01020094 CITY BUILDING
O 'CUPER'PNNO
I \ PERMIT CONTRACTOR INFORMATION:
BUILDINO ADDRESS: PERMIT NO.
j
OWNER'S NAM[:^ APPLICATION SUB DATE
PfONE: SANITARY NO. CONTROL NO.
c c
❑• O ARCHII ECgENGINEER - — BUILDING I'F.Rhtl'1'INFO
z BLDG ELECT PLUMB MECH
y« u
5 y L1cf3NsliUco aINTRACrOR•s D1[a.nlann°N Job Description
0 Z_, hervny nfftnn that I um licensed carter provi.,ams of Chapter 9(aamrradia, P
t,
at with Station 700)(Bof Division 3 ofthc Broinc,and Profemions Coda,and my license
< u'In Tull home an Ih a.
s Dare e °" "�Z�$ TEAR OFF 8 DISPOSE EXISTING COMPOSITIO
DamcdranacmtlZs�
O las, haT[CT'SDF,CLA A I APPLY NEW TAR & GRAVEL ROOF
g 1 nwenntntl;may plmn,haL la rued a,panic redraw.
i�p O Lmemed 1'fnlesuanel
w=a. OWNER BUILDPR DECLAIdAT10N
III I hereby ofli,m that I am exempt from the Contractor's Licen.w Law for the
Z.1 following reason.(Section 7011.1.Buxinms and Prolbs,ions Code:Any city or county
zt o which requires a I cracil m lorelo a,al¢r,improve,een,olinh,or repan:n y"manse
ed prion,I its issuance.also requires the vprlicam lot such permit o Bleu signedsmtnncrn
'hem he is licensed puron,,We pin11mclool'he Cn ancon'v License U.(Chapler 9 S FL Floor Area
(commencing with Station 7000,of Division 3 of the Business and Profession,Court 4 Valuation
or Thal he is cxempn Were l'min and the basis for the alleged clonni ion.Any violation
lir Semon 7131.5 by any applicant for a felt subjects the applicant ,,a civil penalty
,it act mom than five andred million;(S500), I APN Number Occuptn'
Y7PA
❑L downer lir the nd the structure,lir my enspmyccs with dupe, a their note 1,(See vatinn.
will ne the dark,and the deFitClint intended en offered for sale(See fit a
Business and cf,W ran,Build—,
ino owe,0 o a Lifeline r,doe o h s apply ra an Required Inspections
mrofprogeny em Imamlirividedtatsuch and ve aresseenwinkndedor 37541025
ol ed for
his own em,cnec t.provided that such itnpraveis sol are Trot Pon year or
ffecompletion,
rnr sale.If,however. will
l have
t or all of
ftplay n slim within nne year of
hcmonefa,thnnwmr-ImaaerwLlnavemenardamnfpmdngthamneaianntbntiler, 305 — FRAME
npnme for pnrpn,c m,wed.
