02100028 CITY OF CUPERTINO - -
BUILDING DIVISION PERMIT ACONTRACTOR°INFORMATION
BUBpd5gA3DRWESTLYNN WY CAL-PAC ROOFING PERMrrN(p2100028
Cw%'9ZNMf1E GUPTA 36 RAILWAY AVE APPLICATT'UU"5/2002
AhIF ZONE: (406) 874-0784 SANITARY NO. // vv // CONTROL NO.
ARC]IITECTIENGINHER: BUILDING PERMIT INPO
RLDG ELECT PLUMB MECH
0 0 0 0
aOp LICENSED COMRACTOR'S DECLARATION
<bP I hereby alum mn aam Eeenaed under provi.dons of Chapter 9(commencing
REROOF Job Description
ZZw with Section 20c)(Bo Division Sof NC Businessland Professions Code.and my license is
say z fall(n2and CllcC� _ _I 91
Line LIc.MoE nam_ �Q Contractor
t ARCHITECT DECLARATION
ELARA IO—ONb /2H
.L
9:9
< 1understandmyplansshallWusedaspublicrccoNs
'U
Licensed Professional OCT 1 ,8 ZVI
F y�=1OWNER-BUILDER DECLARATION
at a a y 1 hcrcby affirm that I am eacmpt from me Con.......a License law for the $12000
ec_OO following reason.(Section]11)1.5.Businms and Prnffneinas Code:Any city or county MG
which requims a permit it)construct.alter,improve.demolishructre
,or repair any stu
Prior to it iaeumtce,also requires the applicant for such Permit to rile a.ugned.amemmo
En that he is licensed pursuremmthe provisions rfthe Contractors License Law(Chapmr9 3aq�2.ffdkA3EA10A � Valuation
Hn (commencing with Sector.VlgyB(it Divnion 3.f the Business and Pnsfessions Code)or
y Nat he fa eacmpl therefrom said the basis for IM alleged exemption.Any violator.of
Section 7031.5 by any applicant for a permit subject the applicant o a civil penalty of PAYN Occupancy Type
.til ream from Eve hundred dollars ISSUE. 307 - INSULATION
01,as owner of the property,or my employees with wages as theiraole compensation, 68T RPRP
will do fie work,and the structure is not intended or offered for sale(See.7l .Business p(��g
and Prefessions Code:no Condolences License Law des not apply to an owner of 602 - ROOF P Y YJ V njq!Okq?ns
property who luilds or improves thereon.and who dmssuch work himsel(or through his -1_1 L
owncmployeea.provided thutsuch improwmcnuare not intended mothered forsale.if, 603 — ROOF BATTENS
however.the building or improvement is sold within one year of completion,the owner- 604 — ROOF IN—PROGRESS
builder will have the burden of proving mat he did rot build m improve for pmWse of
sain.).
0 1,as owner of the property,am exclusively contracting with licensed contractors In
cinnamon(be project(Sec.7(N4.Business and Pro]essions Code)The Contractor's Li.
ethic Law does not apply to an owner of property who Wilds or improves themon,end
who contracts for such project with a comfortor(s)licensed pursuant o the Contractor's
License L.W.
0 1 am exempt under Sec. .B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of Perjury one of the following declarations:
1 have and will maintain a Certificate of Consenuo sclf home for Worker's Compen-
sation,u provided for by Section 3]110 of fie LhWr Gude.for the performance of the
work for which this permit is issued.
have and will maintain Worker's Compensation Insurance,ss required by Section
,I.)of the Labor Code,for me Performance Of the work for which this permit is Lamed,
My Work sou Insumncc carrier and Policy mum Mra�/'�7SG
Canim: Policy
NO:
7!3
CERTIFICATE OOEXEMnION(ROM WORKERS'
COMPENSATION INSURANCE
(This section need nail W completed if the permit is for one hundred dollars 0100)
or less.)
I unify that in the perfamtanee Of the work Our which this permit is issued.1 shill not
employ any Person in any manner su as become subject o the WorkersCompensation
Laws of Cali bonia.Dam
Applicant
NOTICE TO APPLICAM:It,after making this Cemileae of Exemption,you should
became suhject to the Worker's Compmtalion provisions of the IaWr Code,you must
OO forthwith comply with such provisions or this Permit shall W deemed revoked.
z CONSTRUCTION LENDING AGENCY
�--i 1'0 I hereby union Nat there is a construction lending agency for the Performance of
C7 the Work(or which this Permit is named(Sec.3097.Co,C.)
U] Q Lenders Name
Oa tender's Address
U O 1 Certify that I have read this application and sate that the mcce information is
[I. F cnnect.1 agree to comply with all city and county onlinances and sate,laws relating 1a
O U building conswCiRm.and hereby authorize mpresenutives.f this city loonier upon the
[Ll above-mentioned propeny((it inspection purpnes,
(We)agree In save,indemnify and keep harmless the City of Cupertino against
Iiabililies,judgment;cost and expenses which may in any way accrue against said City
V Z in conuquenu of the granting of this Pcradil. �� 11APPLICANT UNDERSTANDS AND WILL C PLY WITH ALL NO POINT Issued by: Dale 0
SOURCI7 REGULATIONS /
C S Re-roofs
Signmmc of A,plmmd Commeluf Date'
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupo d store or handle harnNous material
as defined by the Caliendo Municipal Cole.Chapter 9.12,and the Health and Safety
Code,Second 25532(.) All roofs shall be inspected prior to any roofing material being installed.
O Ye. g1T."
Will building Occupant use equipment or devices which Ifaroof is installed without first obtaining an inspection, 1agree'to remove
ill the applicant or fun
\ emithvardousat,conmmira as def by the Bay Arca Air Quality Management all new materials for inspection.
Distine y
O Yes 0 N
1 have mail Nc ha codous materials acquimmeme,under Chapter 6.95 of the Califnr. )
ria Health&Safety Code,Sections 25N15.25533 and 25534.1 undersmnd mal if Ne building / 0
does not curreml haw a tenma,that it is my mirymaibility to hand the r'uP of Nr.
regtim a latWda"Pdn , oaanuofaCenificaatrII aney.DL Signature of Applicant Date
Dwner matmoriz ascot a „e All roof coverings to be Class "B" or better
Building Division
i. 10300 Torre Avenue
` Cupertino.CA 95014-3255
CITY40
Telephone: (408)777-3228
CUPEkTINO F= (408)7773333
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.
S. 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 comply with this policy.
Homeowners Name: _y-
Address: A::V3
Reroofing Company Name:
Applicants Signature: Date: /G 3 oZ
.9
Joe Antonucci
(Chief Building Official)
60101