02090017 . CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
,BUILDING ADDttESS: ' - I PERMIT NO,`
. ' 2287.1/-22881 RIDGEWAY DR 02090017
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G yMRIDGE OF CUPERTINO HOA APPLICAO'l s�off1 4/2002
/ PHONE:"J SANITARY NNO. CONTROL NO.
`q Q oZ'ARCHITECT/ENGINEER;' '}" BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH
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LICENSED CONTRACTOR'S DECLARATION
o��'�- , ' ''n1ne.bb4'alrltmthatIa«rcensedunderprovisionsofChapter9aommearmg Job Description
F,.t w',ith Sro1mr]o0D)of Division3ofine Business and Professions Code,edm Banes REROOF
s Lim rmrroapan
d o //yy p[�y /� p t�
OtV License Clesi / Con and
FI N16iWLED
Date: ` Cantmao
3• .f""i i ARCHITECT'S DECLAR
- s i : 1 undersmnA my plans shall h used as p.bit
c c«ds JUN 1. ? 20 03
r s . ;:,:;, .
u. OWNER-
Licaixtr Professional '+ BUILDER DECLARATION
_. ...
' 'I he so affirm that 1 1. exempt from the C ssions r•s Littnu taw for mefollow - BUILDING $35898
t Z C1 which'mg res (Sect ]ons YB sines and improve,
de Professions Cade Any my or county
Z o whseh e9 rte u permit I cnrttmn otter, t muse,h peenash,or repair any tatem re --
C3Q.•mil tsissuance,also req im 16 the provisions
f«sahpcmunocense,Law(Chapter
.. . . . .._
' (comm.k H h withii Sis ion,7000)ofDivision3 fbetm inciaors rcetvelaw(Chepter9 f ,Y 3 1P30T �SAt4a r f .. Valuation
(<dmmenang with Secgon,]0003 of Division 3 of be Business end Profgss ons Code) x 4 ,� ', ,� 1 is J N kA.' ,a0,
it thai he is csempt therefrom and the.roes fur the alleged citimption.Any violation
=oPSection 703P.5 by any applicant for a Permit subjects the applicam to a civil penalty
` f not roam than five hundred d.M.(S500). 3 0 5AP.N VFU@ F4E : ->!l "I 'Occupancy Type
- -Ol,asownerofthepmpeny,armyempiuyeeswithwagesestheirsdlecompen"dion, 307 INSULATION
-
1111 do the and theCoi!rstructure ii mn'im r'd Li or o Law doe sale apply in an 6 01 - ROOF TEFF QWFInspections I;
•I1111 d sthe wProfessions Cade: e'C 21linu•s License taw does not apply to a, q -
ownerofpmpenyWho Wilds minamovestheaon,and whodoessuch work himself 602 - ROOF PLYWOOD NAIL
ar menuyh his own employees.provided that such impmvemems arc not intended or ....__._!.._._____.._._----
completion,
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:offered for sale.If,however,the building or improvement is sold within one year of '" '- 603-----ROOF BATTENS -. •p
mimpletion,the ownervhuilder will have the burden of proving that he did not build or
nPow,1.r Pmpitsaofsme.t 604 - ROOF IN-PROGRESS
.•.'7 d1.as awn«of theproperty.am exclusively
e , y d Professions
withocrnxdcontmnotm ......Vel :;U
License the project Tapp.]Loan Business and Professions Cade:)iThemproves
Contractor'sn, - I' ^ rw_ c.l c'1 �:i
License . does not apply to an owner ih aproismycony who builds« mproves th n, '
d- h nwarol Li.xuch.pro/ecu wish.a.comscmrf9lcenxd.pursuunrt the. ..... ._.. .. _.__.._ ...._....,._ . . ._:_.._J.. .-.:._.. .. 1 .—_.._.._ :. _ _._....__.. ._..
