02110019 CITY OF CUPERTINO *"* ',
BUILDING DIVISION PERMIT CONTRACTORJNFORMATION
L,u11})6B°9181' UO MAXINE DR JIM KRAUSE ROOFING PERM lirNq)2110019
OW^3931RPEKWOK 2310 DIANA AVE APPLICATIIN1S U40rIT1%2002
vpONE: (408) 779-0704 SANITARY NO. / V / CONTROL NO.
ARCHITEC IENGINIir:R: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
t� t�
woo LICENSED CONTRACTOR DECLARATION
w G I M1erchy al lion that I am licensed under provisions of Chapter 9(commencing Job Description
REROOF
G'ad with section?xXOmf Dim,ion 3O the Bicdacasand Peorcsslons code Mnd in,license is
it fulnorea an r
?ionz l.icensc Cly, LR ,—a,11
-o Doc I/03— "nor
r=tH£,a, —r ARCHm:CTS ARIA^TI0a
eau
3w� Licensed Profectional
=0 OWNER-BUILDIIR DECLARATION
<S hereby xllirm that I am exempt from the Contractor's License Law lit the $11450
eu-02 Iidlowing reason.(Section 71171.5.Bminecs and Profnssions Code:An,my or county t
ads$ which requires a permit to construct,alter,improve,demolish,or repair any structure
'o-o+ pdnnniu issuance.also ecyvires the applicant lin such pc.it oftrisigrodshomaral
q�Sz< Imthe ishcened Puouanuo Ncpmvision.,.f,MConlfaclor's Liccnwl w(Chapmr9 3�61a �aAIQ� Valuation
ual- (commencing with Section 7000)(if Division J oohc Business and Profession,Cock)ter
u. $ Nat he is exempt therefrom and the basis rue the alleged exemption.Any violation of
Section 7031.5 by any applicant for a peemitsubjecu the applicant to a civil Knotty of PN'N Occupancy Type
not more than five hundred dollars F$500). 307 - INSULATION
D I,as owner of the pmpeny,or my employees with wages as their sole compensation,
will do five work,and the income is not intended or offered for sale(See7044,Bosince, �+p{�Sr �pg�jjry
and Professions Code:The Conlrectors License Law docs not apply m an owns,of 602 - ROOF PM rV V n 1V H 1 tns
property who builds or improves thereon,and whodwasuch work himadfor through his
own employees.provided that such improvement.ate not intended or offered for sale.If. 603 - ROOF BATTENS
however,the building or improvement is sold within one year of completion,the comer- 604 - ROOF IN-PROGRESS
builder will have the burden of proving that he did not Wild or improve for purpose of
sale.).
D I.as owner of the pro,eny,am exclusively contracting with licensed contractors to ,
consumer the project(Sec.7044.Business and Professions Code:)The Contractor's Li-
cense law does not apply to an owner of property who Wilds or improves Orman.and
who commoufor such projects with a contracmr(s)licensed pursuant to the Contractor's
License Law,
DI am exempt under Sec. ,B&P C for this meaon
Owner Date NOV 1 8 2002
WORKER'S COMPENSATION DECLARATION
141 I hereby e1Bem under Penalty of perjury one of the following declarations:
D l have and will maintain a Cenifieate of Consent to self insum for Worker's Cumpen. BUILDING
union,as provided for by Section 37110 of the Labor Code,for the performance of the
work for which Nis Permit is issued.
1 have and will maintain Worker's Cnmpermmion Insurance,as required by Section
371x1 of the Labor Code,for the performance of the work for which this permit is issued,
My WorkcCry�C,n lion l scone Gamier and Policy number art: o-
Carnien:m�z Policy No.:
� '�Z—O I.3
CERT[ CATS OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need nut he complemJ if the Permit la for one hundred dollars(S 100)
r Imes.)
1 cenify that in the Performance of On,ooh for which this Permit is issued,1 shall not
employ any person in any manner so as in become subject o the Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:II,after making this Cenificale of Exemption,you should
become subject m the Worker's Compenmiun provisions of the Labor Code.Y.a most
Oz forthwith comply with such provisions or this Permit shall M deemed revoked,
z� CONSTRUCTION LENDING AGENCY
'rte.N 1 betehy i nirm that there is a construction lending agency lin IM Performance of
C' 7 the work for which this permit is issued(Sec.YN7.Civ.C.)
W Q Lcndct. Name
z Lendch Address
U 0 1 cenify that 1 have read this application and stale[hut the above Information is
IS. 0 comply and withall yauty and ttpi,stanmay ives el and city
to
ws enter
pm a
V above mentunctiunanJ hereby amhonprposes,ntativcs of thiscity tuenrer ufxm the
above (We)- o,to srtysave for inspection
mnify an keeplos
Fd (We)agreet%save,indemnifyandhich harmlessthe City of Cupertino against !j
!n in consequence
of the toxo and of thisexpenses which may in any wayaccrue against said City
V z A APPLICANT
of thegrantingthispeemit.
r. APPLICANT UNDT:RSTANDS A ILL COMPLY WITH ALL NON�POINT Issued by: Date
SOURCE.RCGULNFIONS. f
°3 Re-roofs
Signature cf ApplicaDaftc
HAZARDOUS MA ERIALS DISCLOSURE Type of Roof
Will the a Caperrt or(Muni Municipal
Ciia occupant nave or handle H mous material
at dCB^Cd by the Cupeninn Municipal Codc.Chapin,9,12,and the Health and Safely
adc.latiOnia 25532(a)! pN� All roofs shall be inspected prior to any roofing material being installed.
❑v
Will thea applicant Or future wading Occupant use t Or devices which If a roof is installed without first obtaining an inspection,I agree to remove
PP b pan Area
n
emit haealloua aircnmamiwnH as JclineJ by the Bay Arca Air Quality Management all new materials for inspection. t
Uinrier7
❑Yes �N
Ihav Safety
thode sedcusm.Sx[)5l2.5533 cmc us 553401 rChrstand atofthe Califor '` NT.�✓�
ng
does Out
to. ny Codc,Scnannshat it i my responsibility
to notimnd a occ paro or the
Oxo not cum u mnanl.Nn II Ix my respnnsihility to notify the iwcupwt or the
resin in which mslhemet it insNanccofaCenifcateof0.c�ypan Signature ofAppl' .nt Date
/ D3 All roof coverings to be Class B"or better
Oona,m icuth and age.. Date
Building Division
10300 Tom Avenue
Cupertino,CA 950143255
` Telephone: (408)777-3228
Fax: (408)777-3333
CUPERTINO
Building Depaftiment
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 YV 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: 0 S'5 -P Off(0 -),)la.
Per oofmg Company NamQe:avv�.-• 40L� • �y
Applicants Signature: _-1� �w✓r�-=s Date:
Joe Antonucci
(Chief Building Official)
6/25/01