02030078 OF
CI BUILDING DIIVIISSIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
18605 RALYA CT. RESPONSIBLE ROOFING INC 02030078
OWNER'S NAME: APPLICATION SUB DATE
HILL & CO . 2882 SPRING ST 03/15/2002
PHONE: SANITARY NO. CONTROL N0.
(650) 969-6151
MaO ARCHITECT/GNGINEER: BUILDING PERMIT INFO
te_ BLDG ELECT PLUMB MECH
a G L=1 1=1 I__I I—A
y z, LICENSED CONTRACTOR'S DECLARATION Job Description
m
I hereby amrIlial I am lickead malar provisions of Chapter 9 anmmeneing P
wFtuwith Section 7")ofDivision 3onhe�usmessand PmfcssiomCode.and mylicense REROOF.
II forec an R¢
s"�a a Lia. T/O & DISPOSE OF EXISTING ROOF
'ods Dale 5=—� eav�' �g APPLY NEW TAR/GRAVEL ROOF .
1 3 u y A ECT'S pyCLAi AT
0g I urder,mad my plans shall be used as public records
a--
i i pE
0 Licensed Professional
6 a ne
u OWNER-BUILDER DECLARATION
H
1 hereby affirm that 1 am exempt from the Contractors License Law for the
?C following reason.(Section 7 Business and Professions Care:Any tiny or county
which -q ge nils construct.
t Icer, mfmve demolish,or repair anyidinforgtt
ou prat t km req Be PPlicam for such pennnt ries signed wtemm�t
is. Ibtn s� mWphuanuthcprot cannaaatraatarxLeaLw(cWpt=r9 S FtjloorArea. �[ h�anon
(commencing thSct 7") fDivision J of the Busiriad Professons Cade) (_f S'\ f�...,tq', -y,5. ..it it'rJ tr�._111 iltM1 ; $54"
or Nal he Is exempt therefrom and the basis for the alleged exemption.Any violation
of Seaton 7031.5 by any applicantfor v permit subjects the applicant m a civil peaalry
of not mom than five hundred dollars(SSW). 375`' ''0'll}1 PtFO Occupancy Type
D 1,as owner of the property,Lir an,employees with wages as their sale compcnsvim,
will do the took, ad the'swcture is amt intended or attired for .to(Sec:703x, - FRAME
'--M-
"Bmidas and Professions Code:The Contractors License Law does not apply to an 305 - FRAE Required Inspections-a' °' '' •a
owner of progeny Who Wilds or improves mercon,and who does such work himself
through his two employees ovidedWiping
mat such yeri meol are not Immpdar or 307 — INSULATION
.offered Tnr sale.-If.however.-the bildin -_Im _ -t as sold wimin one_ -of _....._..__ .._ .. - -_ __._, ._._ _._ __._ .._ ..__. _ ___ __ — _ -
amplobon,the owner-budder will have he or of proving that he did not ate or 601 — ROOF TEAR OFF ^ -r
improvefor parpoaar.ale.l. 602 — 'ROOF PLYWOOD NAIL
__ .. ❑I,vxnwncdmepmpenexclusively azm
dconvrsm 603' — ROOF BATTENS -7
n
- _
construct IW does
a(Sec. in an
Business and Professions Codes'D¢Conmacmr's i t t"I
Licence Law eoes .for sulymart own with property Wildesed.pravestheraoe, 604 — ROOF IN—PROGRESS'`"' .'
:- ,and who commas.for such,Projects with a.comm�orts7.licenzW.pmrsuant.m.me. . ..... . . ----- _._-_.,_ _._._ .__ - ....
ae License Law.
ElI
- ❑ vmexempt under Sec. � .B&PCfar his
Owner Dale
WORKER'S COMPENSATION DECLARATION
I hereby al6rm under penalty of perjury one of the.following declarations:
D 1 have and will maintain a Cenifcme of Conant to self-insure for Worker's
Compemation, as Provided for by Section 37W of he Labor Code, for the
affmmanceofthe work forwhich this permit is issued.
