02080019 CITY OF CUPEe''ONTRACTOR INFORMATION:
BUILDING DIVISIONSION PERMIT
BUILDING ADDRESS: PERMIT NO.
10250 VISTA DR PRO ROOFING 02080019
W APPLICATION SUB DATE
O
5MYF"9 DANIEL P AND DORIS C 100 BLOSSOM WAY 08/06/2002
PHONE: (831) 440-9100 SANITARY NO. CONTROL NO.
pppBUILDING PERMIT INFO
O O ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
d I"-U I'-1 L-L] 1--1
r 6 A.
Z H Z LICENSED CONTRACTOR'S DECLARATION Job Description
O Z- I hereby Alf.that 1 Am licensed under provision of Chapter 9(commencing REROO F
Fit with Section RNID)of Divisiop3 of the Business and Prof tions Cale.and mylimau
is in
all foreman tfb.a'Cl /_ 0 .3 1
yo. License s: J Lic.As Wtor 1A ✓•I ...J 'J�'
3 a rri Dare ARCHITECT'S DECLARATION
L:
1 t.
C Ei 0 S I um damn d my plans shall be used as public records
O O Licensed�6 Professionel �
OWNER-BUILDER ur he CoATIGN
1 hereby Maso.Sero on 1 1. ,Bumps from she Contractor's License Law for the
C Z following reason.(Sumas]031.5,Business and Professions Code:Any city S orcounty $5000
O wwhichconstruct,ch requires permit to construct,Blur,improve,demolish,or apestructure,
r any urn
$ primto its issuance.also requires[be mfil
e applicant such permiteasigned suament
3- rhotvhl R li feptvith Sagoo ro 60)of Division
Ne Contractors License few ons C er 9 ]-p3
„3�Gfs-�T:tf1 a,T.t ,y,n,. Valuation
(commenca:g wnh Sectign 1660)of Division]of the Business and Professions Cade)i y'{��, l TST!L49� y1;.s fir..`',)�.R 4.G; M;
or thedoAi,exempt sang uppl and N,basis far the subjects
th Q applicant to a cy violation
--of nett am]thoo Five
y Any dre doU.ra permit subjttu the applieenuo A civil penalty Occupancy e
;of.nm more Nenfiw hundred douan(s500). 3OSA�,�^R '-' P y�'P
01.nowneroftheproperty,urm'y. employees with wages u their sale compensation,' -
( AM. An:
d or
-will do the work;and the oda:Th C mrl ou'.License
a Lawered for Asia(SAM.71M,11 6 01 - ROOF TEAI�g(BRff Inspections 't"
'
Basin arendProfem oro Cade The Comrecmr's LmenM law does nm e 1 m an
owner of propeny Who builds or improves thereon,and who does such work himself 602 _ - ROOF PLYWOOD NAIL
or through his own employers,provided Net such improvements arc not intended or
pf(red'fo7,hle:IL however.Ne WOdibg_.-p- _Yeirbf __... .._ —_____._-_..__1.. —
err tm rowment is sold within'one - -' O - — -
'improve far P.M.owner-budder will have the When of proving that he did not build or
603 ROOF BATTENS ^• i "
improve far paarsAle.). 604 - ROOF IN-PROGRESS
--.[7 L u awnec of Ne p.,my am exclusw,ly contracting with l censed mnaracmrsto LIP A J PI'',
construct me,proiect(Sec.7044,Business and Professions Coded The Conuusah .. t ^'1 �l"� s c•n
License law docs not apply ser en owner of property who Wilds or improves thereon,
and who c mmus.for such projmetaudth.a comramm(A limmsed.punuant.m.the..
Contractors License Law.. -
❑I em exempt tenter Sec: B&PC forth
1. Owtim . for Nis rea
son
1.
.N .i`�
WORKER'S COMPENSATION DECLARATION
-
' 1 hemby arms under pemisy of perjury one of the fallowing dclamsions:
❑ 1 have and wiWriansnein a'CeNRcata of Consent to sel6insuM for Worker's
CompeCompensation as provided-for by Section 37W of the Labor Code. for the
nsation,
of Ne work fm which this permit is issued.
01 had II ma t n W rkm'b pen t 1 .. As McNi by Sens n n
i37Mssm . the IoW Cad f N perform f the wA k for huh'Nu pante t �'O
tsaucd My Worker's C p s o Ins And Put c cher r `� b _ ww •-_, ,,,� ��,,,.
