03030062 CITY OF CUPERTINO ,T" '>ru' `'...;vzr,,* �'`^
BUILDING DrvIs1oN PERMIT CONTI CT®It TNPORMATION
�j`krYr'�dCYM Fk. +9'.k2? iv�' F:o $03:=A't
BUILDING ADDRESS: PERMIT NO,
PETERSEN-DEAN INC
6;431 MVRTT2WQQZ DR- RZN 30062
OWNER'S NAME: PERMIT RE
7980 ENTERPRISE DR
J BHATTACRARYA SANITARY . 3 2 NO.
E' (510) 494-9982
ARCHITEC(ENGINEER: BUILDING PERMIT INPO
BLDO ELECT PLUMB MECH
3o z, LICENSED CONTRACTOR'SDECLARATION Job Description
f I hereby arm that l am licensed under Preis
vons of Chapter 9(mmmencing -
IN Section 7")of Division 7 of the Budw an
nJ Plutonium Code.and my license Is
pppppp'� In On forte and eff Uow S((s REROOF
y17Z Lim as Cl — - -
eG Dau Camracfor T/O COMP. SHINGLES INSTALL 30YR.. COMP . SHINGLE
ARCHITEC7S DECLARATIUN
1 understand my plans shell be use.)as public nomon '
Licensed Pmfeuiond '
Gin I I.IU uric( DECLARATION
1 hereby affirm that 1 1. exempt from the CoatonsCo :A License law for the
Se following reason,(s=cion 7 cont, Business and ver. wince Cole:Any clay or county
$jxr which requires•permit m construct.Blur,impmw,demolish.or repair any nmcmm
prior m its iuuan=also uquins the applicant for uch permit to rile a$];tied statement
6 chat he isllcenscdpursuant to the provisions ofthe Convmtor'sLicenseLaw(Chapter 9 Sq.Ft.Floor Area Valuation
$ (commencing with Section 71D0)of Division 7 of the Buslncas and Profusion,Codc)or
that he B exempt therefrom and the basis for the alleged exemption.Any vloladon of
Section 7071.5 by any applicant for a permit subjects the appliml 10 A civil Penalty of APN Number - 'Occupancy Type
nm more Nan Rw hundred dollars ISM
❑Luowner of the property,mmy employcetr with vngesutietrsokcompenullon, 36917010 . 00
will do the work,and Instrument,isnot intended or offered for sale(Sm. Business Required Inspections
and Profusion Code:The Contractor's License Law does not apply td an e owner of q p - -
propenywhoWllds or improve thereon,andwhodoeuuchworkhimselforthroughhis 305 — FRAME
me employees,incovidedhaimch improwoundu we not Intended aroffered forsxa If. 307 — INSULATION
however,the building or improvement is within one you of eomplalon,the owner- C
bulkier will have the burden of proving that he dm not Wim or lmpmm for purpose of - 601 — ROOF TEAR OFF ■ INALED
ode.). -
p i,a owner or the property,am exeludd vely convecting with liunucontractors to 602"— ROOF PLYWOOD 'NAIL q
. commie thepmject(s".70M,BusincuandProfes$]ons Code:)rise ConmuuesU. 603 — ROOF BATTENS OCT U 8 2003
come Law does not apply to an owner of propeny who Wilds or improve themon,and, 604' ROOF, IN—PROGRESS .
who contracts for such projects with a conumoor(U pursuant licensed pursuano the Conunw or's
License Law..
❑l am exempt under Sce. .B At P C fm this moon BUILDING
Owner Dau
WORKERS COMPENSATION DECLARATION -
1 hereby ammo under penalty of perjury one of the following decluntou:
have end will maintain a Certificate of Consent self-Insure for Worked Cooper.