13 1.as owner of the propcnI,am aduslod,Cannxting with licensed emarra oto 307 — INSULATION
natural the project(Sec.7044,Business and Pmfe„ions Code:)the Contractor',
,natural Law doI not apply In an owner lir rmpenywon mrd,or impmvc,Werem,. 601. — ROOF TEAR OFF
and who contracts rat such projects with a eonmactorho licensed product to the
Contractors Llan,Law. 602 — ROOF PLYWOOD NAIL
❑1art exemplunder St 1,RP,mad,i,reason 603 — ROOF BATTENS
Dwtm` Dat°
WORRL'MS COMPI6N$rYnDN DECLARATION 604 — ROOF IN—PROGRESS
I hereby alarm all penahy lir prlury one of the following declamlinn.s:
l 1 have and will maintain a Conifrne of Consent to eelf-ino re for Worker',
anpcasalion. as provided for by Section 3700 of the Leber Cam, far the
umonance 9f me work ln iwhim his pern,n i,mated,
❑1 have and will nwin lin Wnrkc,',Compensation[.,.mace,re fequired by Section
3700 of the Labor Cole,for the perGmnanre of the work fur which this pomdl i,
sued.My Worker's Cnmpenmtion Insurance carrier and Policy number arc:
C:uner._V-1�gnQy�l'olicy TIO:(RC 1.////'.'j7/q�
CER'llf9CA'110;N OIEX6MImON FROh lOtjljEl•.��y0
COMPENSATION INSURANCE
alai.,xtclion need ant to rmalleted if the permit is hate,hundred dinar, -
ISIBB)oflessJ
I n•rd y tom in the Peftlnmmla of the work for which this permit is issued.I
shall not employ any person in any manner of as to Monnm suhiect u,the Workers _
Cont"oution Law,of California.Date
Applicant
NurICE'IO APPLICANT:If,lifter making this Cmiftcam of lixemption,you should
7 necn;nesubject it,the workers Cmnpensadna provisions of the ladwr Cot you must
QO forthwith comply with.such Pawisinn,"I Ilii,pencil shall bre dcenmcd rcvokcd.
CONSTRUCTION LENDING AGENCY
I hereby aflimm that them is a ro loorction trading agency for the perfmlnance
W of the work fns wh act leis permit is i,sued(Sec.3017.Ci,C.l
0. a Lcoder's Name
Z 1<ndcr's Address
t*+ O
cancel,
that l have mad this application and state that the shove of...nation.,
F” cm.I agree to comply with all city and county ordinances and state laws relating
O [J m budding amswamicandherel,amlmon.e remT,cmatme,of this city to enter upon
} :i7 the ubtme-mentioned pmperry for inspection p.,,,cs.
[.. 4
(We)aprccrosuve,indemnify and keep hurmlc,,the City of Cureninoagainst
70T liabilities judgments,cto s and expenws which may in ally stay action against said
'Z, City in consequence of Ne gmmingof this commit.
APPIACAW NUS AND WILL COMPLY WITH ALL NON-POINT'
SOURCE REGULATIONS, Issued by: Date
Signature of APPLamUrCnm;iclnr Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSBRE
Wullheappecatnm mrtmildingt cupannlnmt)rhandichw, cm,mnata;aI Type of Roof
a,defined by rho 32(a)f nn, c pal Cole.Chupler 9.12 mad the Health at Sold,
Cade.Sation 25533fa)'! mai 1
13Y" 'l No All roofs shall be inspected prior to any roofing material being installed.
Will the appreantor tnmm building occupant use equipment lir devices which If a roof is installed without first obtaining an inspection, 1 agree to remove
emit haraudou,ai.conaumnWau as ddinnl by Inc ltny Arcu Nr Quwuy Manvgemenl g p
Dolce° all new materials for ins ection. A Meant understands and will comply with
°Y" N" all non-point source regulations. PP
I If.,.read the mourdous matcriws requirement,under Chapter 6.95 of the
all formal I Irtltb k Safety Code,Sections 25505.25533 and 25534.1 undewtand that
if the Mail dmgdoes not quirmentscurrently hich msthave a an met it ie raysuance bilirymnoti lythe ✓/J�/q /��
Oeeuarae sf the requirements which mull an met prior m issuance or a CmiB=att of
v ' Signature of Applicant Date
owner cur amm.n.<a ag=nI Dale All roof coverings to be Class "B"or better
OFFICE
Building Division
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: (408)777-3228
4tCITY OF Fax: (408)777-3333
-'UPEkTIN0
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.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: ZCAY k '2r01 Env-e✓
Address: (p 2_(O2) 5hridV1 G Y(Ne L+- • C U l2fY fi n(I
Reroofing Company Name: ResPnos1 ble K(XI-T-Inq =Y)C -
Applicants Signature:
Joe Antonucci
S (Chief Building Official)
6/13/00