01080100 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
18954 PENDERGAST AVE. MORAZAN ROOFING INC 01080100
}00
DB DATE��I�IPSON 740 SHAWNEE LN A0
8c/20/2001
PHONE: SANITARY NO. CONTROL NO.
qcf 6 _ � 6 (408) 224-5785
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BUILDING PERMIT INFO zQ ARCHITECf/ENGINEGR: BLDG ELECT PLUMB MECH
kL'a'i u CJ LJ L J I I
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LICENSED CONTRACT'OR'S DECLARATION Job Description
O z,SG I hertby affirm In.,[.at licensed under provisions of CM1apmr 9(commencing REROOF.
m 1-J with Section 700 Of Division 3 of the Rosiness and ftit,, Cod and my license
<x2 lsmfull fim-andef-d 3 7J T/O TAR & GRAVEL
z a z License las Lic.p f
Dw� oat= c.nrmdror NL INSTALL NEW TORCH-ON ROOF .
.Be an ARCHITF,CT'S DECLARATION
Fay 3 1 undersand:n4.plans shall Fe aced m,adde reads
f,r�
dp O Licensed Professional
o� OWNER-BUILDER DECLARATION
'-' I hereby affirm that I am exempt from the Contractor's License Law for the
F z< followingrtusnn.(Section]o3L5,Business and Professions Calc:Any city or county
E D which mquim.s a permit to ell uct alter,improve,demolish,or repair any structure
c' prior to its issuance,d.m requires the applicant for such permit to title a signed summand -- -- - - -
that he is I ivemed purrumnu to the previsions ofthcConuacmrsLicense Law(Chapter 9 Sq. Ft. Floor Area $41 �ua[ion
(commencing with Section]ORB}of Division 3 of the Business and Professions Code)
."hat he is exempt therefrom and the basis for the alleged exemption.Any violation
of Section 7031.5 by any applicant for a Permit ubjects the applicant to.a civil penalty
of not a=than rvs,hundred dollars WWI 375 Plt!fnl:60 Occupancy Type
❑Las aortia of the property,Lir my emplovees with wages as their.-le compensation,
will do the..rk:and Ihc'strucame is not intended a,nlfercd forscle(see.7w4,' 3 O 5 - FRAME Required Inspections'
Business and Professions Cale:The Contractors License Law does not apply to an q ° .
owne
rof propcny Whobuildsorimprove,thereon,med x im does such.nrk himself 307 - INSULATION
or through his own employees.provided That such improvements t is sols arc not intended or
601 - ROOF TEAR OFF
'bffercd'for salt.If,however,the building:ir impmvemem is sold within one year of • :
completion.)he owner-huilA<t will have the burden of pursing that M did trot Wild m
ntprovpro.�e for p.mna=nrsal=.). 602 - ROOF PLYWOOD NAIL
La - '--_, . .. . t. h lice contractors 603. .. ROOF BATTENS. . —
❑L as owner of pmpcnY.am cedusiv,ly contracting ns Code:)TheCotor as -
umtrvm the project(sec.]aa,owner
aha erty w fiats ills or The c.ntmcmrs 604 - ROOF IN-PROGRESS.
Lids L d not apply t her with
a come who W Id p cs thto the
and h u t is for M1 projects with a commn.dQ licensed pursuant to the . . .. _. . . ._. _ ... _.) _..
Cum n I:License L
❑1 pt under See. - .B&PC farThis rcmsm "1 ,.;q
22 Owner Dae
WOH KER'S COMPENSATION DECLARATION
' Thereby aRrm under penuhy of perjury one of Ne Poll.wing declamrians:
O 1 have and will maintain a Ceriticme of Consent t.self.inss:re fur Worker's
-• Compcmation, as provided for by Section 37W of )hc Labra Calc, for the
'peffnmmna of 0e work f which ire pirmi,is muod. fff /J
have and will mains w k Cmnpc . i 1 ante e9 - d by Scmi.n
'3 00 of the Labor CNe f- thepc f rn f thework forwhich this permit is O
issued My are
have
C pc ). I ore d Policy mhe at[e:
_ _ . ._. ..
CERTIFICATION�= wO aye qy3� h
�mriec Policy Nu.: .. n . . .
',rt : • OF EXEMPTION FROM WORKERS
. .. COMPENSATION INSURANCE"';s , _ .. ._ .. . .. ._ ..... . ._ .. ...... ._.. _.. _. .. ....
o hn wctiim need:rat M1e nomplcteJ if the permit is for one hundml dollen _ i i, ) . .
(SIOA or less.)
:I ienifY that in the perf.norece or Inc said,for which this permit is issued,1
•shall not employ any person in any manner m as m become,.bjcet m the Wmkr,,
Conp median Laws of California:Dae
.. Applicant -
t NOTICE TO APPLICANT:IL aRa making this Cen rcite of Exemption,you nhu dd "
Mame subject m the Workers Compensation provisions of the IioMr Code,you most
Q O forthwith comply with such provisions or this permit shall be deemed revoked.
'F.Vi _, " CONSTRUCTION LENDING AGENCY
.a l hereby ufion that themaconWocC leading agency for the perfurnance
of rhe work for which this pe t is issued(Sec 3I97Co.C.)
1 D Lenddr's N.5me• . ,., , . ..-
.7 z lender's Address- , ..ad .. ,. :,
U Q I certify that I have rtthis ap,11-tun and.date that Ibe ahnve information in
fz'Ea corten.1 agree to comply with all city and county ordiranr=a and orate laws relating
to Wfeavc-e.nsonedprand M1 for inspection
pupremmbtives.f this city to enter upon
the abp(W,)agree to propertyndemnify and kn p�r nprl
(w'e)agree s.co,s and c Indemnify and keep hamay man,
it. 11war s vere against
against
h liabilities,judgments,sods:nun capcn¢n wean may in:my war acerve againd sail
City in ecave,move of the gminoa,of ill,,
. "'
APPLICANT Issued by: Date
SOURCE REGULATIONS. ' '��1 '. y'
Signature of AppIicaMCo diewr Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE 'S
" Will h;apdi.at or fummImilding occupam store or handle hazvtluus tna¢d'W Type of Roof, - - •
as defined by the Cupertino Municipal Cade,Chapter 9.13,and the Health and Safety , •s _ -w - t•
C,Nh.Salina 3553d(m^,.
❑Yes ''. Ives , . -, All roofs.shall.be inspected prior_to.any.roofing material being installed..
•s W Ilnc�apPlc t f r Wilding atop tusceq p t d vices nidn If a roof is installed without first obItaajuihng an inspection, I'aaree to'remove
ctiii hazardous air conamponars as def dby the Buy Area Air Q I'p Management
Diiibii,,oYn all new mate specti licant understands and will comply with
-, all non- a •-( •'
I have read the It morel,men. a Coupler 6,95 of the
California Health& .ion d 25534.1 undersand that ... .. .. - l _-,/N /
Pik Indiin .in _my rr,,roibilip'uo notify the ,L[/ (_/
necupd print fo issuance of a Cenifcate of
• -aC)-0/ Signature of Applicant _ _ Date
Come'., armed agent Date All roof coverings to be Class "B"or better
OFFICE --
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY&O Fax: (408)777-3333
UPEkTINO
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.
J 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: I V\I - 1 "`� II l ,(S_0-1'x
Address:
Reroofing Company Name:
Applicants Signature: Date:
Joe Antonucci
(Chief Building Official)
6/25/01