02100180 (2) CITY OF CUPER'1'INO xi, ia
BUILDING DIVISION PERMIT :"CONTRACTOR INFORMATION py
1fU"MOMPOEaCANYON VISTA CT ROOFCO OF SILICON VALLEY PERMIT"92100180
'2
D 44P� qO DEEP CLIFF HOA 844B EARLE AVE APPLICAT!M`Y 8Tg2002
Ah
IF'ZONE (408) 795-3335 SANITARY NO./ / CONTROL NO.
ARCHEFECT!ENGINEER: BUILDING P12RMIT INFO
BLDG ELCCf PLUMB MECII
�Op LICENSED CONTRACTOR'S DECLARATION
�P I hereby-!firm that l am licensed ander Provisions of Cheye,9(commented, REROOF Job Description
eat with Bretton]IXZ,,f Divixess lan Sof the BusinProfessions Code.and my license is
_,ay in full tomcat ftt1,
ozan,? Liccnu Cl G` /`I Lic. 77
�, Date —,tyl— Z�IE"_ Co o
ARCHt1ECTSD RA N
2� a v I understand my plans shall be used as public ret its
KOdU
FLLa� Licensed Pndcasinnal
< OWNER-BUILDER DECLARATION
1 hereby altirntIbe,1 am exempt from the Contractors License Law tin the [�
w p o ellowing mason.(Secunn]1131.5.Business and Rofcssions Crwc:Any city far county $12000
m which requires a permit m comaidi alter,improve,demolish,or repair any suction:
prior to is issuance,also requires the applicant(o,such Permit o Glc a signed statement
that he is licensed pursuant un the provisions of the Contractor's License Law(Chapter 9 Mg6Et20631 Meg0 Valuation
m= (commencing with Section 7(M)Of Division 3 o the Business and Professions QWe)or
a 3 9 that he is exempt therefrom and the basis for rhe alleged exemption,Any violation of
Section 7031,5 by any applicant for a permit subjects the applicant to a civil penally of
not more than five hundred dollars(ssm). PN N Occupancy Type
307 - INSULATION
Lo the work,the property.mmyemployees dwith wages astheir(See compensation,
will do the work.and theswcturc is not intended or offered for salt(Sec.]01(,Brininess 6oi -
and Professions Code:The Contractors License, W V law docs not apply to an uwrrtr of 602 - ROOF P n1tlH l LDS
property who huilds or improves thereon,and who doassuch work himself or through his
own employees,provided thmsuch improvements are not intended or offered for sale.If. 603 - ROOF BATTENS
however.she building or improvement is sold within one year of completion.he Owner-
builder will have the burden of proving,drat he did not WiLd or improve for purpose of 604 - ROOF IN-PROGRESS
sale.).
❑ I,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7040,Business and Professions Code:)no Contractor's Li-
cense Law docs not apply m an owner of property who bunds or improves thereon,and
who contracts for such projects with a coaractorbo licensed pursuant o the Contractors ��� �A
License law.
❑ l am exempt under Sec. ,B&P C for this reason
Owner Dade NOV 15 2002
WORKER'S COMPENSATION DECLARATION
1 hereby afGrnt under penalty of perjury one of the following declarations:
❑]have and will maintain a Ceniiicam of Consent tel f-insure for Worker's Compcm BUILDING
ation,as provided for by Section 370()of the labor Code.for the performance of the BUILDING
Vl
work for which Nis permit is issued.
❑ 1 have and will maintain Worker's Compensation Insurance,as required by Section
3]0O of the labor Code,for Ne performance of Ne work far which this permit is issued.
My faker's Compensation l farce came,and Pn by number are:
C ter. �J7Q7P P No.:�(�r7znr�
CERTIPICA OFEKEM ROM WORKERS'
COMPENSATION INSURANCE
(ITIS section need not he completed 11 the permit is for one hundred dollars(S lip)
rr Icss.)
1 certify the home performance of the work or which his permit is issued.1 shall nor
employ any person in any manner m as to become subject to the Workeri Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Ccnilieate of Esemprion,you show lJ
bcarme subject to that Worker's Compensation provisions of the Labor COJe,you most
0 z forthwith comply with such provisions or this permit shall N deemed revoked
Z O CONSTRUCTION LENDING AGENCY
[-� I herby a0irm the there is a ctmsuaction lending agency lin the performancenf
ai the work for which this permit is issued(Sec.3(19],Civ.C.)
lt7 A Lender's Name
LL Lender's Address
U 0 1 eenify that I have read this application and same shat the above information is
ly F^ correct I agree to comply with all city and county ordinances and sum laws relating to
Q U building construction.and hereby aulhoris representatives of this city to toter upon the
abosc-mentioned d pmpc costs
Inn inspection hes purposes.
Fy (We).9.mave,indemnify and keep harmless the City of Cupenino against
y inconsequnce of the
gaining expenses which may in any way came against said City
U Z APPLI gncncc of DERSTAN of this D WILL
r. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOU EREGULATE)
dao rfAppac rntaemor Re-roofs
Da
HAZARDOUS MATERIALS DISCLOS E Type of Roof
ill the applicam far future building occupant store or handle haardous material
az defined by the Cupeninn Municipal Code,Chapter 9.12,and the Health and Safety
Cork,Section 25532(a)?
❑Ye.'s kyr.— All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building occu t use equipment If a roof is installed without first obtaining an inspection,I agree to remove
ran yai dnrdeviceswhicn g pe
mit ha,mdous air conuminankc as defined by the Bay Area Air Quality Management all new materials for inspection.
Di.ynci!
Yd"
[have read the hat Wiousmamrialsfcyuirement,under Chapmr6.95ofthe Culifnr
dial.cathurently haw
amant,shat it is myram12553a.1 in madly Ore,
Oempfft It 01m
does not currently Haze a¢rant that it is my respmsibility m lso myd rw'cupanr of Ne
;jams ants deIprimmissuaneeof0Cc �amot lapaney. Si lureofApplicant Dale
C6-2p-6
Z
taw y,n,.1 a e Bate All roof coverings to be Class "B"or better
Building Division
D 10300 Torn Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY Of POST $ $'"Z D 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
•
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 IV"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: 1 ,:.012 124-
Address: /OA,��
Reroofing Company Name: /200 (�
Applicants Signature: Date:
Joe Antonucci
(Chief Building Official)
6W101