02090069 UDIVISION
PERTNNO
. BUILD NGDPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS. PERMIT NO.
OWNER'$NAME: APPLICATION SUB DATE
CROSBY RAYMOND W AND NANCY 1, 1 09/11/2002
(^ PHONE: SANITARY NO. CONTROL NO.
` ARCNITECT/ENGINELR: a BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
S vONi i LICENSED CONTRACTOR'S DECLARATION Job Description
Z_ 1 morby amrm shm I ins licensed under p ,I ions of Chnptar 9(commencing
astas wilhs«tion7 )ofDivision3ofnh<Businessl rrares.ionscoae.andmyucense RER00
;y�� kx imm�r+rt mla�tt '11 ue.e �la 22Z2/ �r sip /� �^� j
0 U uanse �II��LI Gt"4 nICs 2r_/
13 i F, D e Comrautp�.�$.
ARCHITECT'S DECLARyskTdoOrN
g O 3 I undenrand my plans shall be used as public ds
'
5 8C Licensed 1'ndessional SEP 2 3 2002
ca OWNER-BUILDER from
m he CemnION
y
1 naso affirm runt I I.S.eusin from rhe Commnm's License city
o for the
C?< following mason.(Section 1031. Business and Professions Clsde:Any city or county
v which requires Permitl construct. It imp demolish. rep y t tm BUILDING ._S4
€m
Prior to ts issuance.u1sa requirestherplemf h permittnsigned.tt nt
8.
that he k r osed Iiursdion tothe pravisions ofth Contractor,License Lo (Chapter 9 .). S .F[. Floor:Area' Valuation
(commencing with s«r 7W0)orniss Division r3tidne.,and Professions cWe) r '. q•• ,,� 'tj .'t, G'};.J n.
or that he ii exempt theexfinen8nd the basis for the alleged exemption.Any violation 3 6 2 0 3 0 2 7'.'0 0
of section 7031.5 by any applicant for a permit subjects One applicant to a civil pennity-
ofnot room than five hundred dollars 1S500). APN Number ",rt Occupancy Type
C 1.mrof the property,or Illy nnployees with wages as their sole compensation. 305 — FRAME
will do ror work:and the mrvmare is nor intended or ottered lot sale(Sec.70W. ULA-
Buiincsi and Professions Code:The Contractors License Law does not apply to an Inspections'' S-'I
owner ofprepeny who builds or impasses mtirtion.and who does such work himself 601 - ROOF TEA
or erectthroughfor
ma own employees.provided that such improvements is sole art not intended or -- 6 0 2'--- .ROOF-�PLYWOOD' NAIL Tr'-.
orcti.edror axle.If.however the building or improvement i.onto witni�one year nr" ._
ioiilpleti"n,the owner-builder will have the burden of proving that he did not build or 603 - ROOF BATTENS F"
mprove I.,purpo.enrrale.). 604 -. -ROOF._IN-PROGRESS-- ---
---
Q I,as owner of the p mrY.am exclusively cn shisc ing with licensed contractors to -- 1.
_ construct the project(s«.76N.Business and Professions Code:)The Comrvmor's ,..,n . . 'It !H. ..
Licensc Law does not apply to an owner of property who builds or improves thereon,
and who,e nrucls far such pracma w m.a.coourfew(s)IicensW pa....mr. he
Contractor's License law. 1 11
01 em exempt under S« _. .B&P C fonhis reason
_ _ Owner- . , - Dam WORKER'S COMPENSATION DECLARATION
I hereby ullinn under study of perjury one of the following dedinummns:
0 1 have irM will maintain it Cerificam of fomentoro mlf-insure for Workers
Compcmmion, as provided for by S«riot 3700 of the Labor Code, for the
performance of the work for wM1ich chis permit is issued. � ,
C 1 havc'nnd`will mainsails Worker's compensation Imurarice,'as"Rima by Section
3700 of the Labor Code,for the pelfomlanfe of the woik.for which this permit is
C issued:My Wod<fs Compensation lnsurerlce carrier and Pbliry number
aro. W i TIO l. ..P_,;:,,y 13071 QR. y} �. t➢ � 1 -
TIFICATIONOFE%E ON FROM WORKERS'.
