02100146 r
CI'T'Y OF CUPS rINO . .•'; as inn >''
RUILOING DIVISION PERMIT CONTRACTOWINFORMATION -•,
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a Bw ) E. LLA E DR PETERSEN-DEAN INC PERMTrN0.2100146
ow93Ol+NATHAN MANTZ 7980 ENTERPRISE DR APPLICA'Ta"P1118T�2 0 0 2
:IONIi: 10 4 4-9982 SANITARY NO. CONTROL NO.
ARC]]ITECTIENG]NEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MUCH
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00 LICE.NSfIDCONTRACTORS derpDECLARATION Y ■rJALG®
I hereby affirm that 1 nm licensed under provisions of Chapter 9(commencing REROOF Job DCS I
with Seam,I1XX1)of DivieinnJnf NC Business enJ Pr dessinns Curie and myliansc
a• in full farce and c L•.{j
Za32 1.ittm.Cl. 3_ ..... X
GZF❑ nam Cunwcror MAR 2 7 2003
F=€,� ARCHTFECTS DECI.AR
V�C� 1 understand my plans shall be used as public record.
3LL
Licensed Pndcssinnal
BUILDING
P-LLO OWNER-BUILDER DECLARATION
u�s I hereby affimt that I am exempt from the Comncmr's License law for rhe $6276
aSOO fallowing remrin.(Section 7131.5,Business and Pndessirins Cttle:Any city ser tummy
a� E which requires a Permit m construct.alter,improve,demolish,or repair any structure
y.ats prior uh its issmnce.also requires the applicum for such permit lite a signed statement n, p�� [�]
HC—< that he is licensed pursuam Irish,provisions offie Contractor's License l nw(Chapter 9 3413131Qf3Xf A49 Valuation
n (commencing with Section 7ffloof Division 3ofmm Businessand Professions Code)or
_ that he is exempt therefrom and me basis for the alleged exemption.Any violation of
Sudan 7031.5 by any applicant for a Permit Subjects the applicant m a civil Penalty if 3 U APN NU9WE Occupancy Type
not mom man rvehundred dollars(s50% 307 - INSULATION p y yp
0 I,as owner f the property,or my employees with wages Is their role compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Contractor's License Law does nor apply to an owner of 602 — ROOF PL nelt'ILons
pmNny who builds or improves thereon•and who docs such work himse]formmugh his
mvnemployees,providedshatsuch improvements amntaintended muttered(mule.R. 603 — ROOF BATTENS
however,the building or improvement is sold within one year of completion.the owner, 604 — ROOF IN-PROGRESS
builder will hove the burden of proving that he did not build or improve for purpose of
sale I
0 1,as owner of rite property,am exclusively contracting with licensed contractors to
construct the project(See.7144,Business and Professions Code:)The Contractor's U.
cense Law dries not apply to an owner of property who builds or improves matron,and
who contracts for such projects wit a conmcumbid licensed pursuant to the Contractor's
License Law.
❑ I am exempt under Sec. B R P C for this mason
Owner Dare
Am WORKER'S COMPENSATION DECLARATION
I herehy affum under penalty of perjury one of the following declarations:
I have end will mainoin a Cer iBcme a(Comenno sel6imme for Workers Cori
urian.as provided for by Section 3700 of th,Lehr Code,far the performance of the
week(or which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,m required by Section
701)of the Labor Code,for me performance of the work for which this permit is issued,
My Wor nm on sunnce ca�f r and Policy number are:
T n
Cami,r: y - Bey N., _(Z_
CHEM IFIC TE OF EXEMPTION FROMWORKERS'
COMPENSATION INSURANCE
(This section need not the completed if the permit is futon hundred dollars($I(X)
or less.)
I certify that in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner so as in become subject o the Woracus Compensetion
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Ce nitre,of Exemption,you should
become subject to the Worker's Compe nsalion provisions of the Ichor Code,you must
OO (urthwim comply with such provisions or this pmmit shall be deemed revoked,
Z "t CONSTRUCTION LENDING AGENCY
(—i sN+ Iherehyalfummat Num is a 4onswution lending agency for the performance of
p( r> the work(or which rhispermi r is issued(Sec.3097,Civ.C.)
IA L] Lim cis Name
� ,Z tenet's Address �S
{)0 1 certify mal I ban read this application and some that the above information is
0U comemttrect.I agree loco.plyand herebyth atend rscounty resemaiives of and sure lawsenter
gm
0U building venaeonsuucriooperty einspction trcaracs. mitres nl this city to enter upon the
shove-(We)acd 1.save lar inspection keepbe
(s ju agree m save•indemnify and keep harmless the City io CuPensto against
► N liahilitiu,judgmenu,cnso and expenses which may in any way eccrv,against said Ciry / /y
V 7 in consequence of me granting of this permit.
G7 APPLICANT UNDLESTPRS AND WIL COMPLY WITH AL1. N-P NT Issued by: Dale
SOURCE REGUL 5.
Re-roofs
Signature n(AppncanVCan or Dllc
HAZAR OUSMATERIAI,SDISCI,OSURE Type of Roof
Will me applicant or future building occupant store or handle har4rdous material
as defined by the Cupcninn Municipal Code,Chapter 9.13,and the Health and Safety
,jMILCndc,Scninn 35532(a)/
Yea � All roofs shall be inspected prior to any roofing material being installed.
❑
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
.mit hamrdous air emonar manta ns defined by the Bay Arca Air Quality Management all new materials for Inspection.
DistricR
❑Yes Dw �•
I hove read the haiamous materials requirements under Chapter 95 of me Cali for ,it
nlullenith&SldetyCtlde,Sectinnsl55r15,25533 wJ 3553Y.1 undorstwd mmlfthc holding �� /pa
does
not[urrently h anent thm n el my responsibility m notify the tceupanl id the gi
myuiameno must :mer priori issuanccofa Ccruficmeoluccup. y Signature of Applic,, t Date
!d / 2-
ownm ar omrirized ant D All roof coverings to be Class '•B'• or better
Building Division '
+ 10300 Tom Avenue .
Cupertino,CA 95014-3255
Telephone: (408)777-3228
C 0 F= (408)777-3333
CUPEkT1N0
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
Wand 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/pr 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 W"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
lcomply with this policy.
Homeowners Name:
n �3
Address: //�,,,.-�, .
. Reroofing CompanyName: 75e-&-&a-ems, - Q12Q.-...
Applicants Signature: - JJ /'L Date: /d 1 GLey
Z
Joe Antonucci
(Chief Building Official)
6125/01