77.
n,u provided for M1y Senian 77000(tite labor Code,for Ins petformeme of tW
for which this permit is tuned.hew and will maintain Wmkefe Compemadon Insurer=,m required by Section
of due later Cade,for W,pedmmence of the work for which this re roll la tuned.War a Compeme onlmumaietandPolity numbeter_ Poliq No.:
CERTIFICATE OP MEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rlhlasecllon need not hecomPleted if the Permit Is fortune hundred dollars(SIM) -
employor less.)
ny inthe performanceor the workfor which thto permitlal 'C lshill not
Lawso any ire.pcoson in any manna an n u become subject the Wmkus'Cmnpcuwtion
Laws of California.Date
ApplicaNOTICE
' NOTICE TO APPLICANT.workoe after vision of Exemption.you you
..
becomesubject
comp m the Worker's Comleoutlon prevision of Inc Labor Code,you mutt
0z forthwith fomhwith comply with such provisions or this permit shelf ted=recd mmked.
„z„ti CONSTRUCTION LENDING AGENCY
P: (hereby affirm that dem is a construction lending agency for the pe,rormsoceuf
Dt 7 the work for which Ino Permit i lasaed(Sec.7077.Co.C.)
W p Lcnmes Name .
Lcndcfs Address
U 0 I certify that 1 haw mW this application and min that the show,Information is
Y.r" coned.l agree to comply with all city and county ordinances and sate laws relating 10
p U building construction,and hereby wthorlm mmewnutiw or this city to enter upon the
w above-mentioned property for lmpecvon purposes.
(We)agree to taw,indemnify and keep hatmleu the City of Cupertino against
cn liabilities.judgment,soman!expenses which may In my way acerae against old City
O mcoAPPLICANT UNDERSTANDS AuND WILL COMPLY WITH ALL NON.POINT Issued by: Dat
SOURCE REGULATIONS.
Re-roofs
Signature of AppliunuContrutor Date -
HAZARDOUS M TERIALS DISCLOSURE Type of Roof
Will the Applicant or future building Occupant sm.rehandle haumoos mated$]
In donned by the Cupemno Municipal Code,Chapter 9.12.and the Health and Safety
we,se yes as7x.)7 - All roofs shall be inspected prior to any roofing material being installed.
❑Yes gYe'
Will rite applieem or forum building acupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
IFlIthmamom air contaminants u dcfmd by the Bay Area All Quality Management all new materials for inspection.' .
(staid?
0Yet �
I hawreetyCe ramd=255dW 5533rd ants 4.1e dMpter Mi95 f1M Celifoo
does
cum fetyCndc.Seedomow It i 75577 ammmint y to Ton"the nef the telmtril
he
docs nm consort w a unanu.this it k my respomlNliuy ie notify se necupant or de
myulren ichor ttemepdon 'ssuaccohCeninuuordlFim � Signature ofApplic� "'' Date <
Owner sur awhorizcd a ant ((// Date All roof coverings to be Class"B" or better
03/12/2003 21: 37 5105303202 LEGALITIES INK PAGE 03
Building Division
10300 Toren Avenue
Cupertino,CA 95014-3255
• Telephone: (408)777-3228
CUPEa
O ' Fir (408)m-3333
�u.ilding Department
Subject Reroofing policy for the City of Cupertino.
1: Prior to permit issuance,you must agree to comply with 1997 UBC Standards
and manuf66ures specifications on reroofing.
2. .New roof coverings shall not be applied without fust obtaining all inspection
'and writte"pproval from the building inspector.A final inspection and
approval'sh*ll be obtained from the building inspector when the reroofing is
completed:
3. All roofs sh4U:be inspected prior to any roofing installation,
4. To receive a peal sign off from the City the following steps are required.
1) Preimpedlion and/or tear off approval.
2) In progreis inspection approval
3) Final inspection approval.
a) Spark�=esterinstallation.
. 5. If plywood i.§ 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 most have a minimum of 1,"per foot slope and demonstrate that
there is no ponding.
. 2. An I:C.B.O. r!port is required to be on the job site at the time of P
' ection.
�
We understand ,he.above policy on reroofing and will comply with this polity.
Homeowners Ndme: �x�� 2,1,y0.,
Address: G', `f 3 ! �
Zeroofing Comp�my Name: /� L
Applicants Signahtre: U .Q�9r 4L—
Date:'0013
Joe Antonucci .
(Chief Building gficial)
5
6/25/01