02110079nmLm c 3 MW80 PERMIT
NT"CTOR�INF�QRMATION•"
nu¢JE?SLtCT1 SS:S OW R
'
PERM]I' 2110079
OWNERS NAME.
/
ski
LD WY
APPLICA�5 BDA)?
2002
e8 I Y
IONS:
SANITARY NO. CONTROL NO,
ARCI IIIlif_TIENGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MUCH
0 0 0 0
LICENSED CON'1'RACI'OR;S DECLARAI]ON
REROOF Job Description
I hereby affirm mal 1 on licensed under provisions Of Chapter 9 (commencins
P
with Section 7IXn8 of Division 3 of the Business and Profcasions Code, and my license is
L'n lull liner and cJJLtlgl��
icense Cluss L 9 Lic.
r
Dam_/ COntm
ARCHITI!CTS DA A
ELLL C
of IL►®
I undccrwnd my Plans shall W useJ as public rccor xnr
NoV 1 8 200
Licensed Promssional
OWNEm BUILDER
clemptfod the onr10N
1 hcruby .Mirth that 1 cxcmpt me Contractors License:nylaw lin the
$ 4 9 7 0
L. s of
followingreason. section 71HLA Business oil Pmfcssinns Gsde:AnycityoTcounty
which any.amemre
issaapermit toConstruct,to alar,impnwu,h
pull In -
permit ton.-
Prior In its issuance, also require., the applicant for such permit to tilts signed statement
its
Sy. Ft. "1
Valuation
oW Cummnan cenmLaw
dor Tea
and Professions Cation or
Division 3 the ons Come) it
(commiscinLwdpusoannothepmvivision 3
(commencing with Section ]land
305
the ageBusiness e
that he is exempt therefrom and the basis for the allegcJ exemption. Any violation of
the
-
307 AP Occupancy Type
��]SATION P Y YP
Section IDJ1.5by any applicant for a Permit subjecsthe applicant it) acivil Penalty of
done.ehundreddollarafs5ro).
not mom
601
❑Las ownenllthe property, nr my cmployces with wages as Meir roll cnmpensatinn
- ROOF TEAR
will do the work, and tht strucmm is not intended or offered fof safc(Sec. 7044, Business
- ROOF �s� A�Is,
PLYWid`f'ss`
and Professions Coda: The Common's License Law dcam not apply to an owner of
a +Y etions
Y ffE
603
property who builds or improves thereon, and who doessuch work himselfor through his
- ROOF BATTENS
own employees, provided that such improvements are not intended or nutted formic. If,
however, the Wilding or improvement is sold within one year of completion, the owned
604 - ROOF IN -PROGRESS
ROGRES S
builder will hors the burden of proving men he did not Wild or improve for purroe of
sale.).
I, as Owner of Be propeny, and exclusively cmdeacting with licensed contractors m
commact the project (Sec. TA4, Business and Professions Code:) The Contractors Li-
cense law does not apply to an owner Of property who Wilds or improves themod, and
who commas for such projecs with a comeactor(s) licensed pursuant to the Contractor's
License Law.
0 1 am exempt under Sec. . B & P C for this reason
Owner Dat
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following cialmations:
1 have and will maintain a Certificate of Consent to self -insure for Worheri Compete
,mind, as provided for by Scninn 3781 if the Labor Code, for the performance of the
work for which mil permit is issued.
have and will maintain Worker's Compensation Insurance, as required by Section
700 of the labor Code, for she performance of the work for which this permit Is issued.
My Worker nn n lin as`�rricr and Policy number
Q2.-fj�
Cartier: Polity Na.S
CEKH CAI E OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not W completed if the permit is forme hundred dollars (511X)
n Ic,s.)
1 certify that in the performance Of the work for which this permit is issued. l shall not
employ any pm,son in any manner so as to become subject ht the Workers Compensation
Laws of Cali lornia. Date
Applicant
NOTICE TO APPLICANT: If. after making this Cri ifamc of Exemption, you should
Wenme subject In the Worker's Compensation provisions of the Lubar Code, you most
forthwith comply with such provisions or this permit shall W deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby allirm mat marc is aconswcohm lending agencyI the perfurrome, of
the work for which this pnmit is issued (Sec. 3167. Civ. C.)
Lender's Name
Lender's Address
I ccnify that I have read this application and suite that the above information is
cortecl. 1 agree to comply with all city and county ordinances and state laws relating to
building annstruction, and heathy amhoria ne,mmnutivca of this city to enter upon the
above mentioned property for inspection purposes.
(We) agree to save, indemnify and keep harmless the City of Cupertino against
liabilitic,st udgmens. cost., and expenses which may in any way manic against said City
in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMMPPPLLLY WITII ALL N N�-P NT
Issued by: Date
SOURCE REGULATIONI
Pl
Y /LY.�-/'�- /-
Re -roofs
Type of Roof
Signature of A,pli...VCW or Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building oacvpant store or handle hazardous material
as derided by the Cupertino Municipal Chile, Chapu r 9.) 2. and the Health and Safety
cmle. Section 255320)1� �-
0 Ye,
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant or future wilding occopaat use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
Uistricll
❑Yes 0
Chopmr M195 Call
cha,Sadom ateria.255b3andm,an ,Chv,atMmm'd the
Ihave mad ffiCodeSNomns
n
niallcalI hav Safety 2555.2553oclaidd 255undcr if e, Wilding
does nm currcmly hat a wnt, that u is my eespum.InI'y to notify the t. t of the
reyuiramgn thi ON npdoe6.csuare nfaCcnificalnnlcn"
m �y / %
Signature lican Date
g P�
�i"'-� 4.�
All roof coverings to be Class "B" or better
Qwncror mith agent Dare
CL
Budding Division
10300 Tom Avenue
Cupertmo, CA 95014-3255
Telephone: (408) 777-3228
Fax: (408)777-3333
building Depa ritment
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 3/a' per foot slope and demonstrate that
there is no ponding.
2. An LC.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: 10760 ��-e-v5o
Reroofing Company Name: 1���s
Applicants Signature: IlL Date:
•
Joe Antonucci
(Chief Building Official)
6/25101