'IThis':xti COMPENSATION INSURANCE' r, ___ ... ....._.. .�.._.--._
�or 77 ER
'- od.ednm ix eninpletei if the permit is for one hundred dollars -_ Ipso X 1:111 "1".• :,':.'I il's;;RC� i:';•
•o -
($100)or less.) ,
It em l Thar n the p in any
no of M k f' K h u p rt e slued I
shall not employ any fCnon'n any manner so as to became subject no the Workers
ComAPpLpensation Laws of California
is.Data
NOTICE TO APPLICANT.If.after making this Ceni(cam of Exemption,you should "• "
became subject to the Workers Compensation provisions of the Labor Cade,you must
z� 0 f7m,with'mmply wino such prnvisivas m this pertain shall be deemed revok..ed. ..:
'•�'.� ..� •CONSTRUCTION LENDING AGENCY
a > ' I.hercby R that the n c nst tion lend ng age y f rhe peifarro nee -'x •+ '
of the "k for-which thperms is issued(5 3097'0,C) .:. ._.. .... ....... ____—. __. ..._
Q .. . -_ ._. ....._ __
� Ccnder N e
. .U. Z Lcndc AJd rt,:! r :JI`C1 E
U QIc nify than f h e rc d rM1 s applict d silt Nat rh bo a mfmma o is
h Eco6ea 1 agreerocomply wish all city and county ordinances and state laws existingU m Wiiaing emshuctidn.and hereby authorize'representatives of this city no enter upon
rhe above-mntionedimendforifyadionpurposes.y Iwe)agmem.aro,andepenses whih may inthees say(cruengainst aid /
L h City liabilities,judgments,costs nntl expanses Permit.
rmimay in any way accrue against said
(,1 City in CANT UNDERSTANDS
of the granting D This permit "
APPLICANT UNDERSTANDS AND WILL COMPLY WITH'ALL NON P�Ier Issued Date
SOURCE RE ONS. .. - /1—„//—�, yS
L+ .4 /
sur rA 1+canucontla to Re-roofs
, HAZARDOUS MATERIALS DISCLOSURE '
u
wu to pplkant or Potum Nddnig IXC parrs t re,r aortal harardoru martinet Type of Roof
udefnad by the Caroms
Caro ssMunicipal
,1Cod Chapter
l9t'.2,rand the ficalthardStaficty
Code Section 25532faI ,_ - . • = , f,
El Allroofs
shall.be inspected prior to any roofing material.bemg.installed. . _....._.__IT
__.
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection;1 agiee`to remove
emit haimdous air,conmmitu nu as'defined by the Be,Arca Air Quality Managemem
C3'as
q all non-point source regulations.' ..., understands and will comply with
Dist t . 6 all new materials or inspection. Applicant and _ -
1 h d the h zhN mprtrial. e u cm ti oder Chapter 6.95 of rbc
Cel f H' hh&Safety Code Sect o.25503 25511 d 2553G 1 understand d that
dyhe W Id g d not currently base ¢ant that t Y repo- b 1 ty r notify the
occupi m of the mgfiransi whmh mon be met prior m ...a..of a Cemficia of
° "p"`Y'' Signature of Applicant Date
^` 'r D „raumorive Me All roof coverings to be Class"B”or'better
- OFFICE -. . . _. . .
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
OCIOF Fax: (408)777-3333
CUPEPTINO
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 V"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 abovepolicyon reroofing and will comply with this policy.
Homeowners Name: (U A Ji)C U l' 1 cPy
Address:
Reroofing Company Name:
La
Applicants Signature: Date: 9 —1 -o a'
• Joe Antonucci ^_
(Chief Building Official)
6/25/01