02040001.. .. _. OFFICE.
CITY OF CUPERTINO
- BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
BUILDING ADDRESS:
PERMIT NO.
20065 STEVENS CREEK BLVD
SIMON SAYS ROOFING
02040001
OWNER'S NAME:
APPLICATION SUB DATE
ARBOR PROFESS.
2737 OPHELIA AVE
04/01/2002
PHONE:
SANITARY NO. CONTROL NO.
(408)531-9700
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ARCHITEC MNGINEER:
BUILDING PERMIT INFO
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LICENSED CONTRACTOR'S DECLARATION
Job Description
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I hereby aRsm that I am licensed under provisions of Chapter 9 (commencing
7")af oiwamn 3anhe Busm�ye.}amad Pmassmmead dmyfieensc
REROOF.
w;da Sectie
ne
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T/0 TAR & GRAVEL, APPLY TORCH -
DOWN -COAT ELASTOMERIC.
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ARCHITECTS A N
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1 understand my plans shell he sea as rublic records
pLicensed
Professional
R
RATION
OWNER -exempt
1 M1cmby alnw thin 1 from the License law for the
aurin from the Coruna
Co
1 Profcssiom Code: Any city
followingreason.(section 70315. Business andImprove,
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structure
which requires a perms to consumer, alter improve, tlemolish, or repair any swmurt
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.pnato its iseark!palsorm Btaoaiaw(Chenem
the meapplicant for
f ,S Ft Floor Area. n•p
�'�.)�'�
$656( ation
Conrewiuo
to Liacnseiaw(CM1apter9
(<ommntcing with Section,7(100)of Dlvision3of the Business Professions Code)
(emim islicei w ilh Sinumnp00)of provisionsofof he
and
or that be is exempt therefrom and the basis for the alleged eiemp amn Any violation
i!t -3k9 kt..;L4 et`�::'i,: Lt,!�vf;N,i (U"t,•
of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty
•nr no�moro than E,ehandred douars l5soo),
316�i %nb8'b
i„'r,;r :Occupancy Type
❑ 1, as owner of the pmioxm , or my employees with wages as their sole compensation.
-will do the walk, and 'the snuemre' is not intended or'offered 'for sale (Sec. 76t4�
' Busimas' and' Professions Code: The Contractor's License law does not apply to an
- - -'
305 - FRAME Required Inspections'
ownc r of property Who Wilds or improve thereon, and who does such work himself
-
307 - INSULATION
darough his own employees. bund. mat such improvements an not intended or
of improvement n sold within year or
comptl for sale. IL howuilde twell lave
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-
601 - ROOF TEAR OFF "
t of Prov not
compmtian, the owner -builder will have the burden of proving that he did not bane or
completion,
improve for purpose ser star.).
602 - ROOF PLYWOOD NAIL
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O L an. onaocting to
me p(Sec.
.-
603- = -ROOF BATTENS -ol'I-: ' � •� '
-
7 Business an ns Coda) The Contractor's
construct me projar (Sec. 7B1J, Business arta Professions code:) The camm.or's
the.po
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unarm law tra not apply roan owner of property who Wilds nr improve anon,
604 - ROOF IN -PROGRESS''
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t ,
wida e.canuactor(s).littnxd punuam.m.N<
.aod.who contracts fLaw,.,.I
.-._....
_
Ijecu
C 1 a. axes License Law.,.,
❑lam exempt under, See. ,BAPC for this rwson
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Owns/ �, d Date'.
WORKER'S COMPENSATION DECLARATION
FI�, eALE®
1 hereby afren under Penalty of perjury one of the following declarations:
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0 1 have and will maintnin a Cetifcaic of Consent to self -insure for Workers
Compensation. as Provided far by section 3700 of the labor Code, roe the
APR 0 8 2002
perfomunee of me work for which this pewit is issued.
❑ I have ons will maintain Worker's Compensation Insurance, as required by section
3700 of the Labor Code, for the peifowance of the work. for which this peemit'is
BUILDING
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issued. My Workers Compensation Insurance carrier and Policy number are
SD
'i %CATION
s-s+:••Ia°� kC•-di �. 1JYn �''t._i 1�}�'.
CE OF?E%EMPT FROM
r COMPENSATION INSURANCE,_:'_-['
wT
phis section need not hecomplcad if the pewit is for one hundred dollars
(SI00)or less.)
1 c nif, that in the perf - a c of';he woik foi which the pewit s rcsucd' I
shall not employ any peon to any manned o os m become sub)em to the Workers
Compensation Laws of California. Data
icant
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g <mifce. of Exemption, you should_
NOTICE TO APPLICANT. If: after ..king his
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bciromc'subjecno she Worker's Compensation provisions of the Labor Code, you must
forthwith comply with such provisions or this pewit shall be deemed rooked.
''".i"••: • CONSTRUCTION LENDING AGENCY
"'I I hereby affiim that mere is a conswctidn lending agency for the perfowanca
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of the work for which thispe 't issued (Seo 3097 Civ. C )
Lend r Name - . s.., •-
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1 n fy Our I have ad N application and sum Nab me oho information rs
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code. I grt to comply da all ray and county, ordinances and state laws relating
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to W ddmg cormwa;on. and heritiy audaonae representatives of dais coy t° anter upon
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the about-memioncd property for inspection purposes. ,
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(We) agree m save. indemnity and keep harmless the City of Cupertino against
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liabilities. Iudgmeme, co H end expenses hick y any y against said
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City nc 9oence of g i gg��f inis Permit.
D AN6 WILL COMPLY WyTH ALL NON POINT
Issued by: Date
$O tiEGU ON
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ars^^sags subcontractor - """` Data
Re -roofs
HAZARDOUS MATERIALS DISCLOSURE
W'll me applicant f tare Wilding °ecu t arae m handle hbsatedo es matansl
Type of Roof_-
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az d f ned by the Cupertino Municipal Code Chapter9.12. and me Health and Safety
care.,OcYes'15532(el
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_ All roofs shall be inspected,pnor io any.roofing material being installed. _ .....
Will m npphe t r wumbaialnsnc<a �use�gap t ate' wnien
If a roof is installedlWithout first obtaining an inspection; I agree'to'remove
emir M1assrdouaair contammanrs as defined by the Bay Arra Air Quality Management
Diatom
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teria for' ectieQ. Applicant understands and will comply -with
a lotions.calsetyCe5533a4.unstandihh,
&allwterials
- da&SafetyCad 'S raxant.
and L553a 1 it d t rad thatren
d o snotcu tewm that r s tay apo s b l ry r the
th t itis
theft
ecru At of a rtgdim on beset poor; to rssuencc °fe Ccn Teem of
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Signatu of Applicant Date
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All roof coverings to be Class "B” or better
o„am time
.. .. _. OFFICE.
L
•
z CITY OF
CUPEkTINO
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
i,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) Preinspectioh 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/a" 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: F-rA(iK /J i I hAz-.�
Reroofing Company
Applicants Signature:
Joe Antonucci
(Chief Building Official)
6/25/01