02090080 cIBUILDINOUOPERTONNO PERMIT CONTRACTOR INFORMATION:
a BUILDING ADDRESS: PERMIT NO,
1296 PRIMROSE WY ROOF GUARD ROOFING CO 02090080
APPLICATIONUB DATE
"M' rEDONALD L AND ANITA A TR 740 W SAN CARLOS 09/13/ 2002
PHONE (408) 293-9519 SANITARY NO. CONTROL NO.
pBUILDING PERMIT INTO
WOO ARCHRECT/ENGINEER: r BLDG ELECT PLUMB MECH
Z y i LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby tiff rm that l am licensed under provisions of Chapter 9(commencing REROOF
� is a.fall xfocffect
whhseemre adore rmee ^syrbr nnzcoe rranu
K ad 6 Liten `y.t
3 u{n Da �1 ✓ARCHITECT5 DLL-CA`X0N
t t=I,g I understand my plans shall be used as Public records
�Y
W
dp O Licensed Professional
a OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
It K a following mason.(Section 7031.5.Business and Pmfe coons Code:Any city or county $9000
Z ctn which requires a permit w ronsmum,alter,improve,demolish,or repair any awmum
6t$ -prionoits issuantt,also rcquvu Ne applicant for such pemtiuo fileasigKdemtement- - - --
3- ttimihe'"licphdedpuriu5ntJothEprovis,onsnftheCommmulsLicenuLaw(Choger9l, _ L ttsw�f7 t OAT res n'1 ` Valuation
(imus iamlgiiN'o'ban.'ldllt))or Division3ufthc Busin=3sppd Pmfcssions Cadell Q 'k.l l�f•g .�"L .,ta •qc(V/g�ryp,Jrgy 9.�fl"�:
or,
r th;. s Gxbmpl thcrefi6m drill the basis for the elleg<J exenipddn.Any vimHtimn I
of
Semiom'03,5 by any applieam for a pemtit subjeetrsM applicant m o civil penalty:
n or not more than:five hundred nngam(s5B0) 305APN P(RS§§ ofr":r Occupancy Type
O 1.as owner of Ne property my employees with wages as their sole compensation,�1 307 -
(Sao
-9111 do the wPro ssionse aw=mhe C rand tr intended
or's Lie a Law doe sale apply
'oral.1 -"" ""- _ -"_�- - -_
fBasltm'u�and Profnsiom cW<:Th<Cammnors License Law acts ria appty man, 601. - ROOF TEA�Q(�111�IDSPeChODs :S'-B"Y�1''
owner of property Who builds or improves thereon,and who docs such work himself 602 - ROOF PLYWOOD_ NAIL
or thorough his own employees.provided Nm such impmvcmcros arc nm intended or! __ _ _ .._._ ..__...
udil for silt If;hu the b"Iding p amen,I Idwithinone y f - ----_ - -.. - - --', ._...
!completion the owne hula will have the bud of provingm h did nor Wild r 603 - ROOF BATTENS t
i i,new, br,orposeoferde) 604 - ROOF IN-PROGRESS
-pd:as owner of the` roper.am exclusive) contracting with licemed contractors mi___._...._._.__._�..___-.______...._._._-__.._._
property. Y Swi i LULI•,ti 1^',i:•.Ili is' :
omuua the proles (Sec.70aa,Business and Professions Cor l The Contractor's ._.,�r .Lal P.I %Tc •"I n
License Law docs nos apply on ea owner of Property who builds or improves Merton. ,
..and who cantacu for.such,projecu.with.a.cumracarrls).licensed Pursuant in the.
Commclols License Low., I,.,I .�f!'L, ,)Oft lJ'�;Ti;!i(fila
Olam exempt under'$cc.- �� '' " ' :B&PCfard, mason
Owner ,. t. 'haat •- r .,:. t - If`O1111 GR'4��®
- 'WORKERS COMPENSATION DECLARATION I.
