03010205 t CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION l
BUILDING ADDRESS o JIM KRAUSE ROOFING PERMIT NO.
10768/10770
OWNER'S NAME: 2310 DIANA AVE APPLICATION SUB DATE.
JEFF KWOL 01/31/2003
ON°' (408) 779-0704 SANITARY NO. CONTROLNO.
ARCH1117CTIF.NGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MP.CH
t� 0
1-00 LICENSED CONTRACTOR'S DECLARATION
rc u P 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
with Section 70XX)of Divi" of Ne Busincssoodc.a
d promotions Cond re,been.is
in full tome andef� n" 5 REROOF
ZOgZ License Clx�s Lic,N .
oz—, nate_L/p�—OtmIuci T/0 SHAKES, RESHEET 7/16" OSB, 30# FELT &
F= Aall used OFSDIiCI.ARATIO 40 YR. COMP SHINGLES FINALE®
1 uncn
deand my plansa shall Mits puaro
blic rrds
O6U
NLLO
Licensed Professional
F OWNER BUILDER DECLARATION
Y�<f I M1crchy affirm that I am exempt from she Cmnuacsnr's License Law for the FEB -0 6 2003
—C O following reason.(Sectio 7031.5.Business and Professions Cale:Any city or county
m which requires a Permit to construct.alter.improve.demolish or repair any stmnure
hZ 2 prior to its issuance.also requirexaheapplicam for such Permit o file a signed statement
< that he is licensed pursuant to the provisions of the contractors License law lC Cried,r Sq. Ft. Floor Area � alUallOo
rc�o (commencing with Section 7(XXD of Division 3 of the Business and Professions Qdepn
y $
that 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 applican,to a civil penally of APN NumberC Type
not mom than five hundred dollars WERE. Y YP
❑ L as owner of the proper,or my employees with wages as their sale compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7(M,Business 32602 057 . 00
and Professions Code:The Contractor's License Law does not apply to an owner of Required Inspections
property who builds or improves thereon,and who does such work himself or through his
awn employees.provided that such improvements are not intended orolfered for sale.If. 305 — FRAME
however,the building or improvement is sold within one year of completion,she owner
builder will have the burden of proving that he did not build or improve for purpose of 307 - INSULATION
sae')' 601 - ROOF TEAR OFF
1,a owner of me progeny,am exclusively conmcdng with licensed contractors to 602 - ROOF PLYWOOD NAIL
consumer fie project(Sec.7144.Business and Professions Code:)The Connector's I.1
cense Law docs net pply to an owner of property who Wilds or improves Merton.and, 603 — ROOF BATTENS
who contmces for such projects with a contractor(s)or(s)licensed pursuant me ComracuWa
License Law. 604 - ROOF IN-PROGRESS
Q l am exempt under Sea ,B&P C fnr this ressed
Owner Data
WORKERS COMPENSATION DECLARATION
1 hereby e1Trm under penally of perjury one of Inc following declarations
I have end will maintain a Ceni ficale of Cogent to self-insure for Worker's Compen.
.tion,a4 Provided for by Section 3700 of the latxar Code,for the peKomaime Of the
work for which this Permit is issued.
have and will maintain Wurkels Compeaalion taximeter,as required by Section
I )of meLL,ifiscr Coke.for me performance of me work for which mit permit is issued.
My Work,' .oro nlyi� nicrend Policy
gnurcMrr am___ ��.�
Camricr. 2a Policy No./�J:S OOOoe a
CERTIFICATE OF EXEMPTION IBOM WORKERS'
COMPENSATION INSURANCE
orris section need not be completed ifft fermi)is forms hundred dollars(21(X))
or less.)
I certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner sat as to become subject o the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICAT:IL after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Lahor Calc,you must
O O forthwith comply with such provisions or this permit shall be deemed revoked.
z ^ CONSTRUCTION LENDING AGENCY
Our which
roe that the re is a cmnsnunion lending agency lit the pml'ormence nl'
ai the work rim which this permilis issued(Sce.3097,Civ.C)
W0. Q Under's Name
z Lcndcr's Address
U O I certify that I have read mit application and state that the above information is
[s. P-r cancel.l agree to comply with all city and county ordinances and sate laws relating to
0 U building construction.and hereby authorim refees maroes of this city to enter upon the
D.1 abewomentioned property for inepccfiot purposes.
,l (We)agree to ave,indentexpenses
and keep harmless me City of CUPensts against A /s
CL liahiliti(We)gmcnq cos. ndnpcnsesd kee may inany way accmcagaminoagCtry (// /1J/
U z APPLICANTeof me UNDERSTA gofmrs permit.
ND WILL C PLY WITH ALL N P INT Issued by: Date
3
SOURCES RHGULAT1O .
Y :5 Re-roofs
Signature of Applicant(Contracter Date
HAZARDO SMATERIALSDISCLOSURE Type of Roof
Will the applicant or future building oecupenl score or handle h.nk ms marmot
as defined by me Cupertino Municipal Calc.Chapter 9.12.and the Health and Safety
,aiiiiiiLcmhi, Cr ion 25532(.)? �, All roofs shall be inspected prior to any roofing material being installed.
❑Y,s
Will the applicant or future Wilding Occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
nil hammdous air contaminants a defined by the Bay Area Aim Quality Management all new materials for inspection.
GO wfl
❑Vcs \ \ JJJ
Ih&Siffleave e,Cmicamdoamam05,2533ls .dol 5534.us IcrChratandapwr 95 ifthe WiClilding /��
nim llculth&Safety GodC.Stt'Gons2.S.N15.25533 and 25534.1 unofcamnd that if0c building /
does not coneppp Ily have a tenant,that itis my responsibility to nobly the occupant mf me
requi hich me, ni<xman,e'if.cenificetemraefirc Signature ofApplica t Date
r
oWnm oro amthm dagent Date All roof coverings to be Class "B" or better
Building Division
&CITYO
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Fax: (408)777-3333
CUPEkT1N0
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 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: 70 6 f /U 77 D 291a.,
Reroofing Company Name:Q a,w_
Applicants Signature: :Z—Q— --- Date: /A�/�3
Joe Antonucci
(Chief Building Official)
6/25/01