- CnI a.attempt
)ptmall Lew.l s i"" r ': a"sH&
Alam aempt un_dcr Sec,�.Bh PC for Nis rtamn .t•th � o-ifl l''^.;rII:
+ . Owall - S!', '.Dune '-._,I ,a
WORKER S COMPENSATION DECLARATION
/'` Thereby vBirm unJ penalty fpetyury oa ofithe following declaruwns:
�'s• E'I ha a and will'm of v C mBente of Cense i no self-
" ensure for Worker's
/
Compensation. as, for pro forby Section lisp of the-Labor Code, for the
perfoth
rmance f the work for whichlit,permit is issued.. l i '
y haand ill ma m n W kc
ve C mpensahn 1 e,m rt
cquired by Section
700 of me Latn C vr.'thePerformance of the v'ik for which thisper t is
feta d MY W k uon I um c •!e`n/y�I_Po cy be are. p,
� I CERTI EXEMPTION FROM.WORKERS "' —0 ..Ct�'� t 5 .sal.�T 1\ a! "ZI,_CI11XI"�7i,
COMPENSATION INSURANCE
+Is' (This sewn.,feed nm be cumpleied if de p.it is fora..hundred dollars
f
1.1i certifyIlthat in the pLf mr es(the khit wrib th vinnit i.-ixs edit i .s/,:ai•,: 111','):,.[•111 os. n
Cour n I employ any,pe son m ti.D is nee si m m become euhlcct tithe Wn&en i
Compensaiion Laws of Colifbriiv.Dale "'
NOTICE suOAPo the Wo'I`Ifa1111 ompers gm sCemticate of LatoriofyoushoulJ
"become r t i W h Footstool
o C tope t p t nsll the Lolur Cele,you sun
0 fAvh th comply'with such p .' rix nr'hispernin shall tt dee ned revoked.
'
we n I ar CONSTRUCTION LENDING AGENCY
a , ' I heathy fire thnnh - c .wet lend g agency for the Perf canoe I � C. e
hh wa k f h'ch th s pe m t i. Ism.d(S 7097 CI C 1 r
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„y i.,i_ 1 rosy than 1 ha e rc d nhu eppl¢t nand acme dwuhe bo information is
w"tom correct 1 g tq comply ilh all city anJ c ny nNinancex rid et to lows relating
". O;,rJ mbmldmg conxtsnion;unA hereby aunhonze reprcunlanives of chis myno call,upon
y kl the M e mem ned P pony f r peeion purpo
L 0.' (W)egrte los a mdemnlfy and kc pharmless NeCty fC pen no ogaina
4 V1 liab 1 t ) dgmems,c is rid a genus bah m.ly any y ry gvina said
V Z City n on yuence of nheg mcg N't emu - 7j1
APPLIQANT UNDERSI.INDS I COMPLI ffH ALLN P N (J ��
SOURCE REGULATION r Issued bye Date
Signature Af Applicam/Q/Qomsctor' :"�t ! :-^ 7"�Y:„Dm ,;l'r: Re roofs
M
HAZARDO ATERIALS DISCLOSURE
worn applcant«fwieFuilding ap,ftoa«carol narerdaaameteat Ty -
a def d by th CLpm no Municipal Cade Chapter 9.12,-and she Heahh and Safety + l:.
Crl .2557 WI �lrs I-.Iii lit g s's ! -'�'`+',�4t'. - rtv �l,L: d.e.1• •J. .-sr
7"y
meth N adaircontaminantsu b mega AtiAlf uahi .lana I-be inspected prior.to.any roofing.matenal being installed. _, ...__
1
I.
If a
r;. wu m applicam or fm rc budding ac p t equ pm<nt o dellen which all roof is in talled'witliout first obtaining an ihspecttoh I'5gree to remove
a ore y y Q r gement A roofs,.sha els for inspection. Applicant
t '—ir 51❑Ye _ - - PP _. --... .
n. N pe t a t an wt comp y with
all non If source regulations.,,.:
I.ha cadlthe hamMous n vitriolrequirements under Chapter 695 of me
Cal r aHealffi&SafetiCWe.Seitions5505.25533nd25534.iundentand mat 9(//�
" irthe,building deals not eretlyh eaten t thattimytespo.bltyt -ifyme - -- -'e' --' "_ " '- -"-'-/ OZ -`
occupant of mre ems vhich iv be ant prior m ixs mnce of a Cenifco of
Occup acy '
Signature of plicant Date
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ow eroraam :pdpgem te. All roof coverings to be Class "B" or better•
t
OFFICE
C ... _. ...._.. ._.. . „_._. _. .. .... . ...... . ... ..
Building Division
10300 Torre Avenue
i Cupertino,CA 95014-3255
Telephone: (408)777-3228
coo Fax: (408)777-3333
CUPEIQTINO
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%"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:
Address: 71 Z ek/
Reroofing Company Name:
Applicants Signature: Date: f 4I o Z•-
Joe Antonucci
(Chief Building Official)
025101