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03010116 CITY OF CUPEWfINO -` BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: OU BOUND ADDRESS: CAL—PAC ROOFING PERMITNO. 10745 PENINSULAR AV 03010116 OWNERS NAME: 36 RAILWAY AVE APPLICATION SUB DATE DONALD BARNETT 01/22/2003 IONIi: 408 874-0784 SANITARY NO. CONTROL NO. ARCHITECfIENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH a 0 0 0 �00 LICENSED CONTRACTORIS DECLARATION Job Description KK U U 1 hereby affirm Nat I am licensed under provisions of Chapter 9(commencing p FZ with SectionT"B of Division 3 of the Business and Professions Code,and my licenseis is full Ione and a firs. 9j 2--6 REROOF , t24 License Slyss 1 Lic.M 1 OZ� Dmu II Contractor Y ARCIIITECT'S DECLARA ON Q I undccssind my plans shall nc usJ as puM1lic rccnNs %�D•V NLL0 Licensed Pndcssional FINALED S OWNER-BUILDER DECLARATION Q 99 ft<N I hereby affirm that I am exempt from the Contractor's License Law for the , 2' OOJ E OO following reason.(Seemed 7031.5,Business and Professions Code:Any city or county 2 JAN %$� which requires a permit m construct,alter,improve,demolish,or repair any structure may prior n its issuance,also requires the applicant for such permit to file a signed statement 1Y�1 that he is licensed pursuant to the envisions of the CoMoslor's License law,(Cha mr9 S Fl. Floor Area 12862Itlon aF$ (commencing wid,Section 71x11BofDivision 3ofthe Business and ProfessionsCode)or q BUIL® Ga R Nal he is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant n u civil penalty of not more Nan five handled dollars($500). be Occupancy Type ❑ I,as owner of the property,or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale(Sec.70,11,1,Business and Promasinns Code:The Commacwrs License Law does not apply to an owner of 307 - INSULArjlftj�ed Inspections property who builds or improves thereon,and who does such work himself onhruugh his n employees,provided that such improvements am not intended.,offered resale.If, 601 — ROOF TEAR OFF however,Ne building or improvement is sold within one year of completion,the comm- builder will have the burden of proving that he did not bund or improve for purpose of 602 — ROOF PLYWOOD NAIL sale')' 603 - ROOF BATTENS ❑I,as owner of the progeny,am exclusively contracting with licensed command.m 604 - ROOF IN-PROGRESS construct the pmject(Sec.70,14,Business and Professions Code)The Contractors Li. cense law does not apply to an owner of progeny who Wilds or improves Ihemnn,and who contracts for such projects with a contractor(s)licensed pursuant to Ne Contrai License Law. ❑I mo exempt under Sec. .B&P C for this reason 1Yj711 ner Dare WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a Cer irmam of Consent self-insure for Worker's Counter- ot,as provided for by Section 3701 of the labor Cade,for the porformance of the k for which this permit is issued. have and will maintain Workers Compensation Insurance,as required by Section of me Labor Code,for Ne Performance of the work for which this permit is issued. Workern Ipsyeance gmef and Policy number amrico 7L—'- Yom- Policy Nn.:7/3U W 2-7 O CERTIFICATE OF EXEMPTION FRO Oh 1W RKER�� COMPENSATION INSURANCE (This seelion need dol W a,mpleted if the parmit is foroue hundred d illars(SIM) or less) 1 cem y that In the performance of the work for which this permit Is issued.I shall not employ any Person in any manner so as m become subject to the WorkersCompensation Laws of Calimmia.Dam Applicant NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should become subject to the Worker's Compensation provisions of the labor Code,you must , OZ lialwith comply with such provisions or this permit shall W deemed revoked. ZO CONSTRUCTION LENDING AGENCY (r I hereby affirm that there is a consimedon lending agency lot the performance of the work for which this Permit is issued(Si Mall,Civ.C.) 1+7 Q Lender's Name 0 U Lender's Addtruc �. U Q 1 certify that I have read this application and state that the above information is - 4. H Corect.l agree to comply with all city and county ordinances and slate laws miming to Q U buildingconstruction.proand forenyauthorirerposes. moves of Nis city to enter upon the ,r Lk7 above-meminnree to perty for emnifyan keep ea. (We)agree to save,indemnify and keep hathe City of Cutanea against rFr h liabilities,judgments.sets and expenses which mayy in in aann y way same against said City U Z in consequence of the granting of this permit. ^' APPLICANT UNDERSTA ND WILL CO Y WITH ALL ty0NP01 Issued by: Date SOURCE REGULATI I 2Z Re-roofs Signature of ApplicanVCmnmaor Date HAZARDOU MATERIALS DISCLOSURE Type of Roof Will Ne applicant or furore building occupant store or handle hazardous material as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety cnde.Secman25532(arr All roofs shall begins ected prior to an roofing material being installed. C3 You P P Y g g Will the applicadl or future building necupant use cquipuneml or devices which If a roof is installed without first obtaining an inspection,I agree to remove 7d.srolc il hazardous air contaminants as filmed by the Bay Area Air Qualify Managcmcnt all new materials for inspection. n.? ❑Yes 1 have read the hazardous materials requirements under Chapierri95 of the Califor- llealth&Safety Crate,Seconds25505,25533 and 25534.1 undersand datifthe huilding �+"+ �.�/ 63 urzend have atenant Valais ymaamsdid.Iy torthl. the cupan Itheuircm .wn uslWmclpdntm'. sower"Cenlficemdf9c pa"cy q Signature of Appli and Date Owner or aulhorize4 gem Data3 All roof coverings to be Class"B" or better Building Division 10300 Torre Avenue Cupertino,CA 95014-3255 Telephone: (408)777-3228 OCIO F= (408)777-3333 � CUPEI�TINO 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 Wand 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. INIPORTANT: 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: eowa-a /J Address: 10 7 4-5 Reroofing Company Name: Applicants Signature: ,— Date: T L Joe Antonucci (Chief Building Official) V25/01