02070043 (2) CITY ILDIING
BUILDING CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20343 BOLLINGER RD 02070043
OWNER'S NAME: APPLICATION SUB DryTE
HUNG LUONG AND TERESA T 07/08/ 2002
PHONE: IJ e�
SANITARY NO. CONTROL NO.
w�� ARCHITECirENGIN/EER: BUILDING PERMIT INTO
<u BLDG ELECT PLUMB MECH
--"t 1-1
N= LICENSED CONrMACTOR'S DECLARATION
pz_C I hereby alBrrn Nat 1 am licensed under provisions of Chapter 9(commencing Job Description
F„�-I with vS,enction 7000).(Division 3oftheB esaand Professions Craboundmy hpenae REROOF
���< ii fiac¢`:.,ne ".ft C3KLicn Gr16y7 T/0 SHAKE, APPLY OSB PLYWOOD &
o ar u Data Cotr�t, �For I'K A—t` &
go ARCHITECT'S DSXARATION COMP SHINGLES 30 YEARS .
a g 1 undersmml m/]J'��sMll be used as puhhe rccnNs
iz o O I�ce1�i c�Professionaal 11 LZ,.O
OWNER-BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
M- < following reason.(Section 903 L5,Business and Professions Code:Any city or county,
Em o which requires a permit to construct.alter,improvise,demolish,or repair any.uuctum
at3 ._prior so its issuance,also requires the applicant for such Permit file a signed smlement.
that he,irlicerad pursuant to use provisions of the C,nnmcsor'x License Law(Chapter 9 S F FIOOr Area
(enrrit enemg,with SeNon 701)0)of Division 3 of the ness and PrOfe timt Cork) ;”)'i';' q"y-�, i t a.t: Is j'a t $6 6(y01 nation
or then he is exempt MerefroR and the basis for the alleged eicmgion,Any violation '
-of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
of not more than five hundred aouara(55dn). 3 6 9 R6 krTh"U .... Occupancy Type
O 1.asowrrcror the P Pent Y employees with a..auheir sole compenmtion.
will do the work and the awcturt is a.,intended 01 offered for sale(Sec7011 - -- -- ----- - _...
Business and sol W n Code:Thec t et ,an Law does not app) man 305 - FRAME Required Ins ecnons
owner or propeny Who Wades or mire es thereon,end who encs such work intended
or 9 p
or through his own employees.provided W.en such imprm'aments are not enc yew or 307 — INSULATION
bffaed rot sale wnw-buf. vcr,the will
hav n — - - 1 --- -- l
g'or tinprmemem's sold wnhtn ane Year of --._ .... ..._ _.... ... ._.... .
601 — ROOF TEAR OFF
ompinion the owner builder wtll have the burden of prov ng that he did act build or ... I
`mprove for pnrpse nrame)' 602 — ROOF PLYWOOD NAIL
property.nmexclusively contracting with becnsedeenmacmrsto* 603_ ROOF BATTENS_ .._ ...... ._. __._.._ .
wm uO the project(Sec.7011.Business and Professions Code:)The Contractor's
License Law does not apply m an owner of propeny who builds or improves thereon, 604 — ROOF IN-PROGRESS "I•'
and who contracts for such projects with a ournowror(s)licensed pursuant m the
Conhecmr,License Law.
❑I am caunpt unecr Sec. '� �•,B&P C for this rtason
Owner Dam .
WORKER'S COMPENSATION DECLARATION �tf ,,pp pp
',• thereby aRm runder penvlsy of parjarY nice of tM1e following declarations: PIN ALE13
❑ 1 have and will maintain a Cenificare of Consent to self-insure for Wmkws
Compensation, as provided for by Section 3700 of the Labor Core, for the pe 11 11 1 8 2002
.. ormoocc of thewk I h' h sti a Is'. d
-- bf 1 have and will ma ma W k Compensation In ane tid by Section
3700 of the Labor Chi f the Performance f he week far which his pe.I,I,
issued.My Workers Cmupe.,afifor In su we d Policy b
�a STAT'
ILDING
-io`4 o iw
.
I CERTIFICATION OF EXEMPTI (ROM 110RKERS f.i it j !} 1,ft, , '(,Tits \�'IS
.. ,. _ COMPENSAriON INSURANCE'S s
. section need not be completed if the permit is for one hundred dollars
IS 100)or1 less) "s• `
I c of 4h t in th ,u trued 1
Y pc f m n 1 r k 1 me tit' itis
Com not employ any penon in any manner so as to become subject to the Workers
Comicant ion Lawn of California.Date -'
Applicant
NOomesbj APo the Workers
altermast nprCmonsofofB -- -_ -
ns remotion.Ton annma ... ....... .. .. .
Z become comply
the Workers Cuions or
provisions of she Later code.you man '
z 0 fonbwith compiY with such provisions or this permit shall be Jecmee revoked.
CONSTRUCTION m,isnLENOINGAG ENCY
ar 1 h aWy'trmt that thee '.warm leading agenry for then performance --
of
the work for ishich this permit is is=uee(Sec.3097.Civ.C.)
y Q Lender's Name o
Lender's nJJrcss - - - _ .... _. . ..... __...._. .. . .. _
C.7 1 crody that l hove rend this application and.wm rho the obese information is
I agree in mmPly with all cityand county mehmnces and nate laws relating
0 (, to building connamhnietion.and hwuhyoriza representmivea of this c,ts,c enter upon
} W the above-mentioned pmpny rnr inspection purpnms.
-[.. 0:" (We)agree to save.indemnify and keep harmlcssthe City of Cupcnino against
0 liabilities.judgments,casts and espenus xhich may in any svay acerae against said
.0 Z City in consequence of the granting of this permit.
\ URCNDERSL\IJUS ASD\VILE CO>IPLY N'ITH:\LL 60N-POI\T
REG'
"
._,'•y-�1ors.' Issued by:
)uacE Dale'
tion• Inrw Le8-6R�'
Stgnamrc oGlppbcanVCnmractor V>Drie
pP g pant.tore or handle hazudou m Type
of.
HAZARDOUS MATERIALS DISCLOSURE
Will the oleo future Wilding ac
asdcfncdhY th Coleco oM pal Cod,. (T ps 91 .a dthcH bh nASafety
Type Of.Roof......—.... ..._ .... • ..: ,.
Cwl S t 23532(a)? .
❑Ys 'N fo ys - - t .'s a ' j of ( .h, In y..
All,roofs shal[be inspected.pn0r to'any roofing material being installed,
e Will the applicant future building v t yn p t e .im h If a roof Is installed without first obtaining an inspection, I agree to remove
nth by r not t ,defined by the B y ar..b Quality Mao,ge m
Diaall new materials for inspection. Applicant understands and will comply with
+ all non-point-source-regulations, - -
1 have read the huroandour. n serials requ rc nems under Chapter 695 of the t
Chiffrore Health&Salary Cri S tions 25505.25533 and 25534 I understand that
if the Wilding does not currently have a tenant.that it is my responsibility ne,of
to notify she
occupant of rhe a,iremenn which mbe ust mer poor so nsuenae of a cro r
Occupancy.
_ d
nature of Applicant )ate
[, 'wnernr apmnnzea agent Dam All roof coverings to be Class."B" or better -
.. "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 1/4"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: I testi tl
Address:\L x0247 Gy��irY e✓ R�( -
Reroofing Company Name: , /(2 - DONS �UC<<�a� 4� Pori-iitfT�
Applicants Signature: Uh,:vv ✓ Date: 7.-o 8 -O,?
Joe Antonucci
(Chief Building Official)
6/25/01