02070085 OF
CI BUILDING DIVIISIONNOPERMIT CONTRACTOR INFORMATION:
BffIgN ,� IRNbODBURY DR NIEGEL WILLIAM C PERMITr62070085
Wfflltf
WILLIAM C APPLICAT1f>NnFL" 002
PHONE: SANITARY NO.
1 / CONTROL NO.
M O O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
u_ BLDG ELECT PLUMB MFCH
LICENSED Coin RAM OR'S DECLARATION REROOF Job Description_„ 1 herthy affirm that 1 am licensed under provisions of Chapte,9lmmmencing
,yt-u with Section]000)ofUivisionloflheBusineaandPmfecionsCMe,andmylicenu rj,/O WOOD ,v-„sIF'u�r .'N.S,EAIDL O.S•B & COMP . SHING
:S S< in Full fnxe end effect. .qR AI NSEADL
U License Chas Lic.M a �a
O a Dae Contra or,
3 LLO ARCHITECT'S DECLARATION f
g 1 understand.,plans shall W used as public records AUG j 0 2002
i3Y
3i p x Lkerned Professional
OWNER-BUILDER DECLARATION
=', 1 hereby affan thin I am exempt from he Commctor's License law for me BUILDING 1 1�L I'g�pl�o
V' V Li tlG
M Z m following rima(Section]on..,Business and Professions Code:Any city or county d
€o wmcn regalres a pern,n m mnatma,alter.iinprose,aeman,n,nr xpatr any awemr`or
$4 0 0 0
-
es. G2 prionuits usuanu,elwrcquira the appiicam for such permit mflu signal nacmcm -
chat heishcensedpursuanugmepmvisionof meCommerce,License Uw(Chapter 9 -. S Ft FloofArea,,. , . . ,..e Valuation
(commencing with Sec cion 7")of Division J of the Busiacsp and Pmfeuions Code) CONT '
q'�''��''t .r..?+f:''.}�a4„� •
or that is exempt tnciefrom and the basis for the alleged exemption.Any violation 2 54'5.04 5:°0 0
-of Semon70]1.5 oapplicant forvpennir subjects me applicant macivil
of out mnrt than five nuaarta aaaarx(55(0). APN Number i- Occupancy Type
Gra.owner ofineProperty,ormycmpmyeaswimwages a.their sole compen.aran, 305 - FRAME
will do the work.and the stmctum is not intended or offered for.sale(Sto 7044• - rgdd Ins actions
Business Property
der Professions Code:The Contractor'I License Law does not apply to an 6 01 - ROOF TEA 8if p
owner of o rt Who builds or improves merme,and who does such work himself
or through M1xl own employees.provided mut such improvemeol am not intended or
<,read ror ahle:IL M1owwetme ni,mam .. mem is sant witm�ono .._t ._.... .. . 6 02 �- ” ROOF—PLYWOOD'NAI Lc':,--
g or bnpmve rear o . ,
e
ampleoon,mea.mer-baaaerwiu have the burden orproving that nedid net build or 603 - ROOF BATTENS
improve for purpose of solea.
__ —..-._...__.,__--____.. -. .. __ . 604-._. .ROOF--IN-PROGRESS — - - --.-..
❑Las owner Pr the property,am exclusively commcting withoclu)The Corrcmrs re - - _ _” .,.• t
antmct the project(Sec. r, Business and Professions Cala)The Commcmon.
License law does .f apply mon owner of apropeort,cortin who builds seimproves t ro the r
and who
rs LicenseLsuch projtta wireaconuumr(s)licenud pursuw.w me
Convenor's License Law. - ---�- - -- ------- -
sen
nmun rr Sec.' " "B&P C for chi....on '
_ ' G Date 711S4)Z,'
/1" WO K ENSATIQ/�{-,DECLARAT]ON .
I hereby affirm under pcnultY of perlayone of the following declarm.ne
❑ 1 have and will maintain a Cenificam of Consent to self-instant for Wmkcr'a
V/. Compensation. as provided for by Section 3700 of the Labor Cade, for the
performance of the work for which this permit is issued.
