02110108 ] CITY OF CUPFR'rINO *�BUILDING DIVISION PERMIT CONTRACTOR INFORMATION ,
Buf ,9)4REoS PORTAL AV T D ROOFING PERSHTN02110108
Ow lyRM:I ABI A AND MINOO 3540 MARGATE AVE . APPI-ICAnP1SPTr8T12002
IONS: 4 0 S S 92—S 672 SANITARY NO. CONTROL NO,
ARCIIITECT/ENGINEER: BUILDING PERMIT INFO
RLDG ELECT PLUMB MECH
0
Oct, LICENSED COM'RACI'OR'S DECLARATION
at p Job Description
�� 1 hereby amrm mut 1 am Ecenaea under provisions..r chapter v(commencing REROOF .. p
wish Season]1Xx0 nfDivision3til the Buri rfci+ C andmytmerecis u� B
in lull lo¢'c• c fp O �NIi"ta��®
A.Z Liccne la. ° ', C, Lie.M_
FZ24. l m t con ,m
As sha1TECT5 M RAT(( DEC 0 9 2002
a 1 understand my plans shall used as as public records
%3yUr
uFILLOr Licenced Professional
1 OWNER-0U rapplifr DECLARATIONraualo
u`a a 8 I hereby affirm mal I am cx,mpl from IM Cumraanr's License law Gu tM BUILDING $6500
fulluwinS reason.(Section 71st I.S.Busineaa and Professions Code:Any lily rn county
which ayuir a psmit to connrcen,alte,improve,demolish,Or.,at,any atrunum
h prior it its issuance.also teboueS l he applicant for such plenit to rile a signed statement
<
IY—YZ (hal he is licensed pursuant to the provisions of the Contractors License Law(Chopler 9 3�y9Dt91FJQio AfBO Valuation
atts-$ (commencing with Section]O(0)of Division of the Business and Professions CMc)or
y _ Nat M is exempt therefrom and me basis fur the alleged exemption,Any viNalion of
Section 703L5 by any applicant for a permit subjects the applicant to a civil penally of PNN Occupancy Type
not mom than Eve hundred dollars($500). 307 - INSULATION
0 1,as owner of the property,or my employees with wages as their sole compensation.
will do Ne work,and the struclom is not intended or offered for safe(Ste.7W,Business
{�¢ �k(�
and Pmfecsions Code:Tse w Contractor's Lima.Lava,does not apply to an owner of 602 — ROOF PL fM9 Lns
property who builds or improves thereon,and who dcs such work himself or through his
own employee,,Provided that uch improvements arc nut intended orortercd for safe.If. 603 — ROOF BATTENS
however.me nodding or improvement is sold within one year of completion.the owner. 604 — ROOF IN-PROGRESS
builder will have the burden of proving that he did nor build or imprtive,for purpose of
sa1eJ.
O I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7144.Business and Professions Code:)The Contractors Li-
se law does not apply to an Owner of property who guilds or improves dmmon,and
who contracts for such projects with a contraaor(s)licensed pursuant to the Contractor's
Littne law.
O 1 am exempt under sec. .B&P C for this rcavon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby of ton under penalty of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent o self-insure for WorkersCompcn-
.it..,as provided for by section 3710 of the IaMr Cock.for the performance of the
work for which this Ik rail is issued.
0.1rimal and will maintain Worker's Compensation Insurance,as required by Section
370)of me labor Code,for be performance of be work for which this pandit is issued.
My Workcrs Cpmpcnsstinn Insumncc career and Policy number ale:
LL 14-x1 .
Cartier. r'l h� .J-a lTFf[ONy Na:
CER'1'IFICATEO LI 'AII]ON
FROM WORKERS'
COMPENSATION INSURANCE
(Thissc,liooneed mM completed if he permit is Intone hundred dollars PS Iraq
or loss)
1unify that in formance of the work for which this permit is issued.1 shall not
employ any per any manner so as un section,Subject n the Workers Compensation
Laws of Califor .Dale
Applicant
'E TO APPLICANT:11,after making this Ceridicam of Exemption,you should
subject to the Worker's Compensation provisions of the labor Code,you must
OZ, n with comply with such provisions or this permit shall M deemed revoked.
Z O CONSTRUCTION LENDING AGENCY
F.14 I hereby affirm that there is a construction lending agency for the performance of
(,yr > the work fill which this permit is issued(Sec.3107.Civ.C.)
W7 Q Lcndcr's Namc
G Lender's Address
U O 1 certify that I have mad this application and sum that the above information is
f correct.l agree to comply with all city and county ordinances and nate laws relating to
QU building communion.and hereby authoom repres,nmtiws of this city to enter upon the
above
(We)
to ertysave for inspection
mnify an keep ho. a�
as't (We)egmc to save,indemnify and kip hay in an the Cay of Cupenst s against G
UZliacontrapjudgmentsec mmind of thisexpenseswhich may in any wayacerae against said City
[J z A APPLICANT
of UNDERSTANDS
of this Pelate /h1
APPLICANT UNDERSTANDS AND WILL COMPLY WITH pLl.NON-POINT Issued by: Date �C/
S UR E E ATIONS t
o Re-roofs
Sgnaturc of Appll Ucontmaor aDam
HAZARDOUS MATERIALS DISCLOSURE Type Of Roof
Will the applicant or lawn huilding occupant store nr handle heeaNnus material
as defined by the Cupertino Municipal Cole.Chapter 9.Lt.and the Health and Safety
CoWc,sectiosn 355311x)'! n All roofs shall be inspected prior to any roofing material being installed.
❑Ye
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit ha.ardous air contaminants as dcfned by the Bay Arca Air Quality Management all new materials for inspection.
District]
❑Yes �]Nn
I have read the haeardous materials nocmments under Chapter 6.95 of the Cation. _ �7 ,A
nia HcaM Z Safety Cme.Satmos 155115.25533 and 255.14.1 tar k, rad dor if dr huilding )� �—x it p 0 d_
does not currently haw a tenant,that it is my resp nsibil sty to notify the occupant of the I- ky Z('I L
_yunanarcmunhemetpenrloiauanceoracenirteoracriamy, S.gnatureofApplicant — Date
�/ z 1-6102-
orErie All roof coverings to be Class "B" or better
Owner or auth ivcdage.'
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
OCIO Fax: (408)777-3333
. CUPERTINO
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.
6. Any roofing which is applied without fust obtaining an inspection,will
require the removal of all new material down to the sheathing so that the
proper City inspection can be performed.
IMTORTANT:
1. Flat roofs must have a minimum of 3a"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: A b IC CL -2, m t
Address: l o a 3 4 S poirl G.1 �Ap J e—
Reroofing Company Name: 1 D R""l9 �vtGI
Applicants Signature: UkP4.(t9 Date: it ►g C) I
• Joe Antonucci
(Chief Building Official)
6/25/01