02100149 - CITY OF CUPEW11NO -
Ruu,mvc mvlsloN PERMIT �CONTMWTOR 1114 ATION
Elulq. &TS EWATHANSON AV OLD COUNTRY ROOFING PERMIT N42 10 0 14 9
0W9,V0MANAN MURIEL T 125-3 GROBRIC CT APPLICATIPl�Spez j 2 0 0 2
707 864-5557 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG. ELECT PLUMB MF,CH
�0, LICENSED CONTRACT'OR'S DECLARATION ]Ob DCRerI tions O O
as 0
s u F 1 hereby ffirm that 1 am licensed code,Provisions of Chipar 9(commencing p
with Senin�n 7l�✓�B)ofoivision3ofinellmon a Professions Ctde,and my license is REROOF
infu'IRtrcffect'e3q �' a273i JAN 17 2003
0z Clo y II.L—I—Con act LARATI N
ARCHITECTS
C a< I understand my plans shall be recd as public records BUILDING
0-G.
30 Licensed Pmfessinmsl
iOWNER-BUILDER DECLARATION
<Y I hereby affirm that I am exempt from the Contractor's License Law for the $8000
d 6 C 0 following reason.(Section 7031.5,Business and Professions Cafe:Any city or county
x2� which requires a permit to construct,alter,improve,demolish,or repair any s mature
m—m prion,its issuance.also requires lhcapplicam for such permit to fileasigned statement
1—< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 3$69t3l0MA&,@ Valuation
pin (commencing with Section 7000)(if Division of the Business and Professions Cdc)or
y $
Out be is exempt therefrom and Ne basis for the alleged exemption Any violation of
Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty ofp N Occupancy
Out mere than Five hundred dolmrs(S50). 307 - INSULATION p y Type
0 has owner of the pmpeny,or my employees with wages is;their role compensation,
will do the work,and the structure is not intended or offered for sale(Sm.7144,Business —
and Professions Coulee;The Contrutors License law dies not apply to an owner of 602 - ROOFRE)(5F P L W V V n1VH l LnS
progeny who builds or improves thereon,and whodfassuch work himsefonhrough his
own employees,prodded that such Improvements we not intended deducted for We.If. 603 — ROOF BATTENS
however.the building or improvement is sod within one year of complerton,the Owner
builder will have the burden of proving Nat he did not build or improve for purpose of 604 - ROOF IN-PROGRESS
sale.).
0 1,as Owner of the progeny,am exclusively contracting with licensed contractors in
construct the project(Sec.NW.Business and Professions Code:)The Cmuncmri Li.
cens,law does not apply m an owner of property who Wilds or improws thereon,and
who contracts for such projects with a confusions)licensed Panamint m the Contractor's
License law.
0 l am exempt under Sec. ,B&P C for this reason
Owner Doc
WORKER'S COMPENSATION DECLARATION
I hereby affmt under penalty of perjury one of the following declarations: j
I have and will maintain a Cenitume or Comenuo self-insum for WorkersCompen-
siumn,as provided for by Section 3701 of the Labor Csdc,for the perfmmance of the
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3701 of the labor Code,for the performance of the work for which this permit is issued.
My sk pensgbm lgsttmnce carrier and Policyumber are:
O Z
ier ATE tva✓� rob y
CERTIFICATE OF EXEMPTIO 'ROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed if the Permit is intone hundred dollars otat)
less.)
L cenify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner m as m become subjectto the Workers'Compensation
Laws of California,Dam
Applicant
NOTICE TO APPLLCAN-r:If,after making this Cenilicave of Exemption,you ehould
become subject to the Worker's Compensation provisions of the Labor Code,you most
O O forthwith comply with such provisions or this permit shall Ire deemed mvnked.
Z CONSTRUCTION LENDING AGENCY
F 4 l hereby affirm Nat there is a construction lending agency for de performance of
Ci 7 the work for which this permit is issued(Sec.3037,Civ.C.)
W f7 Lender's Name
z Lcndct. Address s—
V Q I cenify Nat I have read this application and sum that the above iminmatiun is
Tyr U coned 1 agree to comply with all city and county ordinances and state laws relating to 1
O C) building construction,and hereby authic.P. xnutivcs o(this city to cnlcr ulxm the
r W aMwomenti,ned progeny for inspection pu s.
C. (Wc)agrecmrove.indemni fy an harmless the City Of CupeninO against \
.F.t (q Iiabilon.,udgments,c sex and cape w chmayinanywayacemea,unstsaid City — V
U 7 orcon consequence ERSTAN of As WILL COMPLY WITH ALL NON DINT Issued by: Date
,7
APPLICANT
PPLIC R UL IONS Z� 0
Re-roofs
gnamrc afApp °dVCoudWor HAZARDOUS MATERIALS DISCLOSURE ate Type of Roof .
Will the applicant or future building..Part store or handle to ardous national
az defined by use Cupertino Mun I Code,Chapter 9.12,and the Health and Safety
Crile,sectiones
2553201.1 All roofs shall he inspected prior to any of g material being installed.
Will the applicant of future building a'cupant use equipment or devices which If a roof is installe without first obta' 1 an inspection, 1 agree to remove
-mit homNous air contaminants as deined by the Bay Area Air Quality Management all new mated Or I spection.
Di.ariet9
71 Yes yX
Ihave act Ne d.25 rials trireme anderChaptertherif the Califon-
ria licalN&Safer ,, cdnr¢25505. S 3 5511.1 undersand thatif the building
does not cum ave craft.thm/us Paris(
reyuircmena tch Ibemet rtus' uaneeofac ifieaa of 6�Cup y. D
/LJ Si atureofAppli t ale
mauthod'red of Difi All roof coverings to be Class "B" or better
Building Division '
10300 Torre Avenue
Cupertino,CA 95014-3255
` Telephone: (408)777-3228
Cl 0 Fan: (408)777-3333
CUPEkTINO
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 V"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: x-n(4 /C 16-�-L ri M Q4,4i+//.►.,t)
Address: 1 06 / q 1VA'7—/41g415 00
Reroofing Company
Name:
Lam• CO. CA !✓T2y l�0 0 ,z 4/6 .
Applicants Signature: l f�/f�v,»� Date• 10- / G ' a
Joe Antonucci
(Chief Building Official)
60101