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CITY OF CUPER'11NO
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BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
' 4
Ilu,Q)TST01sREGNART RD
WOODS ROOFING
FERMfrNO2100074
DWfi.As9AESURE SH L AND BHAGVATI S
1020 HICKORY CT
APPLIcnTT'0sYl09rY2002
DON':
831 637-5576
SANITARY NO. CONTROL NO,
ARCII'ITCr/E.NGINEER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
LICEMSEDCONN 'ACTORS DECLARATION
Job Description
I hereby affirm Nat I am licensed under provisions of Chapter 9 (eummendngREROOF
with Section 71X10) of Division 3 of the Business and Prefecsiom Code, and my hurt.
L'n ter force and cif try 2
ianm f 4 Lie.
Common
n o2T._
AARCHITECTSDECLARAT ON
I understand my plans shall M used as public records
DEC 1'3 2002
Liern.d Pruless inwl
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Cotnracun's License Law till be
$11000
BUILDING
following reason. (Section 21131.5. Business and Professions Cole: Any city or county
which ropiates a permit or construct, alter improve. demolish, nr repair any structure
prior In its is u ince. also requires the applicant for such permit to file a signed. statement
3gy6H3f0"A@0
Valuation
that he is licensed pursuant to the provisions of the Cumru'mr's License Law (Chapter 9
(commencing with Section 200) of Division 3 of the Business and Professions Code) nr
that he is exempt therefrom and the basis for the alleged exemption. Any violation of
ON NWARM Occupancy Type
Section 7031.5 by any applicant nr a permit subjects the applicanno a civil penalty of
am more than five hundred doBara(S50%
307 - INSULATION
I, as owner of the property, or my employees with wages ses their adc compensation,
will do But work. and the structure is not intended or offered image (Sec. 704,1, Business
Profusions Code: The Contractors License law does not apply to an owner or
n cliEns
and
property who but da or improves thereon. and who doessuch work himself or through his
602 - ROOF P
own employees. provided that such improvements are not intended or offered for sals.If.
603 - ROOF BATTENS
however, the building or improvement is sold within one year of completion, the owner
604 - ROOF IN -PROGRESS
builder will have the burden of proving Nat he did not Fuld or improve for purpose of
vale.).
1, as owner of the property, am exclusively contracting with licensed contractors to
construct he project (Sec. 7(W4, Business and Professions Code:)The Contractor's Li.
tense law does Out apply man owner of property who builds or improves Nereoo, and
who contracts for such projects with a comranor(s) licensed pursuant to Ne Contractor's
License Law.
❑ 1 am exempt under Sec. . B & P C for this reason
Owner Date
WORK17R'S COMPENSATION DECLARATION
1 hereby aRrm under penalty of perjury one of the following declarations:
1 have and will maintain a Cerilicae of Conscm to self -insert for Worker'sCompen-
vation, res provided for by Section 3710 of the Labor Code, for the performance of the
work for which this permit is issued.
have and will maintain Worker's Compensation Insurance, as required by Section
V1
.1) of the Como Code, for the pedormancc of the work for which Nis pm du e, issued.
My Worker' u pcnsatin Insumooce Wrier and Policy num 0(-141
Carticc Policy Nn.
FROM WORKER
CERTIPICA IS'
COMCOMPENSATIONN INSURANCE
('rde cealon need not N ctuarcred it the permit L for Inc hundred dollars (S I IgE
less.)
1 unity that in the a rtormance of the work for which this pemail is i"mol. I shall not
employ any person in any manner to as tit become subject n the Workers' Compensation
Laws of California. Dale
Applicant
NMIC17 TO APPLICANT: If, alter making this Certificate nl Exemption, you should
become subject to the Worker's Compensation provisions of the IaMn Code, you must
forthwith comply with such provisions or this pctmil shall he deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm Nat Nene is a construction lending agency or But pvRurm ucc of
the work fire which this permit is issued (Sec. 3007. Civ. C.)
IenJcdName
/k
Lender's Addm v
I unify Nat 1 have real This and that the shove iws relalinn is
VAJ'---
city and coon dins and nate laws r
cording I agree m comply with all city and county natives
upon t e
representatives of this city menter upon Nc
of
building cotioned ro and hereby inspection
ahovc for comtyi
(We) acdproperty an keepha.
harmless the City of Cupertino against
and which
(Wc7 agrcc m save, Inde expenses
Iiaconiequenc judgments, costs and esmmit. may in any way aucrve against said City
/t
of this
in consequence of the graining of this pCrmil.
APPLICANT UNDERSTANDS AUIZ WILL COMPLY Wll'll AL1.NON���III'0 T
{/
Issued by: Date
SOURCE. REGULATIONS
Re -roofs
Signature of ApplicanUConlraonr I Date
HAZARDOUS MATERIALS DISCLOSURE
Type of Roof
Will the applicant or future building occupant untie or handle harandoue malarial
as defined by the Cuprmdo Municipal Codc. Chapter 9.12, and the Ilcallh and Safety
code. Section 25520)1
All roofs shall be inspected prior to any roofing material being installed.
❑ eta
I(a roof is installed without first obtaining an inspection, I agree to remove
Will roe appllcam or future boimhtg m ,onto nseegldpmrm 11, devices whirs
emit haeanjous art contaminants as defined by the Bay Area Air Quality Management
all new materials for inspection.
Diarin2 /
[)Yes �tS
In&Suct Ncve.seeusmatcualsm33aternu tinter Chaperb.95 Calding
'�iiJJ'moi
ifhe
is Dentin Codc,SttuonQ5N15.2553) and2553s.l unlcrslanJ Naif Joe beilJing
/Q f ��
etc[ not currently have a tenant, WUI it is my responsibility lu nutil'y the pard til' the
mquiremt muslhcme nmmiaauaMeuracerdfiearenr }�a"Je�
Signature of Applicatift Dale
All roof coverings to be Class "B" or better
o»eeT,uNtui daunt Date
•
•
CU
Building Division
10300 Toren Avenue
Cupertino, CA 95014-3255
Telephone: (408) 777-3228
Fax: (408)777-3333
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 obpeon
Wg and written approval from the building inspector. A final inspection and taninall inscti
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 4" 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 olicy on reroofing and will comply with this policy.
Homeowners Name:
Address:
Reroofing Company Name: L-0 Jr-�
Applicants Signature: __ 7%✓�i ' Date:z-
i ,- ��
Joe Antonucci
(Chief Building Official).
6/25/01