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