011200491!'
CITikuiroFNCUOPERoNNO
PERMIT
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CONTRACTOR INFORMATION:
B"T'" 'tANTA LUCIA RD
PERMIT No. 01120049
°N1�7AIC MILADIN AND DARINKA
npiiA�l�"Zp�dF01
ONE:
SANITARY NO. CONTROL NO.
Z ARCHITEC )ENGINEER:
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BUILDING PERMIT INFO
BLDG ELECT PLUMB SUCH
Z LICENSED CONTRACTOR'S DECLARATION
Description
❑ IherebyaffitmthaIn. licensed under provisions ofChapter 9(commencing
ROOF REPLACEMErh'
ad with Section 7000] of Division 3 of the Business °nd Professions Co ld. and any license
ism full force and effect.
u License Class Licb
Date Contractor
N ARCHITECT'S DECLARATION
1 understand my plans shall be used .s public records
pLicensed Professional
OWNER -BUILDER DECLARATION
h 1 hereby affirm Not 1 am exempt from the Cmtmcior's License Law for thefollow
$400
Business and Professions Cost dc: Any city or county
guiresa
whichecaii°n]o31.S.
❑ wit ch requires perm t to construct,h improve, sit or repair any
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poo t tissuance,aur bath ba such er parrot flank signed statement
such
h parr
t pp p p-
- ,3 )517)31®orrA",
Va]Uan00
- thatho'is 1 licensed su'-notit Provisions of the License Law (Chapmr9
It
(commending is of do, Basins, and Code)
Saudn](IDB)ofhe
r
em basiniofthednandimn. A., vi
or thin he is exempt Nerc(mm add the basis for the alleged Gumption. Any
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by any applicant fora permit subjects the vpplicanno v civil pcnvhy
subjects the l Penalty
of Section e than
°rnot mnrethanrive nnnarcaandarstasooj.
30APNNQRB'dE
•- Occupancy Type
❑La4nwnernrmepropny,nrmrempinyee.witnwagesaatheh:oleoompnmdnm.
307 - INSULATION
— U ns ections '
will do the work. and the structure is not intended or offered for sale Sec. 1044,
Business and Professions Code: The Contractor's License Law does not apply to an
owner of propmy Who builds or improve, thereon, and who does such work himself
602 - ROOF PLYWOOD NAIL
or throughhs plyep aidtht mh'p t nmetdd or
ofrred for sale. Ira the building "p t is r
eomplt p b m "un thnMe fp in in bQfgor
improve for t rq. of sale.).
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1! -P OGRESS
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er I �h 0 pe tYran ex0ti'd,ey kniraoir, 'tl I' rad commoor.o,•.
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constract me project Is . 7044 Business and Professions cod xThCd t d,o s
II
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Lie La does t apply I of property x perno bu Id t P Nc ,�
.and who conman forsuch projects with a contracmr(s) 1 p o t to then,
Contractor's License Law, -
_ ❑Inn ex pt rSea ,B&nsil5s.a
..
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Owner Date I1^
-
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under petmlty of perjury one of the following declarations'.
° 1 have and will maintain a Cenificam of Consent to self -insure for Worker's
Compensation, for by Section 3700 Labor Code, for
as provided of the the
performance of the work for which this peemit is issued.
° I have and "will mannain Worker'aCompen,rima Insurance, as require) by Section
J
3100 of the Labor Code, for the performance of me work for which this permit is
- issued. My Workers Compensation Insurance canter and Poly number ac: '
/
CanmT - ` Policy Nu
" CERTIFICATION OF,EKEMPTION FROM WORKERS' -
-
_ -' COMPENSATION INSURANCE
(Thi section need the mpleted if the permit is forone hundred dollars
(5100) les)
/
t, I cedify that in me pI';Eirmandd of the k for which 1Fs Perini is issued, 1
-,
shall not employ any dram y manner an as to becomeubject to the Workers'
/
.subject
Compe setion Laws of, fore a. Data
Appl cant
-
NOTICE TOAPPLICANT If after making this Certificate of Exemption, you should
'became subject m the W rks, Compensmt n p...isms, of to I - to Code you must
forthwith comply with such provisions or thrs permit shall be deemed revoked.
•' CONSTRUCTION LENDING AGENCY
-1 hereby nffihn that there is a doomiction lending agency for the performance.
11YA
i of the wort for which this permit is issued (sec. 3097, Cls. C)
/n
V
Q -Lender's Niiii
-
� Lender's Address
1 cenify that I have read this application and state that the above information is
lcorrect.
I agree to comply with all city and county ordinances and state laws relating
to amctionpze eposemativesmRhis city to enter upon
the ntioned pro,and
for inspection
for
aturiie-meng
nbovWe) tig uned propcny purposes.
6 y
(We) agree to save, indemnify and keep harmless the City of Cupertino against
/l liabilities, judgments, costs and expenses which may in any way amine against saidCit
in It.
the mmin6'D
LlConsegUNct tsTANof
'AI'y q'tlsC MPLY N'I'1'H ALL NON.POIN'T
"g
Issued by: Date
gnamm of Appl at/Coommun, Data
Re -roofs
• Ii HAZARDOUS MATERIALS DISCLOSURE
" wiRth applicant or future building occupant store or handle hezurdous material
Type of ROOF
as def d bythe Cupertino Af id a] Code Chapter 9.12, and the Health and Safety
Cod Sutton 25532(.) t\.J�(/`
'-
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All.roofs shall be inspected prior.to.any roofing material being installed.
Will the applicant orfnmre building(acnpant use equipment ordevides which
If a roof is installed' without first obtaining an inspection,'I agree to remove
if hazardous air contaminants as defined by the Be, Area Air Quality Management
istrien
all new materials for inspection. Applicant understands and will comply with
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all non -point source regulations. ,
1 have read the hazard in requitcmemsorder Chnprer 6.95 o he
Cellfomie Heahh&Safety Code,Sections 25505,25533 and 25534.1 understand tit
ihhebuilding noes not currently haveemnant.Nat it is my the
n w� /I'` /1_
y�`!
/
responsibilitymnotify
or ant of the requirements which, must be met poor to issuance of a Cenificam of
_ /p_
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Signature of Applicant Date
.. .. .. .. ...
All roof coverings to be Class "B" or better
Owner nr,mmadaea again' Dam
OFFICE . ... _..
+ �t
CITY OF
CUPERTINO
Building Division
10300 Torre 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 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:
Address:
Reroofing Company
Applicants
Joe Antonucci
(Chief Building Official)
R4L-
6/25/01