02110026 CITY OF CUPERTINO 1 4 P. �" -W 4 r ;
BUILDING DIVISION PERMIT CONTRACTOR�INFORMATION
BU11913T'DISEPTEMBER DR STEVENSON ' S ROOFING °ERMITNf02110026
bwb@HMIM YUKI AND GEORGE T 10590 WUNDERLICH DR APPLICATITN1S UB 4V2002
[ONE: (650) 969-5134 SANITARY NO. / V / CONTROL NO,
I 11
ARCHITECTIENGINHER: BUILDING PERMIT INTO
RLOG ELECT PLUMB MECH
o o 0
WOOLICENSED COMRACTOR;S DECLARATION
e;U C 1 hereby affirm That I dm licensed under provisions of Chapter 9 Bomnarromg ROOF lob Description
aZw with Sect"io'"n"7'f'/p11ofDivisionJof the Buin.saint Pn fcomons Cods,and my liacn.
in loll(on.t�na yCI cl. // s1 '1YA�
JZ� ? License Cl 1.ie.x.(Q
�:O DwuQ ARC
£ �`^ CHITECTSSD DW
RATION DEC 2 0 2002 i
g 9 of 1 understand my plo msnM all used as public recordsa. DLE; /,l L
Oyu
330'x' Licensed Professional
C a l y a OW NIam exemptifr DECLARATION BUILDING
$13000
I often firm Indt I dm exempt from InC Cltn VdL'I11Is I.I L'CnSC law,(nr 111C y��
no folluwing recon.(Section 70115.Business and Professions Code:Any city or county
which requires a pe.I,to construct.also,improve,demolish,oT repair any.aruclure
prior to its issuance.also requires the applicant for such Permit
like a.signed statement
.Z'< thalncisliccnscJpuesuanut)theprovisionsattheContractor',sLicenseLaw(Chapter9 33 bM4 015A00Z Valuation
p_O (commencing with Section 7000)of Division 3 of the Busincsxand Professions Code)or
it,3$ that he is exempt therefrom and he basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil Penalty of 3 U.41"N-NEMPE Occupancy Type
not more than five hundred dollars es m). 307 - INSULATION
I,as owner of the properly.or my cntployecs with wages as thciT sole compensation.
will do the work,and the structure is not intended or offered for sale(See.70,14,Business — �R
and Professions Code:The Comae,.,.License taw does not apply m an owner of 602 — ROOF P Y W V nSlaCCt Lns
property who builds or improves thereon,and who docs such work himself m Ihruugh his 1VF11
own employees,provided that such improvements am not intended or offered for sale.if, 603 — ROOF BATTENS
however,the building or improvement is sold within one year of completion.0.mown 604 — ROOF IN-PROGRESS
builder will have the burden of proving that he did not build or improve for pons.of
sal.).
❑ 1,as mvner of the property,a exclusively contracting with licensed conn ears 0)
construct the project(Sec.7611.Business and Professions Code:)The Conuacim's Li.
cense Law docs not apply m an owner of property who builds or mom ne theryr�nn,and
who Contracts for such projects with a conmactor(s)liermed pursuant to the C.a Lot's
License Law. I
I am CaemPL under Sec. ,B&PC for thi caon
OwnerDECLARDam N
WORKER'S COMPENSATION ATION
1 hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a Celli frldr of Consent to sclGinsum for Worker's Con pen-
slinn,a provided for by Section 3700 of the labor Code,lits the performance of the
work for which this permit is issued,
1 have said will maintain Worker's Compensation Insurance.as required bylSection
37k)of the labor Cale.for be performance of the work for hic this permit is issued.
My Worker's Com pen alto s ranee carrier and Policy
CERTIFICATEOp EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Thisxemitm median M completed office permit is for one hundred dollars(SII)0)
less.)
I certify that in the Performance of the work for which this permit is issued.I shall not
employ any Persian in any manner m as to Nommic subject o the WorkersCompensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:11.after maMng this Ccnirirmc of Lumption,you should
Mcnme subject to the Worker's Compensation provisions of the Labor Calc,you must
0Z forthwith comply with such Provisions or this permit shall be deemed revoked.
z O CONSTRUCTION LENDING AGENCY
t.. p l hereby affirm that there is a conswaion lending agency tial the performance of
1% 7 the work for which this perm it is issued(See.3097.Civ.C.)
(a]Q Lender's Name
z lender's Address I'
(�(] 1 evol y that l have read this application and sum that the above infoIlnumom is
H correct,1 agree to comply with all city and county ordinances and state laws relating to
0U building eonamclion,and hereby authorial representatives of his city to cite,spun the
1.[2 above mentioned property for inspection purposes.
F0. (We)agalc to save,indemnify and keep narmlcu the City of Cupenimt against 1/
N Iiti illlies.judgments,cosu and expenses which may in any way acme'o,inatsaid City Gf/
U Z in consequence of the granting of this permit.
.-o APPLICANT UND' 'AND WILT.COMPLY WITII ALL NONPOINTIssued by: Date
SOURCEREG
Re-roofs
sisnal°"" A°°t " a,;i type of Roof
.ARDOUSMAn,ove.Ststme Sandi yp
Willed Cupertino Mantriuture pal Co tee Capt r912.and the
bmalth an a cly
a JCBneJ by the Cupertino Municipal Code,Chapter 9,12,and the llcalth unjl Safely
Cortes Section 25532ho? All roofs shall be inspected prior to any roofing material being installed.
❑Yes t I
If a roof is in twining an inspection, 1 agree to remove
Will the applicant if future building Occupant use equipment or devices which
mit na,.amons tar contaminants as defined ray the Bay Area Air Quality Management all new .t c S for inspection.
District? ���ttt
❑Ycx y1Nn
I have mad , ` ricks pelf uitomenss under Chaplerh.95 ofthe Calif or- j
n iolfcaldt d I _, t3LIM255J4.lundccaanJthin if lhc'huilJing
does not u y hale n o .Nat"i.my sponsibikity m ratify IM tecupanl of the
mqu' 'whirl n but i>u. CofaccoilicauctQTkcupnn'— gra r p leant _ Da e
\J/_I m All roof coverings to be Class"B" or better
bac
Building Division
' 10300 Torre Avenue
Cupertino,CA 95014-3255
` Telephone: (408)777-3228
Fax: (408)777-3333
CUPEkTINO
Building Deparibnent
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 VV per foot slope and demonstrate that
there is no ponding.
2. An LC.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.
HomeownersName: L
Address: 93,'4 Q2e- ,..lam �2t 9sz?i5Z
Reroofing Company Name-
Applicants Signature: Date: —
Joe Antonucci
(Chief Building Official)
6/25/01