 - v
Ilk
E. coricI, I greet comply. M all city and county ordinances and state laws relating
0-u mbudd nB rat cbdn aotiekby euNonze rtprtsemailJeS ollhti nrymcmtt upon
-.0, the abo(W.)i Mi to,roperry rob inspcaike p harrol s t
-0.t tale)eyrtt fo rove:i and ;Sp and keep hemay in the way
of Cupenlno egurrst
W City in judgments,cuts and ing of I,wh ch may n any ay eccm ,gun.: sa d
U 7�. City Ili ennsdqucnce of tf gremtng of this perm I l.,
- lOUR CANT UNDERSTAND -ILL COMPL WITH ALL NON�0
sGURce REODLA ONs '• - `2/l7 CL Issued by: Date
Sign hurt fAppl,c ✓C nuecto ",4Re-roofs
it.{ HAZARDOUS MATERIALS DISCLOSURE ' p, 1 ..''
Will the appllum or fume building anupint store a handle haiardou muenil Type of.Roof_._.. -
es defined by ah C p=nmo Mun c fel Uode CMPter9 R end Ne Heelnh rad Sefery ., s I+l•V i.�e': I c - _ --- '" �" "-.
Code Secym 25533(8
❑ .11
fi tK "" 1 l i�'I,i� in v'� t♦ 1 n . .i
y All roofsshall.be.inspected prior,to any roofing material being installed._,._---_..
r.ff s,NS11.UU8. li ataInto rt Wildingoccupant use equipme qo devnces.which If a roof is installed-without first obtaining anlins actionA'ai fee Yo femove
unit hazudous tar containments ss defined by the Bay AM,Air Quallly Mmagerl g n P g
District all new materials far inspection. Applicant understands and will coin 1 with
n ❑Yea pY__. ._._.
' all non-point so rte regulations.
I he e'reLd tha haudoa matetiils rcgmre 533. edcr Cbaplcr ut.of the
hm
Califoml innlN k'Sefay Code ti'"x25505 this yresponsibility
espo30 1 uy to no dthat _ .,,may
pcedpe IcofY qulrem s hchee¢nant that t, Z __.. ._ ...._
tf the tall n does not c trend ria _ `, f .,•7 a
s yres ns blh to notif the ^
✓ O P fie in t be ma no to Issuance M a C Flce¢of
Y Y
Signature,of.Appl ant
/fCZ _ ...
own=r n ria d a an All roof coverings to be Class "B"or better
�F � Den ,
I °'r•=�'1 t�, t - - , .- : --OFFICE.- _
• � Building Division
10300 Torre Avenue
9.W Cupertino,CA 95014-3255
°u` "` Telephone: (408)777-3228
OCITY OF Fax: (408)777-3333
UPERJINO
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: at'1 221t-
Address:
Reroofing Company Name:
Applicants Signature:
• Joe Antonucci
(Chief Building Official)
6/13/00