02100039 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTORgINFURMATIONs
BU]q@ N4DR€§UNAR CT CROSS & ASSOCIATES PERMIT N®2100039
O'KISIRE&EMENDSCHLAG 500 EASTER AVE APPLICATIQtSM4ry2002
ONE: (408) 262-2574 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELEC`1 PLUMB MECH
O
�00 LICENSED CONTRACTOR'S DECLARATION s
¢U 1 hereby affrte That 1 am li cnsed under previsions of Chapter 9(commencing O O 1
<� with Sectio 71 )of Divw n3of the Businc and Pre fess ons Co do an it I is
i(fall[ores Jeffcc
:oa Li N 7�1203
C y F p Dow Qintraclou �
�^4 "1 ARCHITECTS Dk,*ARRA IT ON
a I mok.mnd my plan.,shall be ascots Public records
OU
r O Licensed PnJcssinnal
p
OWNER-BUILDER DECLARATION
ContrON
5y u 1 h..a. .(fore that 1usint from the Cssions is Liccnsc Law for the $7800
a X G O following reason.Permit
t 7031.5.Business and improve,
de professions Code:Any city rte mums
ae$w which requires a Pmmit m nims the.aIle[,improve,demolish,or repair any tawrstructure
t
m�'^ hat h o s licensed
pursuant
requires thovisio s of for such permitto's Lice se Law(s hx menl Valuation
1-�6 that he is license)pursuant In the previsions of the Conwcwr's License Law(ChapmrY 32II.Q�&AdBD
iga (commencing with Section 7000)of Division 3 of the Business and Professions Code)Or
my dust he is exempt therefrom and the basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of 3UAPNN E Occupancy Type
Out more than Eve hundred dollars(5500). 307 — INSULATION
❑I,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and da. ucm.is not intended or offered for sale(See7044,Business 681
and Professions Code:The Contractors License Law does not apply to an owner of6 0 2 - ROOF P nT'&cfif ns
property who builds or improves thereon,and who does such work himselfor through his
own employees,provided that such improvements aro not intended or offered for sale.If, 603 — ROOF BATTENS
however,the budding or improvement is sold within one year of completion,the ve Nowner- 604 — ROOF IN-PROGRESS
builder will haw burden of proving that he did not build or improve for purpose of
.Jr.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044,Business and Professions Code;)on Contracmrs Li-
cense Law does not apply to an owner of property who(wilds or improves themon,and,
who contracts for such projects with a conuacmr(s)licensed pursuant to the Cmdract.el
License Law.
❑ I am exempt under Sec. .B&PC for reason
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby allin,under Penalty of Perjury one of Ne following declarations:
1 have and will maintain a Certificate of Consent o self-insure for Workers Camper-
nation,as provided for by Section 3701 of the labor Code,for the performance of the
W
ork for which this permit is issued.
❑1 have and will maintain Workers Compensation Insurance,as required by Section
3701 of the Labor Code,for Ne performance of the work for which this Permit is issued. -
MyWmwre sCom1pcnsatioRl cecarticr antl PN u bcry�r�p�t�G/I� p�
nier. +(fl i 1 A NN eU
Policy
o."�6'TTCI 3V—
CERTIFICATEOFEXEMPTION WORKERS'
COMPENSATIONINSURANCE
(This section need not be completed if the permit is formic hundred dollars(M(g)
less.)
I ccnify that in the performance of the work for which this Permit is issued,l shall not
employ any Person in any mannerso se,m become subject to the Workers'Compensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:IL after making this Cmtilicate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
OO forthwith comply with such provisions or this Permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
7
[-+ > Ihereby an!,.Nat there is a construction lending agency for the Performance of
(!, the.,it for which this permit is issued(Sec.3097,Cu.CJ
QLender's No
z lender's Address
U 1 certify that I have mad'his application and state that the above information is
0 (~ building
to comply with yandhorill city representatives
Of and itytotate awter Odom
ng a
0U buildingcroopedtpuffer herebyection purposes. of Niscitymenkrulnen the
ul above-(We)agree
to saw,
for inspection keep ha
(We)egret m save,indcmmfy and keep harmless the City of Cupertino against
tiy liabilities.judgments,costs and expenses which may in any way accrue against said Cily
fJ `l iAnPPLIUqucnccuNDERSTANDSthis
gfyD WILL COMPLY WITH ALL NON-POINT Issued by: Date v v
SO RCER ULATIONS. fk/J!/I° ' .I��
a�' Re-roofs
igrown,of Appl lu"C"'O cmr arc
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will Ne applicant or future building occupant store or handle harm ous material
as dcfmcd by the Cupenino Municipal Code,Chapter 9.12.and the Health and Safety
code,S area 1ss3xal7 All roofs shall be inspected prior to an roofing material being installed.
[Dyes MNo P P Y g g
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit luf,mdous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District] ` ,
❑y" \\
Ihave&Sgmust(the harar-g,,Ts.,2 materials 5,255uimmcn534.1.Chapter.dffiaifr Califon.
nia Health&Safety GsJc.Secdons155)5.155JJ anJ 155J4.lun muily Bat at capart.1the
Jrea not currently haviceknant, it my res mibilily mnndly the rccuPant.1 the
ream it which maatbemm nrma.,nancenaceniB'ateifOceuP cyrt Signature of Applicant
mnrized agent ( Dame Z All roof coverings to be Class "B"or better
�1
r Building Division '
10300 Torre Avenue
• Cupertino,CA 95014-3255
` Telephone: (408)777-3228
F= (408)777-3333
CUPEkTINO
Building Deparitment
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 i**+um of V"per foot slope and demonstrate that
there is no ponding.
2. An LC.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: 44d to, r
Address: 1116L Lr;�17) N , 02a2k-nn
Op
Reroofing Compan ame
Applicants Si tore Date• _ v
Joe Antonucci
(Chief Building Official)
6/25101