02100161 CITY OF CUBE R'PINO
BUILDING DIVISION PERMIT CONTRACTORINFORMATION '
Y2's.
Bulr1)GSA1)@UlSSANTA TERESA DR KNIGHT ROOFING CO PERMITN02100161
owiTOAANN:E LIU 42035 OSGOOD RD APPLICATIPV}73TY 2002
Ank
IF'TONE: 5104389077 SANITARY NO. CONTROL NO.
ARCIIITECI'/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB M[CII
w00 LICENSI3D CONTRACTOR'S DECLARATION
Hop Ihereby affirm that lamlicensed under provisions ofChapter 9fmmmbeing REROOF �0� enption
Z� with Scelinn]IXMI)nl Division Jrl lhr Bunincss and Pndceainns Gdc.and mylire is
in ifull Bo me and effect., `]y�'7SS DL U'6 2002
Z O'aZ Date CClass L'3S Cont C
OZ— IAm !r.'Z7 Cnn DELL-
F I:yCy t��s ARCITITT:CrS DECLARATI N
0y 1undcraanJ my Plana shall beueeJ ax Public records �������
n3`Q
FLLog Licemcd Professional
OWNER BUILDER DECLARATION
1 hereby affirm that I am exempt firm the Contractor c License Law Int the 6
w @_
00 following rcamn.(Section 703.5.Businexs and Professions Cole:Any city of county
$10300
n M which mquir a Permit(u construo.alter,improve,demolish,or repair any.drucfum
ac�wi< priorto its issuance.also requires theapplumin forsuch permit file ar,madmummcnt
lFthat he is licensed pursuant In the provisions of theCunlracmr'sLicense Law(Chapter9 A6Ht3f0C AQ9 Valuation
wa (commencing with Section]IXXB of Division 3 of the Business and Promsxinns Code)or
y $ Nal he is exempt therefrom and the basis for me alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects theapplicant oacivil Penalty of 3 UAPNN Occupancy Type
not more than five hundred dollars($500). 307 - INSULATION
I3 I,as owner of the properly,or my employers with wages as their sole compensation.
will do the work,and the structure is not intended or offered for sale(Sec.]M6.Bulinus ��µr �D¢�,IM
and Professions Code:The Conlncmr's Liccnsc Law dors not apply to an owner of 602 - ROOF P W V n1Y Lns
property who builds or improves thereon,and whodues such work himself orlh ough his
can employers.provided that such improvements are not intended oroffered for sale.If, 603 — ROOF BATTENS
however.the building or improvement is sold within one year ofcrmpletina the owner. 604 - ROOF IN-PROGRESS '
builder will have the humbeer of moving that hr did not Wild or improve for pmpnae of
sale.).
❑1,as owner of the progeny,am exclusively contracting with licensed contractors to
cometrucl the Intact(Sea 70-94,Business and Professions Code:)The Convacmr's Li-
cease,Law Jces not apply to an owner of property who builds or improves thereon,and
who contracts for such projects with a carnations)licensed pursuant to the Commences
License Law.
❑I am exempt under Sec. .B&P C for this reason
OwnerDECLARDare
WORKER'S COMPENSATION ATION
I hereby affirm under Penalty of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent o self insure for Workers Com,coo
sate.,as prormvided for by Section 3700 of the labor Cale,fill the pedooom of the
work for which this permit is issued.
IX) o
have and will maintain Workers Compensation Insurance,m required by Section
.]Iof the Labor Code,f r the performance of the work for which this permil is iseued.
My Worker's C� �e (ionlnsumnce carrier and Policy number am:
Cartier: CFNM.- F.wd Polfcybm,out.-990071n-k-
CERTIPICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(lois section need not he completed if the Pd an is future hundred dollars($list)
less.)
I certify that in the pert mmance of the work for which this Permits iasucd.I shall not
employ any person in any manner m as to became subject m the Woskeri Compensation
Laws of California Date
Applicant
NOTICE TO APPLICANT:If,a@r making this Certificate of Exemption,you should
M1ecome subject to the Worker's Compensation provisions of the labor Cade,you must
Z forthwith comply with such Powia.m nr this pe an shall M deemed revoked.
z Ovl CONSTRUCTION LENDING AGENCY
[-. I hereby affirm tha there is a mnstructlon lending agency lonhe performance of
C47 the work for which Nis permit is issued(Sec.3097.Civ.C.)
W Q Laidcr's Name
7z
1<ndcra Addmss
V U I censtr that 1 have fest this application and antro that the sty to inter upon the W P coned.I agree nt comply with all city and county oNinances and sure laws relating to
V buildingconstruction.ion.anJ horohyaction prposettnutirss of this cirymemrr upon the
W uM1ovr-(Wel,agree
to ertysave lin emnify an keep liar
P. (Wc)agemcavo,indemnifyandkith harmless the City of Cutworm,id City
ret
liabilities,judgments,cnaeiand expcnxsnn which may in any wayaccsvc against mid City
V Z A APPLICANT
cc of DERST Nof lA pc WILL
�—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date v v
S?Ur
IONS.
Re-roofs
Signamrc of Applw.aYCmxrcIor Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupenine Municipal Code,Chapter 9.12,and the Ilcalth and Safety
Cade,Secdnn 25532001 All roofs shall be inspected prior to any roofing material being installed.
D Yea Orel.
IIf a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant m Lmm building occupant use equipment of devices which
'mil hamodous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
Diloict'f 5�
❑ nJ
Yes Nu
I have mad the hvmdous materials requirements under Chapter 6,95 of the Califor-
dinPerthASufdyCode,Sccdnns25505.25533anit25534,1uodccsmndthatiflbcbuilthng
does ren-rten0y have a tenant,not it is my res,oneilhility in notify(be occupant of an,
mqu, en w ;rhmnmWmet mmar,,maamrofaCenrfeateoil 0,cupamy. Signature of Applicant Date
to--a"" All roof coverings to be Class "B"or better
Owner or authorimJ agent Mac
I -
•
ij
daBO
�—�I4 �—Q� —
POCa--TP-s
ltJuts 14UdiCtC-10 , lu
aN 2--Pa 24
► a•kzio Oz
D
rP ,vIpci
Ju
Z 6
-7' �
I1N
� Z�t4 L4
0
a
IN ACCORDAPICE VJI-M IME CM1� �
CUPERTINO CODE` ANO ORDB �
N
-
SIGNED— — — crtis U
This set of plan, and spe
be kept on the job at all times and it is un
lawful to make any changes or altemdorrs
on saml`wlthout written permission from
the building Dept., City of Cupertino.
The stamPing of this plan and speciflcaf3bns
SHALL NOT be held to permit or to he on'
of the violation of any
Ip
proval provision
L/ �] ,f ordJJin//ante or state Law.
42035 Osgood Road•Fremont,CA 94539•Tel: (510)438-9077•Fax: (510)438-0604•License#755799
knighlroo(ing.com
Building Division
10300 Torre Avenue
" CuPMt no,CA 95014-3255
` Telephone: (408)777-3228
F= (408)777-3333
CUPEk INN
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
S. 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 2/4"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: Ws, LTJ
Address
Peroofmg Company Name: �CtiL'I
Applicants Signature: �/� Date: ' 2 3-oW-
Joe Antonucci
(Chief Building Official)
6125/01