03010145 CITY OF CUPERrINO
BUILDING DIVISION PERMIT V CONTRACTOR INFORMATION::.
BUILDING ADDRESS: LOS GATOS ROOFING PERMIT NO.
10145 MC LAREN PL 03010145
WNER'S NAME: 1771 SMITH AVE . APPLICATION SUB DATE
SCHARPEN LEROY H AND JUDITH A 01/24/2003
HONE: (408) 298-9399 SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
0 0 0 0
OC LICENSED CONTRACfOR'S DECLARATION Job Description
U o
1 hereby affirm that 1 am licensed under previsions of Chapter 9(commencing
wiNSco NkBnf DlvLvhlniOf Ne Bus�and Professions Code,and mylic tits
REROOF
in rouB arta _ 0 0
�Z. Liccnm I s Lic
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w DaiJ ✓ C u
Gipp �V CHI gD., DN FINALE®
� a I understand my plans shall be use s Public records
Lp V
Licensed
1-1-0.0Pmfcssinnzl JAN 3 2003
OWNER-BUILDER DECLARATION O
Sys I hereby affirm that I am exempt from Ne Contractors License Law for the
6 p O
following reason.(Section 710 1.5,Business and Professions Code:Any city or county
x S R which requires a permit m construct,slier,improve,demolish or repair any structure
prior to its issuance,also requires the applicant for such permiuo Allen signed statement
�szse that he is Formed pursuant it)the provianns of the Contmctoh License law(Chapter 9 Sq. Ft. Floor Area $12 Y410atlon
F$ (arm mottling with Section 70(10)of Division 3 of the Business and Professions Code)or
.. that he is exempt therefrom and the basis for Ne alleged exemption.Any violation of
Section 7831.5 by any applicant for a permit subjects the applicant to a civil Penally of
not more thin five hundred dollars(SSW). �' Occupancy Type
❑I,ss owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended of offered for sale(Sec.7044,Business 305 FFU&E
and Professions Code:The Conuacmrs License Law does not apply m an Owner of 307 - INSULA_11f Itffed Inspections
prnperty who builds or improves thereon,and who does such work himself or through his
own employees.provided that such improvements are not intended or offered foraale.If, 601 — ROOF TEAR OFF
however,the building or improvement is mid within one year of completion,the owner-
builder will have the burden of proving that he aid not Wild or improve for purpose of 602 - ROOF PLYWOOD NAIL
Sala.)' 603 - ROOF BATTENS
❑ I.as owner of the property,em exclusively contracting with licensed contractors to 604 - ROOF IN-PROGRESS
consumer the project(Sec.70da4,Business and Professions Code:)The Connactora Li. _
cense Law does not apply to an owner of property who builds or improves thereon,and.
who commas for such projects with a cummemr(s)licensed Forward to the Contractors
License Law.
I am exempt under Sec. ,B&P C for this reason
wart Data
WORKER'S COMPENSATION DECLARATION
1 hereby aRrm under penalty of perjury one of the following declarations:
I hav and will maintain a Certificate of Consent to self-insumfor Worker's Compen-
sation,a provided for by Section 3701 of the labor Code,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
3700 of Ne labor Code,for the performvrc o(Ne work for which this Permit is issued.
My Wor Co nsatinnfsumnce ca er and Pulicyn ram:
Ca Policy NO.:
CE IFICATE OF EXEMPTION FRO R ERS'
COMPENSATION INSUR E
(This section need not be mmplered if do ptrand is forono hundred dollars a 101)
,it less.)
I certify that in the perfmmmce of the..,it for which this permit is issued,I shall not
employ any Nand in any manner an as to Aecomc Subject o the Workcri Compensation
Laws of Cali(nrom.Dara
Applicant
NOTICE TO APPLICANT:If,after making this Ce nillcvte of Exemption,you should
Become subject In the Worker's Compensation provisions of the Labor Code,you must
QO forthwith comply with such provisions(it this Krim l shelf he deemed revoked.
Z CONSTRUCTION LENDING AGENCY
E7' I hemby aflirm Nm there is a construction lending agency for the Performance or
E
7 the work for which lhispermil is issued(Sm.3097,Civ.C.)
114
Unders Name
0. Z Condo's Address
U 0 1 certify that 1 have read this application and sum that the above information is
{k. (.. coned,l agree to comply with all city and county ordinances and state laws relating to
0U building conswciion,and hereby audomize representatives Of this City m enter Upon the
Lkl above-mentioned Property for inspection purposes.
(We)agree m save,indemnify and keep harmless the City of Cupertino against
hliabilities.judgmena,costs and expenses which may in any way acme against said City
U z Inc
encc of Ne grading "B's
Pon"
i
NT DERSTANDS AND W MPLY WITH ALL NON-POINT Issued by: Date
ATIONS.
Re-roofs
Si I of Ap licum/Commum Dom
IDU ARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant ur furore b (ding rMcupanl store err handle hazardous material
as definetl by Nc Cupenimo Mum pal CrWe.Chapter 9.12.and the Health and Safety
CrNc,Section 552x)?
❑Yea No All roofs shall be inspected prior to any roofing material being installed.
Will the appliam nr fumrc ridingdccupa um equipment ordevlccs which If a roof i 'nstallied without first obtaining n 'nspection, I agree to remove
Unit hazardous air contaminants JcfumJ by the Bay Arca Air QmlOy Menagcmcnt all t rial 'or inspection,
District?
D Yes Nn
I have mad the hamolousmamrials tequimmems under Chapter 6,95 of Ne Califtr-
tial Health&Safetyctalc.Sceuumsl:fse,25533 arv1255/.1 Mrsmnd chat if DW Wilding )
does not try k o mount,
Nat itis my respon A to nyyufy tM rccupant of Nc - I
mquire j!
hie n slMmcipnonoiaauancer aides Ott nano'. r o Apn15Cant Date
U0 era r rami agentT4, mare All roof coverings to be Class "B" or better
Building Division '
• 10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CI Fax: (408)777-3333
CUPEkTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
I. 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.
S. 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 Vi"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: �1� S Ch 1 ac r P e Ig
Address: I . J 4 S ` • Ma Laren ln)
Ijeroofng Company Name, J~(JS ' C COS R10 o- 1 ti 4
Applicants Signature: ate: l)3
Joe Antonucci
(Chief Building Official)
60/01