01120023 CI nuDING DIVISION
PERTNO
BUILDING
PERMIT CONTRACTOR INFORMATION:
BUILDING„DDRESS: PERMIT NO.
940 t20SE BLOSSOM DR ABOVE ALL ROOFING 01120023
pW APPLICTIONS BDAM
4W WILLIAM B AND MONICA 700 NORTHRUP ST. 12,05 2001
I.PHONE: (408) 292-4188 SANITARY NO. CONTROL NO.
C e Ia ARCHITECT/ENGINEER: BUILDING PERMIT INTO
O BLDG ELECT PLUMB MECH
t'— I-1 IJ LJ
e N 2 LICENSED CONTRACTOR'S DECLARATION Job Description
z_0 1 hereby affirm that 1 am licensed under provismns of Chapter 9 teammate,Ia, COMP TO COMP
mem with Sermon 7000)of Divi' Jofthc Busincsesnd Pmh,si C yam
Y m$n is In IYII farce an ffaci.
aLicense Class Lic.a
t 3�u Dmc Cair.”0
ARC ITELT'S DECLAR
u O I undersmnd or,plans shall he used as public c s '
u p p Licensed Professional
'W R OWNER-e U1LDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
!-z a following reason.(Section 7031.5,Business and Professions Code:Any city or county $5200
f$O which ra,mra,.pcount t i t 11 r.imp...a dmonfid.mor,eir my maction,
a3ec Pitot r Iso rq
e _ the PVIcant batsman pefmn fl imal em
tm .
that he 'leen dp°im no the imaximm,of the Conerseme,License Law(chptvr9 �. • l R9�r';.Fa..n.0.01®4- � ,1. Valuation
from nein,w'nh Sect a,7WXI)of Div stun 3 of the Buame. d Profc.c ons Coda) Q s- y•Ys.', ,Q
or that he is exmmpt therefrom and the basis for the alleged exemption.Any violation
of Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty-
of no,mora In.five hundred call.,(s500). 305APN gtE " .t Occupancy Type
❑I,an owner of property.or my employees with wages as their&ale compensation. 307 — INSULATION
sit]do the works and The structure is not mtended or o0kred for sale(Sea.]rvw,- 601 - ROOF TE7 tf?i E'�'Ins actions '
Business and Pmfessiam code:The Contractor's License Law ams not apply m an Q p '
owner of propany Who hands or improves thereon,and who does such work himself 602 - ROOF PLYWOOD NAIL
ar through his own employees.provided tact such imp...ccn¢are not intended or
"Offered for saleTIf,h6wever.the building or im
mprovement Is sold within one yar of 603 —" ROOF'BATTENS
completion,the oxmenbuilder will have the burden of proving that be did not build or
mpravemrpurpazcnfsale.). 604 — ROOF IN—PROGRESS
orfthe
Property,am exclusively dProlengwith licensed e Connors to -
_
constructicenseLaw ons r't(Sec.71Ma,Business and em,whioa Codes The Contractor r
and who
law does oat apply wan owner th a witty who)ditlice se improve maroon,
.' and who,comnms for such proje[u.with a contractions)licensed pummneto Ne . . .. .. _ _.____.. ..._1 ...
C nuacmri License Low.
C I am eaemptander Sec. B A P C fm this reason
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby efBmt under penahy of perjury one of the following declarations: /� )
O I have and will maintain o Cerifcate'of Consent to self-inmm for Workers
Compensation, as provided nor by Section 37W of the labor Code, for the /
prommucance of the work f hich this Permit is issued.
❑1 have and will maintain Worker's C pensation insurance, req red by Section
37W of to Labor Code f th parramoun c of the works f h permit is
iss
or,
My W rk e - I arae carzrer P _
sO
Garner � � r ) rv,'4M11i....
ERTIFICATI0 OFE%EMITON FROM WORKERS' - 4/ ^
COMPENSATION
"(This secti6n need not be completed if the Permit is for one hundred dollars
IS[W)car Iaa)
il. 1 ccnifY ihet in the performance of the work for which this pemnt is issued,I _ -
shall not employ any person in any manner so as to become subjat to be Workers'
Compensation Laws of California.Dem
.Applicant
NOTICETO APPLICANT.IL du r making ibis Certificate of Exemption.you should -
become subjee,to the Worker's Compensation provisions of the Labor Code,you must
Ofonovith comply with such provisions Dahl,permit shall h deemed rooked.
Fr^�s "CONSTRUCTION LENDING AGENCY '
'" lending
- -'
1 h by alrrm that the -onsw t o I ding agency forthe performance'
Wof the xviark for which this .it is caureal(Sec 3097Cts.C)
Q Lendee s Name -
n' Lender's Address
�. Z .. l
_ V1 candy that I have read this appllemion and state that the above information is
ti E. 'cones, 1 agree to comply with all city and county ordinances and state laws relating
O.0 tobuildm9construction.and hereby mobonie¢ptesenmtives ofthiserty menterupon
;,.'.w the above mentioned property for inspection purposes.,,
1 1 We)igree w save.Indentnlfy and keep harmless the City of Cupcelno against
F-Vyliabilities,judgments,cases and expenaa which may in any way Saranac against said
U.Z cayin conmquenc h°gmming of this permit.
APPLICANTU RS ANDSAND WILL COMPLY WITH ALL�NfJf�'POINT/" ]SSUedb Date
SOURCE RE ATI 'S: Yn44 IK 7 +/'�(�p/A/ y'
signmureo c "Date -/ Re-roofs
HAUsRDOUS MATERIALS DISCLOSURE - \ ,p
` W11thcupplicantorfuturctu'ildingoccupotswmorhandlehavudouzmatedal Type of Roof '!. .b - - e----- - - %-"as defined by the Cupertino Municipal Code.Chapter 9.12.and the Health and Safety
Code.Section 255320
0 l " j i All roofs shall be.mspected prior to any roofing-material being installed. ...-.. ,.
Will the applicant.ofuture ba ld' gmmpant use aq 'p devices which If a roof is installed without first obtaining an inspection; Pagree tri remove
�•
emir b'uNo s air contaminants as defned by the Boy Arca Air Quality Management ...
District. all new materials for inspection. Applicant understands and will comply with
l�• "� pYn b - ❑yo r I ,` I all non-point source regulations: .,
V, 1 have mod'the havMous materials requimmenu under Chapter 6.95 of the
Califomia Hcalth&Safety Code,Sections 25505.25537 and 25534.1 understand that e _
if the building does not currently have atenant,that it is my.rcsponsibil ity to notify the ` I , t� jfir/i-ap /
oar pant of the 'cots which must be met p' r to ssuantt of n Ccnificate'af I+�
`°p°"`y' ��CV/ Sign re of Applicant Date
owmr or Dal aa-cn� Date, , All roof coverings to be Class"B"or better
n`. - - r OFFICE
i' 'a .. ..
ap-0
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
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 1/4" 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 policy on reroofing and will comply with this policy.
Homeowners Name: / � 7 r-a- `—
Address: y� `✓� /rJ eo S�5( �
.07
Reroofing Company Name: / — v
Applicants Signature ilr���//E Date: S —�
Joe Antonucci
(Chief Building Official)
6/25/01