D 1 have and will muinmin Worker's Comperuncr9nsumnce,as required by Section �•n
3700 of the bettor Code,for me performance of the work for which this permit is
Issued.My Wader's Compensation Insurance earlier and Policy number arc:,
. AR 2._7.2002..._. . '-
s_.y/ a. th se�n'f�'�/'-u�<Y N 3756° .� (V I l:t� 1 ry I1,J'� T a
J' n 1, CERTIFICATIONOFEXEMPn FROM WORKERS-1-
COMPENSATION
ORKERS se
•, _.-s COMPENSATION INSURANCE_ --_._ _„_ _ �Ug7a DING _„ _ , 1
•_ LSl gYV __.... _ ...
neW net W completed floc pennies for one hundred dollars -
($I00)orless) ,
1 certify that in the performance of II a work for which this perms is issued 1 -
shallnot employ any person in any manner sat as to become subject,to the Workers -
Com
pensinumLawsofCalif ornix.Data -
.Applicant.
NOTICE TO APPLICANT.If.after making this Cenifcrie of Exemption you should - -
z Qbecume subject to the Worker's Cnmpenenumn pr visions of the Labor Code,you most
fonhwitb comply with such provisions or his permit shall be dccmed revoked. - .l
CONSTRUCTION LENDINGAGENCY
f1 h by_ff.thath - omuu I leading agency for the verficurc ri e
of tIt
'which Nis,Permit s issued(S 3.097 Cie C.)
(� Lende sN ._ ✓ -. Lc .._ .. . _ .. _.—. ... ._.. _.-
�.z Lender a Address.' .. .. .. /^�
V - e 1-• / I
1 minify hat I have mad his application and state that the above infomution is
k+'E. correct.I agree m comply with ail airy.and county ordinances and state laws relating
C) V to Wilding conamaimrseld hereby authorize repreminsoesafhis city roomer upon
me ebo(We);gme ou save.ny,for inspection anpurposes.
[.< G (Wclegmemecost Inde .,a.,keepwhich
hat a,rose City r Cupc u,sim,io ainstd
m liabilities,se uences,fMet end expcnas which may ibrarou n any way accrue against sold
City in
e of the graming spin”
APPLICANT'UNDERSTANDS'AND WILL COMPLY WITH ALL NON POINT Issued by: �. Date
nature of pP aanvca unor'• "" y .Dade I. Re-roofs /
HAZARDOUS MATERIALS DISCLOSURE -
W'lltbcnpplarre or!tire Wlding occupant store or handle Intimandatistat 1 _ Type Of Roof..as defined by the Cupertino Municipal Cod Chapter 9.12,and the Uediftb and Safety
Code Seerimi 255]21^)
0y` 'D'" - t - "-i All roofs shall bl: inspected prior_to,any„roofing,matenal.being installed.
Will the applicant or future biidins occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I'agree to remove
calhi. air cont mints asdfined by Ne Bay Anes Air Quality Management
Disrriaa - all new materials for inspection. Applicant understands and will comply with
Over '. O.N.. I , '. all non-pointsourceregulations: ,
6uw.ar
ave read the.hamidous materiak requ'remen¢and r"C1,pmr 6.95 of the
California Health&Sdfny Code.Sections 25505:255JJ antl 25534.I uradcrstand tam
ingdoesuncunenly have etonanl.that it is my resporminility m notify the --
f the requirements which most be,met prior to issuance ora Certificate of
11
” —Signature of Applicant Datez/aumomeeagant lie All roof coverings to be Class "B" or better
. . . _ `. - - OFFICE - - _
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Fax: (408)777-3333
UPEkTINO
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.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: C
Address: 1 8(n CSS IKQIWCA CA-
Reroofing
Reroofing Company Name: �QS�YISI ble �O�i 111[n �NC
Applicants Signature:
�9
Joe Antonucci
(Chief Building Official)
6/13/00