-I hereby affiml under,penalty of peijury me of the follow aa,declwwions:--
10 I him nia
4E and will"min'a'CenificSmof Consani'm self-inmm for Weideh SEP is 2002
Compensation as;provided for by Section 3700 of-the Labor Coal for the
performance of the worksfor which.11this Permit L issued.t
01h vd nd'wil mefntiin vlrider's'Campenipiiuo lniumrice;aircyaired by Sktimi BUILDING
3700 of the Labsii Code for the kerformancei of thework for which this Permit is
iss eJ M1'yk Worker'Coin,atmanion insurance c rrs(-d Policy nA�b{�^are
/" _
PU�ZY r �� ..g_ a..+`.l I,ta tvt�+'i 4 .TAI I ...,mac... vYz.,--•7. it l.,.n.
or �ht r CERTIFICATION OF EXE�MTION FROM vORKERSg ONTI
AZ-
s COMOENSATIONINSURANCE ____._._. _,�__--___-._ _�. _-__. _.____._.-.__---._—..__-..,.,._....,
` �` t (Th i sttunn'rieN bot be rompletad d the perm I is fur mnc hunJreJ JUIWrs � �•r d' '` t3 V '
s'
tS1001m 1cs�.1 �,--„
-...• .� �.m .-. . ..
x, Ic mythrum Pert t e' int' h etc pe mIts is e 13 - '.q.c G II tr tt-la ••'
shall nm empldy any person n u iy owner st as t' hs n suhdea to Rte Workers'
hat
Cron aactionLa f C I f ,Date to '
vN ICETOAPPLICAM If,after aftt making fExemption,you should '` " "�x-'•d y '
z he III n Om Wm kC:tlmpen t p I dlhe Laborc riyourrunt
Q
fordawith ixonplywith suchprovisions o tM1s Permit shall be deemed revnkeJ
CONSTRUCTION LENDING AGENCY
ai > 1 hmxby affirri that -coinstructi6ir leading 8 Y Too&plrr rat nee Y a' %1•: ' L IL '.IF
U, 1.
rk fir Nhthis p unn tl iued(S 3(yl] C' C)
U!Q I d fy th t l ha i d th app( t o d t t th the above,info t s
W,[� ecncct 1 gree ro comply Ivth all city. J or,-dominates and tate laws relating
=iQ:V lm buildin!,=nmation.end herebyaothdrirnreprcsemaibec nfthts airy to cnmr upon'
>i�,,, (y] ih bo e t and property f pea P rposc .
Y (We) gree int a demmfy AMkeep h rind sd Ctyoftupertirio aganst
r.r fn liabilities,judgments.costs and expenseswhichim y n any y agai t sa.d /p
ime-
U Z Ctyy eq nce fth gmntngoftM1 p t 'I " ' I
IAP Lf N7U�T)`$TANDgA�DW LaC-O�MpLY3y',ITHALLNON�'3� � issued45V Date
SOU _E REGII ATf0N5.J•;'' N�%VV cT G by
:I
of ApPlicanVComruanr " ,.; n t' Dme' Re-roofs /
HAZARDOUS MATERIALS DISCLOSURE
. wll the applic t or future is IdI g race 'anormorhandiahvaNmu mom-nil Type.DER ._-_._ ....•,...,..--_-....-.,.
a d fnedb theCu no raMunicipal Cod Chapmr912 dtheHealth rads fetyd t 4 '-"- --_.. _.. _. _.--,- - a-r \t I 1 •❑
'cmde s«uqn u5ij1, t - ,. �It tr` •,lI C.`' � % j ,a�'I� S;in•qy E'1 lEa
an
All roofs_shall be spected prwr.to- y_[oofing,material being installed.-„_ _ , ,
Will be applucart or future Wilding -p t y.earmament a de which If a roof is ihs4alled without first Obtaining an inspectrbn Vagree'to'remove
em t hozduo. u tis dedined h t
•o t t _ r h e rAne A Quality M n g all new materials for inspection Applicant understands and will comply.with
n p 71 ,.� all no - cant source regulatto s .
C I f m have
&Safety Cod Sections 125505 3533a d Cn parr erva of dor ((�L/p - '
q and]SS7a I undcrsmtd that G
Safety
/` //,5 ✓
'if th ba IJIng does n t cu eptly ha ea tenant th t t my rc po.abJiry to notify the •� .,I
occupant of the iequ rcments'xhic must he met poor m Issuance nLa Ccnlfcote of,
.. :4 Occu airy.. .,. rt
. _ .._. _.Applicant- "- -- - -'- - Dae... -
`-'�'�'� II roof coverings to be Class"B"or'
Signature of
weer or awhmrzed g t y. . .Date -OFFICE.
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY 0 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
-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 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.
HomeownersName: t/ , par
Address:
Reroofing Company Name:
Applicants Signature: / rr Date: //3 I a
Joe Antonucci
(Chief Building Official)
6/25/01