03010065 CITY OF CUPERTINO is ar�:iro - .ms+d
Buu.DING DIVISION PERMIT ORMATION
BUILDINGADDRFSS: ASH ROOFING INC PERMIT NO.
7542 WATERFORD DR 03010065
OWNER'S NAME: 620 ORVIS AVE APPLICATION SUB DATI4
FARRELL JAMES E AND CECILE 01/10;2003
IFTONE 408) 295-7681 SANITARY NO. CONTROL NO.
ARC]IITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MEC13
0 0 0 0
�00 LICENSED CONTRACTORS DECLARATION Job Description
m anti p I henchy affirm that I am licensed under provisions of Chapter 9(commencing p
FX7 with Section 700(hof Division 3 of dte0 cs and Professions Code,and my license is
ler ora eand err .a - k" 30 L TEAR OFF 2 EXISTING _ROOFS
Ole- Date levo Lk.x43,11- 9,121-1,V6 Ildt ELK PT. 50 YR. DIMENSIONAL SHINGLES
Ole—F Da1c understand
d m 7Cnn r
qq �— ARCHITECTS UI- TION
2< I understand my plata shall he..it as public records .®a�,A��X B
6O6U F1. ACED
3u. Licensed Pmfessionul
O OWNER-BUILDER DECLARATION Contractors
ON
<F I h,rchy altirm that 1 am exempt from the Commctor's License Law for the
$ Following miunn.section 7131.5.Business haul Professim a Code:Any iy or moody JAN 2 7
$E which uyoires a permit to censtowL mhen improve,woodian or repair any abuaurc 2003
�s?s< Pon,m its issuance,also m,ims the applicant fill such permit In Zile a signed slalemeni
that be,is licensed pursuant to the provisions of the Comoor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
Fct (comncing with Section 7")of Division 3 of the Business and Professions Code)(it
(hal rtmee is,accept therefrom and the basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant u a civil penalty of APN Number Occu e
nut more than five handled dollars C1500). 366],6011 . 00 p ane y yp
❑I.us owner of the propeny,or my employees with wages as their sold compensation,
will do the work,and the slrucmm is not intended or offered for sale(See.7(k4,Business
no Professions Code:The Contsomrs License Law does not apply to an owner of 305 - FRAME Required Inspections
progeny who buildsor improves thereon,and who does Own work himself orthrough his
own employees,provided Nat such improvements are not intended or oRemd for sale.If. 307 — INSULATION
however,the building or improvement is sold within one year of completion,the owner
builder will haw;the burden of phasing that he did not build or improve for purpose of 601 - ROOF TEAR OFF
`"le) 602 - ROOF PLYWOOD NAIL
1,as owner of the pr lirr y,am exclusively contracting with licensed contractors to 603 - ROOF BATTENS
construct the project(Sec.7 WA,Business and Professions Cadc.)The Contmcmr'a Li.
cense law does not apply to an owner of properly who Nilda or improves thereon.and 604 - ROOF IN-PROGRESS
who contracts for such projects with a contracmrfs)licensed pursuant to the Common's
License Law.
0 l sm exempt under Sec. ,B@PC for this mason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby elTum under penalty,of perjury one of the following declamation:
I have and will maintain a Cenilcam of Consent m self ileum for Worker's Compere
salion.az provided for by Section 370XI of she labor CsWe,for the performance of the
work for which this permit is issued.
❑I nave and will maintain Worker's Compensation Insurance,m required by Section
371X1 ill the Labor Cole,for Ne performance of the work for which this Permil is issued.
My Wnh rsGn tsatim lnsummce carrier and Pnlic numb rare.
er. t S Policy No.: �)n��
CERTIFIC TE OF EKRMPTIONFROI,V ORKtRS' 2013
COMPENSATION INSURANCE J
Grids section need not be completed If the permit is forms,hundred dollars I$lisp
ca".)
1 ecmfy that In the performance of the work for which this perm's is issued,1 shall not
employ any person in any manner so as to became subject to the WorkersCompensation
Laws of CMinoria.Dar,
Applicant
NOTICE TO APPLICANT:IL after making this Certificate of Exemption,you should
become subject to the Workers Compensation previsions of the IaWr Cmk,you must
7O z forthwith comply with such provisions or permit shall M decreed mvnkcd.
q O CONSTRUCTION LENDING AGENCY
t-r Ihereby affirm that there is a constriction lending agency lot the performance of
�iNe work for which this Nonni,is issued(Sri.3097.Co.C.)
WJ 0 Lenders Name
0. Z Lender's Address
V O 1 certify that 1 have mad this application and state that the shove information is
W F correct.l agree to comply with all city and county ordinances and state laws relating to
Q U building construction,and hereby authow representatives of lois ci ty,to enter upon the
W anove-memiondd properly for inspection purposes.
W (We)agree Iq save,indemnify and keep harmless the Ci iy of Cupertino against
(A PAM,
,twisendexponses whichmayin any way a,cmc againstand City h�D/
U2 ,, beg oWsperm .'—' STA NOS AND ILL COMPLY WITH ALL NON-POINTIssued by: Dale
I NS. /w ]�
41 4( / Re-roofs
tBnatole of pplicam finne
I IAZARDOUS MATERIALS DISCLOSURE Type of Roof
WI the applicant or future building Occupant store or handle hazardous material
.d, by the Cupertino Mu cipal Cale.Chapter 9.12,and the Health and Safety
Code.Section
Y s 23512(a)? No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or fulum building rccupam tau equipment orJ,vics whim If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
Uiuric'IY
❑Ycs
Ill.. the haardoun materials reifiremem under Chaprcrfi95ofthc Califor.
a Health& Iy Code,Sections 25515.35533 and25511.1 undersand thatifdte building
oes not c ly hoe a tenant,that s my responsibility m nodfy the wei p rm of the
or swh ch must fnetp r.h;'..caandd ill a cerificam�f Occupancy
Signature of Applicant Date
- t arm rnedagent L °�Z Dale All roof coverings to be Class "B" or better
Building Division '
10300 Tom Avenue
4 Cupertlno,CA 95014-3255
Telephone: (408)777-3228
CI Fax: (408)777-3333
CUPEkTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
I. 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.
MWORTANT:
1. Flat roofs must have a minimum of Vi"per foot slope and demonstrate that
; there is no ponding.
2.. An LC.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: Le L i I a-re, I
Address: �LI'Z Wil,"vrd Dir'
I;eroofmg Company,Name- 2a*_-1 tJ Cx I NJl✓
Applicants Signature Date: /X0-03
OOP .9
Joe Antonucci
(Chief Building Official)
6/25/01