02120087 a CITY OF CUPEWHNO t -" r+• `' ' ��`<
BUILDING DIVISION PPRMI'P CONTRACTOR,•INFORMATION '.�
. BU ILDI NIG 777 —1 G PERMIT rNO, �a J
OWNER'SNAME: '/C/ a� /����_ �a/ � APPLI�TIZSUB Z� -rV
IONI:: � � SANITARY N6 CONTROL NO.
C
AHCIIITGCT/I7NGINEI3H: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0
00 LICENSBDCOMRACTOR'SDECLARAIION
.I"!F 1 hereby infirm that I am liumcd ander pro,mi ns of Chapter 9(ermmenemg Job Description
<zw cairn secaunIy)oroivi.ion3or, the Bu`Ie�t and rkurcGdnntcode.ani tr berate it I�
in full(nine effect'• /" 6 !! F1 NA E®
zogzLicense Clat( C. 3� Lic.a e r
"M Date / -04 ll—Cn n
�- AHC ]M;CS . LAI ATIO -- []
aIunderstand myplansshall Wused xspublic record., JAN 2 3 2003
ad 'l- Licca.,cd Pnticaional
FLLO
OWNER-BUILDER DECLARATION
as uvi<y 1 hereby affirm that 1 am exempt from the Contractor's License law for the BUILDING
i S O O following reactor(Section 7131.3.Business and Professions Code Any city or county
which.,equine.permil lac construct,alter,improve,demolish,or repair aoy Rmeture
w'm pnnnn its ow,friae.uso regtro,,, heapplicant lorsuch permiuo file axigned"Olement
r�'< mat he is licensed pursuant o the provisions oflhe Conuacwr:s Liccne Law(Chapter9 Sq. Ft. Floor Area Valuation
die (commencing with Section7(YX))ofDivision Sof the Buainessand Professions CushOur
W $ that he is exempt Ocrumm and me Intens for the alleged exemption.Any violation of (J
Section 7031.5 by any applicant for a petmit sob)ects the applicant to a civil Penally of APN Number Occupancy Type
not more man five hundred dollars($510).
❑1,u owner of the property,or my employees with wages as their We compensation.
will do the work,and the striatum is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractors License Law does not apply to an Owner Or Required Inspections
property who builds or improves meeenn.and who does such work himself or through his
own employees.provided mat such improv rdena are not intended or offered for We.If.
however,the building or improvement is sold within one year of completion,the owner.
builder will have the burden of proving mal he did not Wild or improve for purpose of
sine.).
❑h as owner of the property,am exclusively contracting with licensed conmctors to
common,the project(Sec.7044.Business and Professions Curb:)The Conousem's Li-
cense Law errs not apply t0 an owner or property who Wilds or improves thereon.and
who contacts for such projects wit a enntracton(s)licensed pursuant to the Contractor's
License law.
0 I am exempt under Sec. ,B&P C for this mason
OwnerDam
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under Penalty of perjury,one of the following declarations:
I have and will maintain a Ceniliaate of Consent)self-insure for Worker'sCompen-
737](X)
ind.as provided for by Section 3]1X)of the labor Code,for the performance of the
rk for which this permit is issued.
1 have and will maintain Worker's Contperssaion Insurance,as required by Section
of the labor Code,far the performance of the work for which this Permit Is issued.
y Worker's Compcnsam uam'c camcr end Policy num Ne rrier:_`=� Pili O.: C;OQ 9
✓/�I CERTIFICATE OF EK EM ROM WORKERS'
COMPENSATION INSURANCE
rllrit.,emir need nest W completed if the permit is for tine hundred dollars(110)
if,lcsx)
I unify that in the performance of the work for which this permit is isued.1 shall not
employ any Person in any manner m as to become subject to the Workers Compensation
laws of California.Date
Applicant
NOTICE TO APPLICANT:Ir,at making this Cull line or Exemption,you should
Nu me subject to the Worker's Compensation provisions of the IaMn Coale.you most
OO forthwith comply with such provisions or Nis permit shall W deemed revoked.
z y CONSTRUCTION LENDING AGENCY
[-. I hereby alarm that Nene is a cOnxtmction lending agency(or the perforrhan.of
a7 the work for which chis permit is issued(See3097.Civ.C)
W Q Lender's Name
7 z Lender's Address
V 0 1 unify mal 1 have read this application and state that the above information Its
W P correct.l agree to comply with all city and county ordinances and slate laws moling to
Or` Wildi ng construction,and hereby authorize representatives of this city to enter upon the
W about-reed ioned property for inspection purposes.
d (Wc)agree to save,indemnify and keep harmless the City of Cupcninu against
V) liabilitics.judgmenq cosy and expenses which may in any way scenic against said City
U z in conWqucnec of the granting of this pcnmit. �3 ,
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:9 Date k/v
S CER.GUL TIONS. 'J -(
,~ \ Re-roofs
gnature Of Appfic n .tntactur are
1 LARDOUSMATEHIALSDISCLOSURE Type of Roof
Will the applicant or future Wilding wcupant store or handle hvmdous material
as actor,by the Cupcnto.Manic I Code.Chaptm 9.12,and the Health and Safety
Code.Section 25532(.)'! No All roofs shall be inspected prior to any roofing material being installed.
Yes r Nu
Will Ocapplicantorfuture building decupanluse equipment Ofdevices Which
If a roof is installed without first obtaining an inspection,I agree to remove
mit hviddous air contaminants as deMcd by the Bay Area Air Quality Management all new materials for inspection.
District/
Y. Nn ^/
IIT seeadthchaa dtwsmacrialsmquimmen¢undcrCbaprr6,950ftheCalifnr
nia Hcalth&S:dctyCJc.ScNons25N15,25533and255.s.luntkr da atifthr Wilding
dura m t Gwent h'�nam wr it is mY reslxmaibility to notilY the "upanr tl the
,erpimm¢n W t mmi.�aaneetrtaccmBygrrra-�ty IgnatureofAp lira Date
/"``� II roof coverings to be Class "B" or better
thorimd agent Date
Building Division
*C10TINO 10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228CUPERF= (408)777-3333
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 fust 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 I/"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:7�74�U�
Address: /��//E/�.s� /l!2
�4 . reroofing Company Name:
Applicants Signature' ate 2
Joe Antonucci
(Chief Building Official)
6/25/01