03010095 .' CITY OF CUPFKI'INO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
BU I LDING ADDRESS; R E ROOFING & CONSTRUCTIONS PNCNo_
k 19681 MERRITT DR 03010095
OWNER'S NAME: 15230 CLYDELLE AVENUE APPLICATION SUB DATE
LUCY & JEFF TUTTLE 01/16/2003
IONF.: (408) 925-9995 SANITARY NO. CONTROL NO,
ARCH17ECr/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MPAII
0 I�
wor 00 LICENSF.DCONreseda 'DECLARATION
IF I iherebyo.10 affirm that I am licensed under provisions of Chapter,9(commencing Job Description
i,� with Section 7g0y of Division 3nf NC Business and Profession.Gak.and my license is
';„ in full fn andeffcNl G g �qL^'yCIC1 REROOF
z�n License / l 1
°�� Dam
ss c 3m T/O 1 LAYER OF WOOD SHAKE, INSTALL 1/211CDX,
AR Hn:crs DEr )
� � do lad myplaaa m1 n m.nrds #ASTM & LIFETIME ASPHAL SIL9- ES
Licensed Pmleemonal
X
FIl
OWNER BUILDER DECLARATION
zf 1 hereby affirm that I am exempt Imre the Convector's License Law for the [ 1 O 2003
600 following reason.(Section 7031.5.Business and Professions Gale:Any city or county Fy L
X 96 which requires a permit to construct,slot,improve,demolish,or repair any structure
xa;° prisoto its issuance.also requires Ilia applicant]or such Permit o file a signed statement
t' a that lm is lice said puravunno the pnrvini......f the Contrrelin a lienee law(Chapter 9 Sq. Ft. Floor Area1 p�/'w Valuation
(commencing with Secure 7100)nl'Divi.sion 3 of the Business and Professions Code)or BUILDING
r3$
that he Is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7131.5 by any applicant for a permit subjects the applicant to a civil penalty of ppN Number C pry,
not more than five hundred doll...($500). Y Type
❑1,as owner of the properly,or my employees with wages as their role compensation.
will do the work,and the structure is not intended or offered for sale(Sec.7111 Business 33:635885 . 88
and Professions Cash:no 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
own employees,provided that such improvements arc not intended or offered for ssle.If, 305 — FRAME
however,Ne building or improvement is sold within one year of completion,the owner-
builder will have the humcn of proving that he did not Mold or improve for pmlmse of 3 07 - INSULATION
sate.). 601 - ROOF TEAR OFF
❑1,as owner of the property,am exclusively contracting with licensed contractors to 602 - ROOF PLYWOOD NAIL
convect the project(Sec.7(W,Business and Profusions Code:)The Contractors Li.
conte law does not apply to in owner of properly who builds or improves daemon,and. 603 - ROOF BATTENS
who common for such projects with a eommictor(s)licensed pursuant to the Contractor's
License law. 604 — ROOF IN-PROGRESS
❑ I am exempt under Sec. B At P C far this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
41 1 hereby aRrin under penalty of perjury,one of the following decimations:
El I ban and will maintain a CcnifocateofCom enuo sel6ineure for Workei sCompen-
ation,as provided for by Section near of the lather Code,for the perfonnana of[be
work for which his permit is issued.
❑1 have and will maintain Worked Compensation Insurance.as required by Section
37110 of the labor Calc,for the perfarmmme of the work for which this permit is issued.
My Wmk(r'ss Cpommpseaation Insurance artier and Policy number sm:
cr: 0Ir11 ( t Pn1RTRO: _ 1t 8100�tU
CER'I'IPICA'1'Ii NSATI P I PPRAN WORKERS'
CO 'IiNSATION INSURANCE
(This section need not be completed if tbe permit is fromm hundred dollars($10d)
of lair)
1 comfy that in the performance of the work for which this permit is issued,l shall net
employ any porasn in any manner her)as m become subject o the Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:If.after making this Ceni licme of Exemption,you should
become subject in the Worker's Compensation provisions of the Labor Code,you must
0 z forthwith comply with such provisions(it this permit.shall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
[r I hereby.firm that there is a construction lending agency lir the performance of
Ix .moi the work for which this permit is issued(Sec.31197.Civ.C.)
dQ Lender's Namc
z Lender's Address
U O 1 certify Nal 1 have read this application and sore that the above information is
D. P coned.l agree to comply with all city and county ordinances and some laws mining a
0U marnngroveconstriction,and herthyection p rcoses. tivcs of Nis city menmr uqm Ne V
W above-(We)a cd pmpcny for in taily,an keep hs.
(We)agree m save,indemnify,end keep hay in an the City accrue
Caperton s against
F'rjjliabilities,judgmrnts,cosu and espenuswhich meyinany wayaccme egatmtsaid City
U ucnce of the gramingofthispermit.
C APPLI Nf ffi ST OS AND L COMPLY Win]ALL NON POINT Issued by: Date
SOU G .ATI
✓ Re-roofs
ig rcofApplica"1ARDOUSMATERIA LSDISCL am Type of Roof
WiH Ne epplicam ear future building wee pant store or handle ideas material
u defined toy the Cupcninn`Mun�ipal Gxlc,Chapter 9.12,and Nc Heal ad Safery
Cndc,Scninn]5532(.)'! ��{�',' All roofs shall be ins inspected prior to an roof
material bei.. installed.
❑Yea �1 P P Y g S
Will the applicant or rota building uccupanl use mimpmcnt ordcvices which If a roof is installed without first obtaining an inspection, [agree to remove
emit huvallous at conwmi ams es defined by the Bay Area Air Quality Management all a terl&IS'for❑$pCCllon.
Uistrict7
❑Ycs Nn
(have maJ the Mrrurdnits mmriul.e rcquircmcnl umkr Chupmrfi.95 of the Ca(1i
s�
niulles"mik Sulety G¢Ic.Sealir 25W5,25533and2553Ylundeesund Nmif Ne hui
N• renHy M1asew. ant,4om ipi rcxponsi ilify lit sof' Ne me ant of the �- —� � b I O � .
rc 'mmcn'w ua-n erp 1,issu mor enificareaf ou c. Slgnatufe`of Applicant Date
I�` d
owm a tdvedagcnr Data All roof coverings[o be Class"B" or better
Building Division
10300 Toren Avenue
4 Cupertino,CA 95014-3255
Telephone: (408)777-3228
Cl Fax: (408)777-3333
' CUPERTINO
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 of4"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: ,.. C�� CM 5
Address:
Reroofmg Company Name: �uUF l N(�i ��C fl Oly� (�Jz .
Applicants Si gg store: - Date: I l 103
OOP .9 J �oe Antonucci
(Chief Building Official)
60101