02100079 CITY OF CUPERTINO s ' � � "" �' -1 dm W,
ro BUILDING DIVISION PERMIT *ICONTRACTOR INFORMATION:.
BuB21301151WOSS AV APACHE ROOFING PERMIFNC2100079
OWN31A(S*I:::HONG 5829 EL DORI DR APPLICATTtff'T(91Y 2 0 0 2
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I IONI:. 408 363-0205 SANITARY NO. CONTROL NO.
ARCIII"ILC/17NOINE[R: BUILDING PERMIT INFO
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.O: LICENSED CONTRACTOR'S DECLARATION
C U r 1 hereby affirm that I am licensed under provisions or Chapter 9(commencing Job Description
yaw woh ScansnitgMBof Division3of Ne Busincavand PrrlcssionsCod-andmyliccnwis REROOF
6a III once and Cf�appp f FIN reto
p LE®
oz—o Date " O Cnntracmr_
F4y to ARCHRUTCTSDECI.ARAI'ION
C K a I understand my plans shall W used as public records OCT 2 2 2002
3O`"
Licensed Procivion ll
O< OWNER-BUILOPR DECLARATION
aecp I hereby atrium Nal I em cxcmPr Inmm the Contractors License law for Ne BUILDING $9500
E no following reason,(Seen 7031.5.Business and Professions Cock:Any cilyor county
of$ which requires it german m construct,alter improve,demrllsb,to,repair any,crrucnan,
IWpriIt)its iauence.alsowsp ares the applicant for such Pcnviuo file asigncd.sulement
>a that he isreemedpursuant mNeprovisions of the Commelor.,ucensel.aw(chaplery 3AM.QIIt036AI@O Valuation
� o (commencing with Section 7000)of Division 3oflhe Businessand Professinm Code)or
a 3 that he is cxcmpl Ihcrefmm and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicamfor a permit subjects the applicam to a civil penalty of -3 UojQPI`rNNi9&FE Occupancy Type
not more man five hundred delta.U$500b. 307 - INSULATION
❑ Las owner of the progeny.or my cmpluyess with wages as their sole compensation,
will du Ne work,and the structure is not intended or offered for sale(Sec.AWA,Business �p,�yr �{�g
and Professions Code:The Contractor's[.I..Law does not apply to an owner of 602 - ROOF PM nWjkcfipns
property who builds or The
thereon,and who docs such work himself orthrough his
irwnemployea,provided Nonsuch improvements arenol mmndedorofrered hurdle.If. 603 — ROOF BATTENS
however,the building ser improvement issrld withinone year ofcompletion.Ne owner. 604 — ROOF IN-PROGRESS
builder will have the burden or paving Nat W did nor Wim or improve for purpose of
sale L
I,as owner of the props ny,am exclusively contracting with licensed cnntrsmrs tu
instruct the parcel(.Sec.7(W ,Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who Wilda or improves thereon,and
who contracts for such projects with a contractors)licensed pursuant to the Convacmrs
License Law.
[:] 1 am exempt under Sec. .B A,P C for this reason
Owner Daw
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declamation:
I have and will maintain a Cenircaw or Consent to self-main,for Workers Compem
satin,as provided for by Section 3700)Of me Labor Code,for the pertnrmancc of the
work for which this penmir is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
3701 of the Labor Code,for he pertorm ince of be work for which Nis rOmil is issued.
My Workcr's Cn son/i�ar�Isumnccc cam and Policy number are:
C. L (�r i Policy Nn.',Je1 L I
CIiRTIFICATE Of EXEMP ION FROM W ORK17RS'
COMPENSATION INSURANCE
QTis see inn need nor W nmmplered if IW permit is Ior mac hundrvd drllam(SILYB
or less)
1 sonify than in the Performance of the work for which this permit is issued,I shall not
employ any perum in any manner sr as to become subject to the Workeri Compensation
laws of California.Date
Applicant
NOTICE TO APPLICANT:11;alio making this Ccnilinw of Excmpnion,you should
become subject to the Worker's Compensation provisions of the labor Code.you must
OZ, forthwith comply with such provisions or this Permit shall be deemed worked.
z CONS'rRUCT10N LENDING AGENCY
(-. I hereby affirm Nal there is a conswClum lending agency sof NC Performance of
y' 7 he work for which this Permit is issued(Sec.3197.Civ,C.)
lA Leaders Nmnc
z sander's Address
U O 1 versify Nat I have read this application and sow that the above information is
F_" cone.1 agree to comply with all city and county ordinances and ,are laws relating I.
OU building Construction.and hereby ouhorim representatives of this tiny to enter upon Or
above mentioned property for inspection purposes.
(We)agree to save,indemm fy,and Yap harmless the City of Cupertino against
babilidcs.judgments.costs and expenses which may in any way accrue against said City
U Z, in cunvyucmc of the granting of this Permit.
.. APPLICANT UNDERSTAND D WILL CO PLY WITH ALL NONA I Issued by: Date C/( ;51 �Z'
SOURCE REGULATION. I /
Re-roofs
Signature nr APphQmcln Dale
IIAZA
IIAZARD bMATERIALS DISCLOSURE Type of Roof
Will the applicant on Muni building Occupanthmrc of handle M1 leallous material
at Jerred by the Cupertino Municipal Code,Chapter 9.1 .and the IIcaIN and Safely
code.5eerns n 25532(a)'1 All roofs shall be inspected prior to any roofing material being installed.
�Yc0
Will the applicant or future building overpaid use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
min hay.aNnus air cr,aaminanlx m der by the Bay Arca Air Quality Management all new materials for inspection.
DStria7
❑Ycs L]No
1 have read the htiaNnus materials requirement'under Chapter 6.95 of the Califnr
rias Health K SalelyQJc.Section 25515.25533 and 25534.1 indcnmad Nm if Nc building
tines not currently h. tenant,Na it is mY reslnneibility m notify IhC rccupanl of Nc
refoimmentsm ion met pdnra ' ante of a cenireatu of Occupancy Signature of Applic t Date
ownermaammiad ag agent Dove All roof coverings to be Class "B"or better
Building Division
10300 Toas Avenue
Cupertino.CA 95014-3255
` Telephone: (408)777-3228
kCITY0 Fax: (408)777-3333
.CUPEkTINO
Building DeparAnent
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 Y4"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:
Address: -2 3 !s Ynnw'�
Reroofing Company Name: /0 Q'� ,-5�- 5_
Applicants Signature:
Date:
Joe Antonucci
(Chief Building Official)
6/25101