02100054 CITY OF CUPEWHNO ".1, '> «•a----- •-
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
nuB119(90319ESTWILIGHT CT PERM]rN®2100054
OwRUNMLA LOUIS A AND SUSAN W APPLICATIyVylYTY2002
I IONH. SANITARY NO. CONTROL NO.
ARC(IDT:CflENGINHER: BUILDING PERMIT INFO
PLUG EL[CT PLUMB MECH
0 0 0 0
O�itpp LICENSED CONTRACTOR'S DECLARATION ee$$
1 hereby affirm that I am licensed under provisions of Chapter 9(commencing
C< won Sectii
5070 EOf Division Sof the BOsmesrand PrOrzs.inn,Code.am roy heene is
ZO} REROOF �V
In to llforceandelleet. ,y
f= License Class Lic.N��J
o=-o Dae 0n. Conlmnr'r
ARCHFFECPS DECLARATION NOV 0 5 2002
K aSy a 1 understand my plans shall be used as public records
OPV
�3LL�
Liceroadprofexanna' BUILDING
c,1 S OWNER-BUILDER DECLARATION
<x hereby alli m that 1 am exempt from the contractor's License haw fm Inc $6900
w_00 following reason.(Section 7131.5,nosiness and Ptdes.sions Cods:Any city or county
°'K 2 e� which requires a permit fit construct,alter.improve,demolish.Or repair any structure
prior to its issuance,also requires the applicant lie such Permit f)file a signed stmemem
�?< that he is licensed pursuant ha no,prnvivnmof the Coomacto",License l.aw(Chapter9 3S46I31RDD2)8AIQ9 Valuation
(commencing with Seclion70i of Division 3 nfthe Busiamcand Professions GMe)or
y 3$ Nat he is exempt therefrom and Ne has§for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of -3 U)MIMENWE Occupancy Type
not more than five hundred dollars(951gy 3 07 — INSULATION
1,as owner of the properly.or my employees with wages ss their rule compensation,
will do the work,and the structure is not intended or offered for ade(Sec.7(144.Business gp,µ� gpg
and Professions Code:The Contractor's License law does not apply to an owner of 602 — ROOF P S 1V V n yyyclrns
property who builds o mgUUA,s thereon,and who does such work himself or Omagh his
Own employees,provided that such inprowmen,are not intended or offered for sale.If. 603 — ROOF BATTENS
however,Ne building or improvement is sold within one year of completion,the Owner- 6O4 — ROOF IN-PROGRESS
builder will have the burden of proving Nat he did not build or improve for purpose of
sale.).
1,as owner of the property.am exclusively contracting with licensed contractors n
conrtnet the project(Sec.704,1.Business and Polesnims Cnde:)T he Contractor's Li-
cense law docs not apply to an owner of properly who builds Of improves thereon,and
who comment for such projects with a contractors)licensed pursuant to the Contranm's
License Law.
❑1 am exempt under sec. .B&P C for this reason
Owncf, Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 haw and will maintain a Certificate of Consent to self-insum for Worker'a Conpcn- -
smion,as p...vlded for by Section 3700 Of the lahnr Code.fill the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Warkcr's Compensation Insurance,as required by section
3701 of the labor Cole,for the parinfmancc of the work for which this permit is issued.
My/Worker'.sICo--m11pen�sation Insurance'carrier and Policy number art: __ ll
Carier:.s-h"i^`G l .,,A Policy Nn:YS-5;-19 —ca
CERTIFI ATE OF EX EM MON FROM WORKERS'
COMPENSATION INSURANCE
((Tis section need nm be completed if No NMit is foronc hundred d(Illvs($Ig)
or less.)
1 cenify Nat in the perlormance if the work for which this Permit is issued.I shall nil
employ any Person in any manner so as in M1cemae subject In the Workers'Compensation
Laws of California.Dare
Applicant
NOTICE TO APPLICANT:IL afire making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions or the Labor Code,you must
C Z forthwith comply with such provisions or this permit shall be deemed revoked.
Z O^ CONSTRUCTION LENDING AGENCY
PI hereby affirm Nal there is a construction lending agency lfir the performance of
a Ne work Iof which this Permit is issued(Sec.3107,Civ.C.)
ft1 0 Lcndef5 Name
U Z 1<ndc' Address
V Q 1 cenify Nat I have mad his application end start that the above information is
LL F come".l agree to comply with all city and county urdinmces and stale laws relating to
0 U building constrtclion,and hereby authorim representatives Of Nis city to enter upon the
r above-mentioned potbelly for inspection purposes.
0. (We)g me ls,save,indemnify and keep harmless w you Of against
against ^�
UZ inconsegjudgme ueacc of the cnaand granting of thisexpenses
mit. may inany wayaccrue egamn said City / /� /•J-- ,\
r APPLICANT UNDERST US AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUEGO TION .
-L Re-roofs
namrc of pelican n ac r
Data
AZARDOUS MATERIALS DISCLOSURE Type of Roof
Will We applicant or future building occupant store Or handle harardnus material
as defined by the Cuper in,Municipal Cole Chapter 9.12,and the Health and Safety -
.Udk,Section 2553200? All roofs shall be inspected prior to any roofing material being installed.
❑Ycs Nu
Will thea scant of future building Occupant use equipment rot devices which If a roof is installed without firs[obtaining an inspection,I agree to remove
PP g pan aAir
Dmil ie,? us lar atma is as dclincJ by the Bay Arca Air Quality Management all new materials for inspection.
isldcl't
❑Yes �Nm
I have read the Inardous mawrialsnyuirements under Chapter 6.95 of the Califon a
nia lle.)O&SafctyCock,Savour 25515.25533 it 255U.IundersmnJ that Indic building �7_ d2
does not currently have a tenant that it is my resixtnsihility to notify the acupant of Nc
myuiremon which must .w kauance ofd curifica¢of acupaney. (gnat ,df Ap ican Date
0—o 0
fm demo sed age Date All roof coverings to he Class "B" or better
BuRding Division
10300 Torre Avenue
4 Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY 0 Fax: (408)777-3333
.CUPEkTINO
Building Deparitment
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 Y"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: ..Sid.S~u�n Ru�Fv l a 2 a\,N a all CG Y f J 1 1
Address: I g q 6 9
Reroofing Company Name: 06k 4 J a(I'(1 I? C" , F Ci
Applicants Signature: Date: 10— 07_ o °L
Joe Antonucci
(Chief Building Official)
6MI01