❑1 have and will nodaudin Wod<r's Compensation Insurance,as required by Section
37M of the labor Code,for me performance of the work for which this permit is
o .errs carrier and Policynumber are
:
issued.MY Worker's Compensation Insurance„- ....�.. :.•.�...... ... . .. ............... .. . ..........„. .r-._ .:.......... -. ..- ... . .. .. ..
_. Cmeier. {;t•; I'I-s>+ it •Policy No.: ♦ s !! t ,e y I •• .
CERTIFICATION OF EXEMPTION FROM WORKERS't' \j.' it}};•. t15� +Ltirfun4) sti:ll Ptt4'l:
COMPENSATION INSURANCE
'
_... -,
(This icnion need not IS,completed if the permit is for one hundred dollars t �'
1S 100)or less.)
1 entity shot in he pe f-•T c of thek f which tb pe 1 ns ismcd I
6611 note pl y any pc o n b object 1.'he workers s
coca Simon Jn wish rom D rc n tr
APPB, -Y// _ 0.f.
NOTdC' �'L'IL'A s�'t tsar er mal g vs-CcPoRcdc of Exemption,you should '
z Oberm il u3winWorker',Compcnsaion pro visions orthmc Labor Come.you ust
(oMwiW comply wit.such provisions or rots permit shall be leaned revoked.
'.� '• CONSTRUCTION LENDING AGENCY
— v
GC 7 of the
Nater Noris is issued(See. 097. 'a&encY for me perfonnunce
" 1 herthy nffmm mai mere iz'canmm�ion p
of r work for which rots 30Y],
y:G ,..... . -
z LeMer's Address
U 1 eenify that 1 have rted this upplicniion and stain roar the utmve in4nmaion ie
W,F shomn.1 agree to comply with all city and county unit...ces and Stam Iawa miming
0.0 rebuilding canswction.and hereby aumorix representatives of this city to enter upon
the above-mentioned property for inspection pmpous.
C6 (Wc)'agree 1.save.Indemnify and keep harmless the City of Cupertinr against
t0 liabilities,judgments,costs and expenses which may in,any way acetum against said f.
U ZZ City in mmaequcnce of rhe granting of this permit.' % - /
( ' URICANTUh'LDESrySNDSDWIL• N
MPLY 'THAL NON /IM/ Issued by: r Date
Signa AAAAcomracmr am Re-roofs
' HAZARDgUS MATERIALS DISCLOSURE
WOl mcappt he future
t balding occupant note or,h al na;ataaits mm al ..Type of Roof. -
eidefndbymcCupn Municipal Calc.Chvpmr9J] andth Health and Sof ty
Code. Inc255]31,) .. , .s is Sf. (.Sn' V".4'( .. ..'Lgt4X 'il .k t..:
tiara:'r' Na' ''("' " All roofs shall be respected pnor.to any roofing material being installed_
Will the applicant orfuturebuilding occupant use equipment or deviceswhlch If a roof is installed without first obtaining an inspection, I agree to'remove
emit truncations air contaminants as def tied by the Bay Area Air Quality Management
Di:a;en� all new materials for inspection. Applicant understands and will comply with
oven - - Na ' all non=point ce regulations:
1 have rind he hazbrdous'sna,oils mcdoemem,under Chapter 6.95 of the /pC. s
ifthe mil Hcalm&afcty Crderiverinsan.flit 5533 aismnd355J4.luymnsi nd that x li
Ifttu building a ma not avrtemly have a tenon,mm itis rry xuance of a e notify the /f/ / /
occopam o!me requye ms which must be m4 prior to issuance of a Certificate of / /
Oc p4g 9 =
n r
_igna[ure of Applicant to
;:-1'i w.et �, nt r k ode All roof coverings to be Class"B" or better '
'r.• 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.
IMPORTANT:
1. Flat roofs must have a minimum of YV 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: li✓i /.9� C• A/
Address: 2 ��5� �✓4 c�ICy�+ ,UQ I've
Reroofing Company Name:
Applicants Signature: �i C Date: 711XS l?
• Joe Antonucci
(Chief Building Official)
6/25/01