01050001 CITY OF CUPER'FINO
nun.DtnGurv'SION, PERMIT CONTRACTOR INFORMATION:
NUILUING ADDRIisS: PERMIT NO.
19g8 WH[-5AT0 o�� l� G 010500 0 1
OWNER'S NAME: APPLICATION SHE UA'I'L'
W f4 f.l 0 U L hN oS H s — I — 01
•PHONE: SANITARY NO. CONTROL NO.
M W Z ARCH'I EC17ENGINEER: BUILDING PERMITINFO
00
111.DG Iih1iC'1' PLUMB M1IECII
IXI I_I CI C_I 1
S?j 1 hercbLICCNSEDCONTRACIOR'S DECLARATION Job Description
ZO T O y aRrnt that I am licensed muter provisions of Chapter 9(commencing
F_I-cwith Section 7001))of Division 3 of the liminess and Prufeviws Code.and my license C (�
<y 5.Ja is in full tome and dlecct (� -yam . I g I
x y y 6 Liccme class C�/— [.it.x_-L�1
1e'O u U Dum 11 Contractor �a ��y�aa�
set 3 w N 1_Q_ I—vARCHII'I:C'I"S OF N A] not 1-�--v— .
t ii O g 1 mwcnluml Illy plan,.Quill hu nscd ns pWBc.,ad,
W 6 ap 0' Licensed Processional
OWNER-BUILIIIiR DECLARATION
1 hemby uWon tom I am exempt trent the Contractor's License Low'for the
1-i N follwing mason.(Seais)n 7031.5.Bl incsQ and Pmfcs,tons Code:Any city or county
f€D which requires a permit u,conswet.:dter.improve demolish,et repair any shall G5 p p 1 g T 1 1>1G1 I'll, P S 4 G E —'T1
ce
4.3= prior tons I .ala,re"aire,the ippli l far suchre milt Msigned.etemmu
duah _ data tt In p : the Con., i Limew Law ILhapter9 Sq. Ft. Floor Area Valuation
(eo:nmcncing withSinton 7110111 of Di"'aa,3 al the Bmit..w u d l'ufc"i e Crdol /_ �0
or flat hall"vault thcren fnnmal,be basil for he:dleged cxana,n a.Any veda(tm �!'
of Section 7031.5 by any applicant for it wnnit object,the opplicunt to a civil Family
of no,more than live hundred dollars S54)(B. yp-a APN Number Occupancy Type
❑I.as owner of,be property.or my employers with%agns as their ole comFensa,ion.
will Jo the work,and the awcture is not intended or o0brcd lin sale(Sec.IDIS.
Business and Profession.Crate:The Cablumbr s License Law does mot apply to an Required Inspections
o.aerotau,rn,Who h d,orumprove,dualism, ad hodow,hoduch work himself '
,r f I l y p I J I Jimprovements i build or
of d 'I It I, 'II nb 1 t IJ 'l' a Year tl
pitio the rase lJ love lot
Ilh android Ip itgth 11 It s buJJtr
improve for Pam,W if al,7
I of the P rent' Ise i , do vanmsm C1�
con, t tis at n(\p 7(1m B :i J e mf..ons Cel I mp C s tai lean. J
LicenseW J putt't owner 1 property ho hu is improves t to the
9�
C' h contract,t h p 3 t w,M1 t t q.)licensed p m m 0c 7
Cot t I
❑tanvu jn madi Sea l4.&11 C lotmil is it O
Owner Urate /
WORKER'S COMPLNSA'1'ION OECLARA'1'ION
1 hereby u irn under Finally of rerju,y one of the following declamnons:
❑ 1 have :aid will maintain a Ceniticae of Consent n,salt-insure for Walker',
Cour,p loo, as m,iJm for by Section 3710 of the Lubar Code, for the
,altannue,s of the work for which in lQ pvmil is issued.
IYI halve;aid will in"...tall Worker's Cmnpcnsminn Iremarm.ns required by Section
Ifo of the LaM,r Code.for the performative of the work for which this permit is
iuoed.My Workds Coa,penution Insurance simmer and Policy amother are:
Carrier:`SfgTGNN 0 Filter No: 1!S G 12—+94`Q
CEKI'II'ICNI[ON Of:EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
fDll♦ mlun uecd rani Is, to plelcd if the permit la fur one hundred dollars
6100)or Ic,,,.l
1 certify that in the performance of,he work for which this permit is issued,1
ahall not employ any arson in any manner so as to become subject n.,the Worker.:
Compensation Laws of California.Date
Applicant
NOTICE TO APPLICANT':If,after making this Cenificme of F,semption,you should
bemwuhjmt m the Wilder',Cnitgensmion provisinm of the labor Crile.Yeu moa
Q Omtomhwith comply wish Inch pmvisioas ser tis lQ Fermi t Quill be dcumW mvnkm.
Fy CONS'FRUCi'[ON LENDING AG ENCY
> I hcrchy afirm that there is a coast action lending agency tor performance
of the work for%hlch mi,permit is issued(Sec.3097.Civ.CI
L Q lender',Name
r7 Z lender's Address
U Q 1 ccnily that i have read this appllcutlon and state that the above information is
V. Fr co,rect.I ngmu m comply with:JI ray send enumy ordinances and state laws miming
Q U to bnddingcumtmcfun.amdhcmb, Ill racretire,untativswot'thl,ally n,coli,upon -
>. rt'( the above-incnroncd prolarly far inslarlra p sluts-.
fWdngncn,sava.indemnity and keep hanales,the City Ill'Cupemno against
N liabilities,judgment.coats and eslnnw,which ley in any way accrue against said
U z City in consequence of the granting(if this permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
< I CE Nf::U1,A111� 1•s� �'1_0%
:tgnmme Lrnpr �C' DOU Date Re-roots
IIALARUOUS IAIS DISCLOSURE
Winthe aPo":mt nrlumrchuilding,em:Faml nuhuu:rdua,
m nr la,..rte n,v¢l,d Type ofRoof
is defined by thu Cup_ninn Mu"icipal Clam.Chnmav 9.12,and the IleJlh and Safety
Coda.Section 25532(.1:' grNo
All roofs shall be inspected prior to any rooting material being installed.
Will the applicant orfuture building r.cupmause cgniFmemordm;ccswhich If a roof is installed without first obtaining an inspection, I agree to remove
mnbiv, ons air connotations as by the Bay Area Air VualitY Mam
n'vgeen,
Dik
ontrIma all new materials for inspection. Applicant understands and will comply with
ElY"a Tboo all non-point so cc regulations.
1 have read the hvardnu,inabanals Rgaircmeall under Chapel 695 of the
California Ile:dth A S:dvy Calc,Sccdon,_55115.25533 a 25534.1 nndcrsmtiJ tins, f
if the building does nm eurrcnfybavco clmm.mmit is my rcapmsibili,ytonotify
occupant of the requirements which nm,t be net prior to iI'mall of a c,,1 ac rat
gnature of Applica t Date
0 — I roof co to be Class QB" or better
i) n r or ant a 4..m ugcm Date
OFFICE
Building Division
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: (408)777-3228
CITY OF 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.
We understand the above 11policy on reroofing and will comply with this policy.
Homeowners Name: ri[)�N (� (✓ /fir t� OS�F't \
Address: H E— h— �
Reroofing Company Name: -3 -P- Z OJT P G
r
Applicants Signature:
Joe Antonucci
. (Chief Building Official)
6/13/00