1 /�� 11 .�(ylp e��(Carrier: .� Q rlYsl n'.fA°R hyNo.. l O .�✓ ..y.. it sl
s CERTIFICATION OF EXEMPTION FROM WORKERS`.' r_ t 1.s 3
This ':y ` COMPENSATION INSURANCE:.
" ( section need not W completed if the permit is for one hundred dollars ^D '
(SI00)or usa.)
shall o,employ on periami An m
1 denif Net m the rformencC of Ne work for-winch N permit is ucd,l _ - -- _-
' p y\ y pe y ginner m ex to become aublecs to the Workers'
Compensitian lads of Celilornia.Dates" -
N ICETOAPPLICANT.If.after making this Cenifcmeof Exemptio - - -_- \---
Applicant ,
OT n,you should
Q z bemmi mnhwidi comity the such provisions
Compensation Pamir
shall
fe dLector Co de, 1. ss
'Ply with such provisions or this permit shall be domed revoked
.. ........ .. .. .....'- . STR .. . .. . ._. _— ._... .-
V� .ftt... :•hiMby Affirm
�'CbNSTRUs HON icomm ENDING AGENCY;• ". .m p.fy
i
-a I heab err Naths_ c win lending agency forty pesfossmnce
� � Lender,Addasi' Civ C7
of chew kPa whah thsa pe t d15 .]09] _ ,,\ .., _ ... _.I .,y._ .- ...-.\
Lender Na a -•'•
Z - ,nl
V C 1 c mfy the 1 heve Mad Nis apphcm on and AIAM that the ahave into Mandan is
W'E 'ronct.l.'MA to,comply,with all city and cuuntv uncomic.and stem laws elating
_0I to Wildingconstuctim.and hereby u.tlmHm M,Mientmives ofthn cirym eatF,.,a
•y w :the abovementioned ph"ity for inpmd..Purposes.
L .
(Wej agree to 1.m indemnify and keep hmmless'Ne Ciry of Cuamino against
W .liabilities,judgments.costs and eapenux which may in Any way accrue Again,said
61 Cry to consequence fhh g t ng of Nt pe s. .." r
EO(gRCE DTRS .YDS AND WII COMPLYPITH ALL NON- INT'' Issued by: Date
Sign mrc fppplicat dCAmr mo ,�', v, Dm ,'a" Re-roofs
HAlAR0005 MA RIALS DISCLOSURE
W II tAe apPl cant r funs Wild ng m porn store err hmtdl,hewdous mmenal TYPe of Roof _- - .._....._a._w.........,_..............v
es dented' Ne Cupwtw :sme Code Chapter 9.13 Asha Ou Health and Safety
sCode $ t n 25A2 P) ( i w (• t; 145x'.y R t v ' d I ti'(
area •f a : ^ All roofs shall be.lnspecied prior•to anytoofing material being installed.___
v.W II sh.appbc m r boom building occupant use equipment or devices_which If a roof is installed'without first obtaining an inspection,•I-agree to`remove
trot herard s at contaminants a defnrA by dhA Bay Are.A Quality Men gement
Dwtrctsa _ all new materials for inspection. Applicant understands and will comply,with_
ave _ . all-non-point source regulations.,01 1
California Health&Safet I ty Code. ctions125505,25533 And 25534.1 understand
of the
r' q , errand Net
Safety _. \. . . . . ... ... ..__..___ ......_- ... - - -.._- — .... _.
-if the building does not curtendy.strap a anan4 Nm it is my responsibility to notify she
oceupam f the requirtmenB which it be met prim to iashe ae of a Cenificam bf
r
occur -
G /� fC ;�:;� Signature of Applicant -__ _ -_ Date
_ -.
o n, erramnapgpa gig t Dpm•, All roof coverings to be Class'B"or better
: m a
_ OFFICE
Building Division,
10300 Torre Avenue
4 Cupertino,CA 95014-3255
Telephone: (408)777-3228
o Fo Fax: (408)777-3333
CUPEkTINO
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%"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: 'Da n l )16 -e f
Address:
Reroofing Company Name:
Applicants Signature ht x e Date " d Z
Joe Antonuccd
(Chief Building Official)
6125/01