02090163 CIBUILOF
NG DIVIiSIO NOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22164 VIA CAMINO CT SECURITY ROOFING INC 02090163
W NAME: APPLICATION SUB D9TE
& JO ANN KOENING 406 EL CAMINO REAL 09/24/ 2002
PHONE: 650) 595-1213 SANITARY NO. CONTROL NO.
(
O O ARCHITECT/ENGINEER: 4 BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
a i W T—I 1=J
Tata
LICENSED CONTRACTOR'S DECLARATION
rO14LC Iherebyaffirmmat1nmlicensedunder dprofsofChapter nsCode9(commencing Job Description
F=t with Section](AO)of Division 3 of the Buziis
nd professions Cod=.and my license REROOF (� /q p �s��
=z a 6 Le.(opf; eff i. Liw# y�O y g-14
9=D p V A Cm 1E:.rfcdJ'
3u. at O� ARCHITECI"S BEpCARATION OCTO 2002 I OCrss mY shall as public recoNs
W tt p O Liccncd P so...I
n a nlI OWNER-BUILDE DECLARATION
I thenky affirm that I am exempt from the Contractor's License Law for she BUILDING
I 1 t 1L®�I:YI/�
r z a following mason.(Section 9831.5.Business and ProB U Profession Code:Any city or county t V G $13900
y D which acquires is para ism construct,alar,improve,demolish,or repair any suumure
ca3es poor to am issuance.also q the ppltf ch permit rile a signed statement,
t4a]a WR ata s¢the piu'sio s fele Convacmf 13 Wwum,Co e) A p 1p �rLL ,t Valuation
(cm ncnglwith Seca 7M)of Div. 3 of the Business.pnd Profess on Code) (' (1'413,2.4 � (Fo �
or doubt is exempt flcr2from and the basis for the allegdl eieafpaan.Any violation j s g'.
-af Section
fpr not More
than five hun
v=Wndred dollars
nafor aa spoeurlm.it subjcns the applicant m a civil prnilry
Occupancy Type
01,as owncronhe property,or m>employees with wages as their salc=ompensation. 307 - INSULATION
-will domM e work,and the s8ucmrc is norinanded or'offered'for sale-(sec.?W- 601 - ROOF TEAReefI�jYFd jnspeCtiOnR11�'''
I Buiirris aProfessions Codom
Castle:The CracmrY Law License w does na Illy an
owner property Who Wilds or impmsms thereon.and who does such work himself 602 - ROOF PLYWOOD NAIL
or through his awn employres.provided Bret such improvements are nm intended or ,,.,_- __
..-?rcet�rarxalelr.n mwltlgaatmpmr<medt . Id a �r�aaf'-- 603 - ROOF BATTENS �..•. '� ' �::.; '.. t
omplcafIX the ownerfWi'c'r will have the burden of proving that he did not Wild or 604 - ROOF IN-PROGRESS
improve purpawo
consumer vof tncproperty um Business and Professions
ns CFdentthe Connors m CL"_C °I 1,01:•.I
•.;.- t ownc
conwn she Project(Sec.7844,Business and Profession Coder The Contractor's u1t� r V!1,01 �Itt!,
License Ww docs not apply man owner lb pra,my1-tr sono) ills st improv.I to flue-
' -'
_and wha.cansnets forsu<h Projects with a enmmemr(s7 Jicened pursant.w.the. ....................._,....._.._-._..----.___... _._.____..__.
n 1 u ars License Law.... .._.._-
Conan .rv.r: /, +r ..aY �;_I-;n
p ndcrSee." " .BRPC(or Nis reason 1!`h ;)i^_�'lllt. .•
m to
_ Os n�i' eDom' •, ' ,
`WORKER'S COMPENSATION DECLARATION
I M1erebY vRrm umlcr perehy a(pcijury;oir of thefollowing dcdaratioru: -
0rr1 have'and will maintain a Ccrti5caiebf"Comem to sdBitume for Worker's
iCompensation, aspasided fm-by Section 37W of the Labor Code, Por the
performahce of sho'work fur which this permit ix issued..1;.,
0.1 have-arol will itialmain Worker's Comper6tion Iniunnce,as mquiied by Sation
37M of the Whor Code,lc be pirformance of th_'work f which his c t is
m �u
issued My Worker's Com,armatmn Insurae c r and Policy be
n �e p
S+ LPsI v1 7-'„OS 0 ., pp ,1
+C TIFlCATION OF EX ION FROM WORK I Ill ij + t;R iIt5 t s 4 iJ
COMPENSATION INSURANCE ( } ' _
�9� d�Iss -- - - ---- - - --
,. ., u,.;) -•.;u r, lir;
f(Th s section need t be campin d el the permit is f 1 h O I
' (81001 ur less.) .. . . _ _. .... ,..,.» ,4 . .... ......... ....«......
