02100076 .. CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: I'
Boll r 1 SSMC LELLAN RD CENTRAL FOAM ROOFING PERMrrN02100076
owrNl8WAMLIFE CHURCH OF THE NAZAR N321 WOOSTEK AVE APrucATTC0S)IE0)9F1Y2002
DONE: (800) 773-9700 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MF.CH
0
Amarca LICENSED CONTRACTORS DECLARATION
o ,heron fermthat l am licensed under fChater9 Job Description
�jyO r y a provl.dons o n (commenting REROOF p
bQ1 Wnn s«Ilmt 7( If DlviFion 3nrmn BYM liC55 and rSr�ore(FSionoY cnaC.�w nay Teens`{Y
Z
Ln full lnnc(f 1. $cr .--7-
hatcho
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ARCIII'1'Ie nee DECLARATION
o w i I understand my plans shall M Iced as Public record,
°w° OCT 2 1 2002
Licensed Ymlcs,innol
F�aac OWNER-BUILDER DCCLARAION
1 hereby alarm mat 1 am exempt from the Contractors License Law for the pg�1 1 1 $13000
w—°a following reason.(Section 7031.5.Business and Professions Cade:Any city or county 'LD
al m which requires a Permit to construct,alter,improve,demolish,or .s
repair any tructure Uy
prior m its i.auance,also requires the applicant for such permit to life a,Igmed smmm„t
ING
SEE that he is licensed pursuant to the provisions of dm Contractor's Licence Law(Chapter 9 .3!g9H.G0&RAIQ0 Valuation
,FG (commencing with Section 7(k0)of Division 3 of the Business and Professions Code)or
i that he is exempt therefrom and the naris for the alleged exemption.Any violation of
Section 7031.5 by any applicant for apemit subjects the applicant to a civil penally of PNN Occupancy Type
not more than fvehundred delta.(s5W). 307 - INSULATION
❑ I,as owner of the pro,scry,or my employees with wages as their sole compensation. 601 RE1191'
will do the work,and the structure is not intended or offered for sale(Sec.7146,Business �kµ�r �yg
and Professimton
s Code:The CtOI Lice.law docs not apply to as owner of 602 - ROOF P IYVV nWAc1ipns
property who builds or improves thereon,and who does such work himself ormmugh his
owncmployces,pnwide&thatsuch improvements arc not intended oroRered for sac.If. 603 — ROOF BATTENS
hrwcw,,sur building or improvement is sold within one year of completion,the owner- 604 — ROOF IN-PROGRESS
Nil let will have she burden of proving mat W did not build or impress,for purpose of
sale.).
❑1,as Owner of the property,am exclusively contracting with licensed contractors to
construct the pmjm(Sec.II0df6,Business and Professions Code:)The Contractor's Li.
remit Use docs not apply to an owner of property who Wilds or improves themon,and.
who contracts for such protects with a contractor(,)licensed pursuant to the Contraarn's
License Law.
❑1 am exempt under Sec. .B&P C for this reason
OwnerDECLARDae
WORKER'S COMPENSATION ATION
1 hereby affirm under penally of Perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self-incus for Workers Compen-
vtion,az provided for by Section 3710 of the Labs Codec,for the Performance of the
work for which this Permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
.700 of the labor Cock,for the performance of the work for which this Permit is issued.
My Wmkrr's Cum�''ti�;��u n��carticr and PolicynumWr are:
Carticr.'S�J�'Z`�`Policy Nn. 7SS
CbRTIFI ATEOF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE.
(This section need riot W completed if the Permit is for one hundred dollars(S 100)
nr less.)
1 ccnify that in the performance of the work for which this permit is issued.1 shall not
employ any Person in any manners)aro Wcomc subject to the workersCompensation
Laws nl California.Dole
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Workers Compensation proviomrs of the labor Code,you mus
O O forthwith comply with such provisions or this permit shall W deemed revoked.
z CONSTRUCTION LENDING AGENCY
I he rehy allirm mat there is a curchic ori lending agency lot the PeHormane of
IYi the work lar which this permit is need(Sec.3047.Civ.C.)
Ia] Q Lender's Name
z Lender's Address
V O 1 ccnify that 1 have read this application and state that the above information is
^F cores,.l agree to comply with all city and county ordinances and state laws relating to
Q U building conswmion,and hereby anthoriA,representatives of this city to enter u,sm the
r eWvcmentiomd Property for Inspection purposes.
(We)agree Co save,indemnify and keep harmless the City of Cupertino against
F' N
liabilities.judgments.cost%and expenses which may in any way same against said City
U z in consequence of the granting of this Permit.
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALLNO -PO T Issued by: Dale
SOURCE REGULATIONS. g� 9
/' Re-roofs
Sigrmmrcof Applicant/Cmnmeor - Date
I IAZARDOUSMA-:RIALSDISCL(ISURE Type of Roof
Will Be applicant or fuure building occupant sore or handle harnrlous material
as&,fined by the Cupertino Municipal Code.Chapter 9.11,and the Health and Safety
Code,scree,1
zs53z(a), Z>— All roofs shall be inspected prior to any roofing material being installed.
❑Yes
Will the applicant or future building occupant use equipment or devices which I(a roof is installed without first obtaining an inspection,I agree to remove
-n,I,ha—dote an,romammaadmdor rte me Bay Area Air Quolity Management all new materials for inspection.
District? LaY,��/
Yes
I have read the harardnnsmuterials mquireactim under Chaptcr6!/5 01 0,Cxlifnr- 6 /
nialMalth&safety Cwk.Stttiom255,15.2SS33 artJ 35538.1unden ftthatifJ,c Wil ling ^ /Q 7/OL
does rte,curendy have a mum,ma o is my orsry,nxfoli y to notify the rpcu ,of the
rcyuirrmcnuw w a,tWmm pct,. m ixeanre ora cenmcam mf O.yy+ Signature of Appl' ant Date
owne aumedr�grri, �r All roof coverings to be Class "B"or better
All roof coverings to be Class 'B"or better
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)"n7-3228
CITY O Fax: (408)777-3333
CUPEPTINO
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 1/4"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 o/n reroofing and will comply withthis policy.
Homeowners Name: _;!n—� l t h rL U, IDI
Address: 2Q, 6rd C�c� — AC_.ac N•`
Reroofing Company Name//: [o— �� a0 �� /'� 'Q1
Applicants Signature: D Date: la 9
Joe Antonucci
(Chief Building Official)
6/25101