03020079 CITY OF CUPEW11NO '
1 BUILDING DIVISION PERMIT �CONTRACTOR�INNFORMATION
' BUILDING ADDRESS: ABOVE ALL ROOFING PERMIT NO.
OWNER'S 700 NORTHRUP ST APPLICATI A E
NE: SANITARY NO. CONTROL NO.
(408) 292-4188
ARCHITECnENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB NIECE
LOO LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm Net 1 am licensed under provisions of Chapur 9(commencing P
wish Section MIM Division ofthe Businuaand (casino Crede;en dmyli'eueis
as LicenlseoCleenda 12' ( Lie.« 1�t REROOF
�� Da contra T/0 EXISTING SHAKE INSTALL 1 LAYER OSB &
ARCHITECTS DECLA 10 r
�i undersand my plans shall W used as p c records 55 0 YR. ROOF
OyO
3 C� License)Pmfcasion°I FINALED
�, Oat I am CUILDP.(,DECLARATION
E:00 I hchchy affirm on 1 1. exempt(rum the Cnn ons Co License Lew fnr the
00 following mason,(Section 7f13L5,Business and Professions Code:Any city or county
E:00
S K which requires a permit to em,slow.alter,Improve.demolish,or repair any ato Lure MAR 13 2003
F�Sr Prior m in issuance,also requires the applicant Permit to file a signed statement�sC
that he is licensed pursuant o the provisions of the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
u�$ (commencing with Section 7qM))of Division 3 of the Business and Professions Code)or
...
that he Is exempt therefrom And Ne hula for she alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects she applicant to a civil Penalty of
not mon man five hundred dollars($500). APN Number I tj�l4y pe
❑L u owner of the property,or is emntendea with wages r the sale(ante Business will do Him work,Cdthenocmulationot.Licenseed Law
i�f .1aply 7044,Ownir of 36230017 . 00
and ert ywh ons Cada:The Convumrt License Law does trot apply r an owner of Required Inspections
property who builds Provided improwa thereon,andwho doestuAmnot i twort oroffeedEnoughWe his
Own however.thees, ingorimpat rovement
Improvementswartne intendedorfor talc.If. 3055 — FRAME
however.me building or Improvement Is veld within one year of Completion.the owner
builder will have the burden of moving that he did not build or improve for purpose of 307 - INSULATION
ole.). 601 - ROOF TEAR OFF
❑Lea owner of ct popery,.Business s and contracting with licensed conmcmrt m
mnsvua Aase pmjetapplyo anowrorpmpnywhtlonsds or i pr Contractor's
mon,Li 6O2 — ROOF PLYWOOD. _NAIL
censelawdoesnotapplyetsownero(popery whobuildsorimprove dsemon,and, 603 — ROOF BATTENS
who convects for such proJecu with acontnctor(q licensed pursuant m the ComnnoYe
01 an Law' 604 - ROOF IN-PROGRESS
❑I em exempt under gee. ,B&P C for this moon
owner Dau
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penally of Perjury one of the following declarations:
I haw and will maintain a Certificate of Consent to selbinsun for Worker's Compcn-
utinn,u provided for by Section 3700 of the Labor Code,for[be performance of the
work for which this permit Is issued. -
❑1 have and will maintain Worker's Compensation Insurance,u required by Section
3700 of Ne LdMrCode,forme performance of thew rk kin which this permit is issued,
My CMk CMoNnudnn Insurance carrier ard�q n��l ;
CE IFICATE IOP E%EMRr1 NFROMWORKERS'
COMPENSATION INSURANCE
frhis section need not be eompleud lime permit is(bone hundreddollen(5100)
or less.) -
I certify met in fee Performance of the work for which this Permit is issued.I NalI not a
employ any person in any manna an u to become subject In dm Workers'Compensation -
Laws mf califonhi..Dau
Applicant
NOTICE TO APPLICANT:If.after making this CCedfiean of ExemPsion,you Should
become&object to de Worker's Compensation previsions of the LAW Code,you must .
.JO forthwith comply with Such provisions or this permit shall be damed revoked. '
Z " CONSTRUCTION LENDING AGENCY
'C. iN+ Ihereby AM.ren On.its construction lending Agency for the pormonam,of
Q'i ti the work for which this permit is issued(Sec.3097,Civ.C.) -
GQ lender's Name
z Lee&,,Address
U Q I certify mat I have reed this IPPINALAn and state that the above infotmetion is
ly F+ correct l agree to comply with all city and county ordinances and state laws telling Ire
�U building construction,and hereby amhodm representations of this city to enter upon Ne
shove-m noosed property for inspection purposes.
G (We)agree In Save,indemnify And keep harm leu the City of Cupertino against
i h liabilities,judgments.Costs and cxpenAu which may in any way aCCNe against said City
f, in consequence of the granting of this Perm it.
�i APPLICANT DERSTANDS AND WILL OMPLY WITH ALL NON-POINT Issued by: . Date
SOURCE ULATIO S. -
e-c RRe-roofs
nature of ApplicantlComncsor Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building uccuPant store or handle hazardous material
As defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
ode,SCCdnm 25532(a)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes on
If a roof is installed without first obtaining an inspection,I
Will the applicant or future building occupant use equipment or devices which g agree to remove P
it ha'rasdous air contaminants s defined by the Bay Area Air Quality Management all new materials for inspection.
mrict7
❑Yes
I haw mW the heraNmu matedals n tiomments under Chapter 695 of the Califon
rias notC&Sd�tyCSilyhaw atenant,hat it 1355J3and2553a.1 undcnunJ dw iflM building �� �� //
dacemolcure yhaw a hneral Net isumynsrufjcodmnn' aceupant ofdu (((///"a��� V iA
myuiremcn hichmu be manaofaCcnifreauafa cr;/ glgnatureofApplicant ate
mer car authorimd agent Daea All roof coverings to be Class "$" Or better
Building Division
! 10300 Torre Avenue
•
%cl
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Pax: (408)777-3333
CUPEPT[NO
Building Department
Subject: Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,youmust agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
I 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 Vi"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: ~Q 4!��2C S e5
Address: 75 2�1 �cA�r� « QlrF�luF
ReroofmgCompanyName/:A4�k'iLc AA (2eNerP;ura �,c'�� o-1
Applicants Signature: Date: Z d d.3-
-Joe Antonucci
(Chief Building Official)
6125/01