Icant fy,'ary0the perf any ocarer of I rk forwhichthecpermit 1. is,ssaed,l 4(",,, I (I �„I.,U�., '•'^
shall not employ nny pe. n n any manse w m become subject Yrs the Workers r
CApplici t i I..Lmvof Col f. 11ore 1.n,.1.
77
+NOTICE TO APPLICANT lt'ofter making this Cemncme ofExemption,you,should
O O 'haeme subject io the Workers Compenslnon prows ons of the Labor Code,you must
forth '@ comply with. h p ns or his perm t shall be domed mvaked r
._---- ,. - ., -.,-_.- --.,. . .. ._
� 1', - ! 'I” CONSTRUCTION LENDING AGENCY
a'; I thereby vfnim th t th ,is-a ipn.i cion lending agency 76,ih pcFfoimance 1 _ I ,
sof the whakfor whichm permit shauled(Se 30Y7.Civ Cl -_,
A L dr N - -. 4
z 'W Jr mAddr.s
1 ccn-a thatl have read this city
and co mm nae thin s a d state
wx relating is
.'GPs' agree m exon,and he all ambiai county ordinances and.nam laws relining
V ;w Wilding con ruction,end hereby ausM1oriie rcprcumativcs pfthiscirywcnmr upon
rig) .the aboyemcnilaoed pro,rfy for inspersion pmposcs..,��. ,,, _, _,,,.rr la, (WcI`gmd io save,indemnify and keep harmless the City'uf Cup<ninoagaint
Fn-V1 liabilities,)_dgmems cos¢ ad capense which may,in any;ay accrue again said
U-y Cly ncise nc -Pm g%mi dth p' t Sl r
APPCI I'm L lDE $TA\OS NI WILLC MPLY WITH PoIN'T' Issued bLAsU Date W
$OV f(s.RL IL;' ON4 ' 1t,3_O y<
rumor orA tern camncsur , i1a.— DLam.l.',,:." Re-roofs
II ,HAZARDOUS MATERIALS DISCLOSURE
son m ppa s future W IJi g pmt roma naadle hanma x anal. . Type of Roof. ._ .. ....__._ _ ..
as defined by the Cupertino Municipal Cad Ch pm 9 12 d the H IN arN Safety
Cod 2553Z,0' 1 1.N i.-'k, tsi 4.,
-All to
shall be in spected.prtor-to any roofing.matetaal betng.installed _._...
Wllth a l t ft building t equipment M n tick ♦ ,
PP g p = If a roof is installed'witlfout first obtaining an inspectton;'Iiagree to,
remove
e ti lmzam co( ant defined by th Bay Am A Quality M Management
Untilt` _ all new materials for inspection. Applicant understands and will comply with
fir + 11"° 't "I" all non-point sourc regulatio s.•. ,( ,}r:,
s 1.
1 helve read.ihe M1ozaMuuz mmenaL rcquircmen¢under CM1apmr&95 of�hc
Colifamia Health&Safety Gale,Sections 25505.25533 end 25534:1 undersand thel - _ _ .-
iMM1Gbulldl gtl9e ionic ndy hate at t that t say responsibilitytd nobly the _ • /�"� L
0,pPant tnc qy cn t. h ch mut m t p w purce�f Ccnifum of _ _ _.. _. _.. a'. - - - -
°” pa ,`✓ tgnature f Applic nt Date
y-o
tar or as nzcd agent „ Dam All roof coverings to be Class `B" 6r better,
7
�_, .. . .._.
OFFICE ..... _..- . .._. . . .__ .... ..... ... . . ... .. .._-. .. ..
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
` Telephone: (408)771-3228
S0Fax: (408)777-3333
CUPEIITINO
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.
IMPORTANT:
1. Flat roofs must have a minimum of V"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: (kA G +N Ld niN tn EAL9Z e'Vb
Address: _� �/ { K-10"i iV O �24
Reroofing Company Name: C fl-00 f7it<
Applicants Signature: Date: z
Joe Antonucci
(Chief Building Official)
V25101