02100102 CITY OF CUPER'11NO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION .
BuIT)TS5A3kpce`0AK SPRING CT SV ROOFING PERM11N02100102
Owe-MSN EKAM H AND SHAO Y 1 PRESTON ST APPLICATIPnSy`T94T)t2002
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tfONE: (408) 295-0215 SANITARY NO./ / CON TROL NO.
ARCHITEC(ENGINEER: But LOS NO PERMIT INFO
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w00 LICENSED CONTRACTOR'S DECLAR ATION
y U F I herchy mrrm that 1 am licensed under provisions of Chapter 9(commencing Job Description
U with Semon'(XXN_)nfLivixio�nlnfNeBusin�v�J'JPfnfcainnsGtJc.andmylittmcis REROOF
Z,ovI iolulllOnc Jy y/ Ir _/�l�"� �i / ,5
Z Limns,Classical— Lic.
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F'J�w r ARC�CI':SRATION
pa 1 understand my plans shall be used as public records
OaU
N Licensed PnrlcsSional
=0g OWNER-BUILDER omDECLARATION
E2 a 5 hereby:dlirm mat I am cxcngn tinm the Grmruemr's I,i<cnsc Low lin he $8300
ca ff no following reason.(section 703L5.Business and Professions Code:Any city or county
x$� which requires a Permit ba etmxsuct,alter,improve,demolish.or repair any structure
w'r^ prior to its issuance.also requires the applicant lorsuch permiun file a xigned.mamntml
$�Z<
'hat he is licens,d Pursmnun the provisions ofthc Contractor License lzw(Chaplcr 9 33A6621D�A@Q Valuation
S�O (commenci ng wi m Section 9100)of Division 3of the Buxiness and Professions Code)nr
Ci that he is exempt therefrom and She Onto for She alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of PNN Occupancy Type
nor mnmthan Five hundred dnnmi,($5a). 307 - INSULATION
1,as owner of the progeny,or my employees with wages as their role compensation,
will do the work,and me allmctum is not intended or offered for .Is(Sce.704,1,Business
and Professions Coonom
de:The Caemrx License Law does not apply an owner of 602 - ROOF P W V rigN l Ens
property who buildsor improves thereon,and whodoes such work himsalfm through his
own employees.provided that such imporworcns are not intended or offered for sale.If, 603 — ROOF BATTENS
l o,oci the building or improvement is sold within one year of completion,She owner-
builder will have the burden of proving that he did not build or improve for purpose of 604 - ROOF IN-PROGRESS
sale.).
C I.as Owner of the property,am exclusively contracting with licensed Comments;Io
conswm the project(Sec.7044.Business and Professions Code:)The Contfacnar's Li-
cense Law does not apply to an owner of progeny who Hilda or improves thereon,and,
who connotes Smirch protects with a contracho(s)licensed pursuant o the Contractors
License Ins. 1 NA L
lam exempt under Sec. .B&PCfor this reason
Owner Dale
WORKERS COMPENSATION DECLARATION NOV O O La 2002
I hereby affirm under penalty of perjury one of the following declarations: L
I have and will maintain a Certificate of Consent h)sIff insure for Worker's Compen-
.net,as provided for by Station 371X1 of me Lid or Code.far the performance of the UILDII y1�,
�
work for which this permit is issued,
❑1 have and will maintain Wufker's Compcminion Insurance,ss mquifN by section
3701 IS the Labor Coal ,for he performance of the work for which this permit is issued.
My river' Confirmation Insurance carrier and]I Hey OOTN,
INCASE ry�1m yFRO
CERI'II ICA'IEOE COMPENSATION
FROM EORKIiRS'
COMPENSATION INSURANCE
phis rection need not he completed if the permit is Intone hundred dollars(d IIXB
or less)
I certify that in the performance in the work lin which This permit is issued.1 rhall not
employ any perm any manner so a to become subject the Workers'Compensation
Laws of California!Date
Applicant
NOTICE TO APPLICANT:If,after making this Ceni6care of Exemption,you should
become subject va the Worker's Com pe nsal inn provsons of the I.olun Code,you most
or OO forthwith comply with such provisions his nefmitshall be deemed revoked.
z CON S FROM SON LEN DING AGENCY
1-. I hereby affirm mat mer,is a construction lending agency Into,Nrformance of
f47 the work for which this perm 11 is issued(See.300.Cle.C.)
W 0Lender's Name /
11 Lender's Address
U 0 1 certify mat 1 have read Shit applicmion and Stam that the above information is
W F crrem.l agree to comply with all city and county ordinanme and sum laws relating to
0 V building construction,and hereby authorite representatives of this city to enter upon the
} W above-mentioned property for inspection purposes.
6. (We)agree to save,indemnify and keep harmless the City of Cupertino against l
N Iiabilitics.juJgmcnts,costs and expense which may in any way attmc egatna said City /
V Z in consequence of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITII ALL NON-POINT Issued by: Date
SOURCERE��G�yyyyWIONS. ,�
/0 Re-roofs
woe�Al�PLcan clof Date-
IIAZARDOUS MATERIALS DISCI.OSU Type of Roof
Will or applicant or In,..buildingoecupanlstmcorhon minors matenul
as defined by the Cupertino Municipal Code.Chapter 9.12,and the Stealth and Safety
Code,Sec0nn 25532(.)'' All roofs shall be inspected prior to any roofing material being installed.
❑Yes
If a roof is installed without first obtaining an inspection, 1 agree to remove
Will the applicant or fmwcbuilding occupant use equipment mdevices which
emit haraNnus air conumimmB as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Ycs PbHr—
I have nad the hvraNnus materials requirements under Chapter 6.95 of the Calder. /
ria Stealth A Surety Crile.Scetion,25%5,25533 and 25534.1 understood maids,huilding
does not currently haw a tenant,that it is my responsibility In notify the oa'cupam 01 the T' 1
feat,bentemewhich must beme,poormirtnammOf.CemacamIII Occupancy' Signature of A 'cant Date
wnef or authon,ed agent 1,41 Date All roof coverings to be Class"B" or better
Building Division '
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY O Fax: (408)777-3333
CUPEkTINO
Building Deparitment
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 YV 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 L�C—�,e v�
AddressX f (L S'd
14=oofmg CompanyNam�e
Applicants Sign`aDa}e
Joe Antonucci
(Chief Building Official)
6/25/01