02100122 CITY OF CUPERTINO a
BUILDING DIVISION PERMIT �CONTRACTOR,INFORMATION:,q
IIUTP@(q10DRR0BINDELL WY GARY CARMINE PHRMIT"®2100122
GW1L41X A*IiCARMINE APPLIcATTTdVVnT672002
PONE: SANITARY NO.// CONTROL NO.
ARCHITECfIENGINEER: BUILDING PERMI r INFO
BLDG ELECT PLUMB MECH
wOp
LICENSED that I?DCONTRd under
DECLARA'T'ION
s T:U. I Wmhy affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
Zap with Section]gaOofDivision 3ofNCBusiness and ProfessionsCode.And mylicenseis REROOF
�,42oy in full loom and effect
Z 0 12 Z Lisenu Class
ti
Z Use ConFIV rLE D
,fARCHITECTSDECLARATION
s IundcrsnJ my plans shall te used A,public records
i,al
au JANO ( 2003
G Liecnud Plnfecslnwl
q OWNER—BUILDER DECLARATION
Yqa� s 0 1 hereby affimr That I am exempt from tW Contras Co :Any c law for the _c ],/�
a po followwhich
nquires motion.Permit on to
construct,
t,alter,improve,
ve,dsiol Code:Any city Or Comity BUI D'l doo
$ which its requires n eermit r fumes the
eller,improve,demolish,or repair any saecmm W L g1\\V
FZ< prionnits iuuanec.also tcyvimsthe ePDlicam fir such Permit n file aaigneJmem
pS that he is licensed pursuant to the provisions of the Contractor's License law lChaChapter9 3S�25t.9U&2AI@fl Valuation
r(F � (commenei ng with Section70(ad of Division 3 of the Busineu and Professions Code)or
ca $ that he is exempt therefrom sod One basis for the alleged exemption.Any violation of
Section]031.5 by any applicant for a permit subjects the applicant to a civil penalty ofpN-N Occupancy
no,...than five handled dollars(s5nB). 307 - INSULATION
p y Type
0 1,u owner of The propeny,or my employ.,with wages as their ole compensation,
will do the work,and the structure is not intended or offered for sde(S..7M4,Bassin as �Qy�{
And Professions Cade:The Cmdoo rim's License Law does not apply hs en owner of 602 - ROOF P T V`l V nWAGfIODS
property who builds or improves thereon,and who does such work himself or thmugb his L
own employees,provided that such improvements are not intended or offered for ale.If, 603 — ROOF BATTENS
however,the building or impfovement is sold within one year of completion,thc owner-
builder will have do burden of proving Bar he did no,build orimpmvcfor purpose of 604 - ROOF IN-PROGRESS
sale.).
❑I,as owner of the property,am exclusively contracting with licensed contractors to
construct The project ism.70,14,Business and Prefueium Code:)The Contractor',Li-
cen s,Law does not apply to An owner of progeny who Wilda or improves Ihemon,end
who contracts for such projects with a mahar ni licensed pursuant as the Contractors
items law.
am eacmgT under Sec. ,B&PC for this reason
Q'wn �Q`'1 i` o 0
WORKER'S COMPENSATION DECLARA
1 hereby Alrum under penally of perjury one of the following decimations:
1 have and will mainain a Certifrcareof Coment to off fi cute for Worker's Compere
cation,u provided for by Section 37ro.(the laWr Code,for the performan.of drc
work for which this permit is issued,
❑1 have and will maintain Worker's Compensation Insurance,n repriced by Section
3]m)oW
f Ne Lar Code,far the performance of The work fur which This permit is issued.
My Worker's Compensation Insurance earlier and Policy number are:
Carom. Policy No,
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This action need not be completed if tlepermit is for one hundred dollars(1100)
or leas.)
I certify Net in the perfo once of the work fur which This permit is iamed,l shall not
employanypersont sone k)u1xTl: 7Auhjectmthc Workers'ComMnsation
Laws of Cali4Nnia. t�Je111Ds�"116f0��
Appleo /�
N It t TO APP CA :IL after,making this Cenilicale of Exemption,you should
become subject as the Workers Compensation provisions of the Labra Cale,you must
OO ii comply with such pf,smions or this Permit shall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
I heathy
uftirm deal there is a construction lending agency lot he arlormanc,,of
6i ? Ne work for which this permit is issued(Sec.3W7.Civ.C.)
IQ Q Lender's Name
z Lender's Address
U O 1 certify that 1 have read this ayPlication and sale that The above information is
U. Pcorrect.I agree to comply with all city and countyordinances and sae laws retain,to
DU holding constmclinn,and hereby authddre representatives of this city it toter upon the
D.1 above-mentioned pmpeny for inspection purposes.
(We)agree to save,indemnify And keep harmleas the City of Cupertino against
y liabilities,judgments,costs and expenses which may in any way scene,against said City
f the granting
U z APPLICANce T UNDERSfAN ofthis
IAND WILL COMPLY WITH ALL NpNPOINT Issued by: Date
rRC .GULAT10.GULATIO S. nRe-roofs
APPI 'aHAZARDOUSMATERIALSDISCLOSURE odinCoutoolm Da Type of Roof
the applicant or future building omupam.store or handle hvzrdous material
y the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
n 25532(x)? All roofs shall be inspected prior to any roofing material being installed.
CA the applicant or future buildingacupanTuseequipmcmurdeviceswhich If a roof is installed without first obtaining an inspection,I agree to remove
ouc air contaminants as defined by The Bay Area Air Quality Management all new materials for inspection.
C]Yes
I have read the haardnos materials requirements under Chapter 6.95 of the Califon / I
nia IIcalth&Safety Cale,sections 25515,M533 and 255M.l understood that inhe Wilding � `! V
docs our currently havcatena T i T is my respansibll ity to and fy the useepeot of the /� ����fff-���"WYI b v
rcyui nu which mu. W inmissuo ufaCeniOcaa of Occupant. ` Dz4e
SgS�ofApplic t Date
sae nrnotho(oc agcol Date All roof coverings to be Class "B"or better
Budding Division '
10300 Torre Avenua
4 Cupertino,CA 95014-3255
ao Telephone: (408)777-3228
Fax: (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%"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: 1M l N I
Address: t��y �o a( N b i 'G L A
Reroofing Company Name: S(- L F
Applicants Signature: Date: /0 4/L4o Z
Joe Antonuc
(Chief Building Official)
6/25/01