03010122 (2) C�
CITY OF CUPERTINO r '.'
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION -
�. -
s� BUILDING ADDRESS' yADVANCED ROOFING TECHNIQUE PIiRMIT NO.
a 10790 CARVER DR.
OWNER'S NAME: 1179 MYRTLE DR APPLICATION SUB DATE
HOWARD PITNEY 01/23/2003
HONE: (408) 249-4937 SANITARY NO. CONTROL NO.
ARCHITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MMI
pp LICENSED CONTRACTOR'S DECLARATION
P4 1 hereby affirm that I am licenud under provisions of Chapter 9(commencing Job Description
with Section 70)0)of Division Sof Ne Business and Professions Code,and my license is
E mf BR caadeffect. �7 oQ REROOF
zog: Lie ?Class c-'SY r.r"r
F=q�q (H —G ARCIIITf:CI'SD�Cr ATI T/O BUILT-UP ROOF, INSTALL 30 YR DIMENSIONAL
0 Niy 3 I understand my plans shall M mic' public MOMS
oyu
Licensed Professional
OWNER"BUILDER DECLARATION
ann�yy I hereby affirm that 1 am exempt from the Contractor License Law for the
"00 following reason(SeBusiness and 7031.5.Busineand Professions Cole:Any cityar county
sae$(L which requires a permit to construct.alter,improve,demolish,Or repair any structure
m�'^ prior m its issuance,atm raluires the applicant forauch permit to rile a signed statement
that he is licensed pursuant o the provisions of the Contractor's License Law(Chapter 9 Sq. Ft. Floor Area Valuation
�F$ (commencing with Section RXXd of Division 3 of the Business and Professions Code)or
r3' that M is exempt Ihemfrom and the baso for the alleged exemption.Any violation $7500 of Y
Section 7031.5 by any applicant for a permit subjects the,applicant to a civil penally of APN Number Occupancy Type
Out more than five hundred dollars($500). 37532005 . 00
❑I,as owner of the property.or my employees with wagesuthch role compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7(NX,Business
and Professions Code:The Contractor's License Law does not apply to an owner of 305 - FRAME Required Inspections
property who builds or improves thereon,and who container work himself or through his
own employees,provided that Such improvements am not intended orortemd foraale.If. 307 — INSULATION
however,the building or improvement is roll within oro year of completion,the Owner-
baader will haw the burden of proving thm he did not build err improve for purpoSe of 601 — ROOF TEAR OFF
sale.). 602 - ROOF PLYWOOD NAIL
❑I,as owner of the properly,am exclusively contracting with IicevW contractors to 603 - ROOF BATTENS
consumer the project(Sec.7(W.Business end Profes,ima Code:)The Contractor's Li-
came Low does noupplyto an owner of property who builds orimpmvesrbemon,and 604 - ROOF IN-PROGRESS
who contracts for such projects with a contracim(s)licensed pursuanno me cminctm
License Law. 1 qtr
❑ lam exempt under Sec. .Bd:P C for this testi ,311 /J
Owner Data ,rra•-
WORKERS COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declantions
I have and will maintain a Certificate of Curacao to til binmre for Worker Co
.tion,u provided for by Section 3700 of the Labor Code,for me peHmmaace of the -
work for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section f
3700 of the labor Cole,for the performance of the work for which this permit is issued. /
MyW ker' Cionfamas nlnmmncccanier Ey number are: 1
fti
SL. I� Q wRlNn.:/SYaR53-V
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Tris Section need not he completed[[the permit is fortune hundred dollen(Sla)
or hiss.)
I cenly that in the performance of the work for which this pmmit is issued,I shall not
employ any person In any manner an as to become subject to the WorkersCompemation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:IT after making this Cenificme of Exemption,you shouW
become subject to the Worker's Compensation provisions of the Labor Code,you must
O7O forthwith comply with such provisions or this permit shal l be deemed revoked.
q CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a constmction lending agency[(it the performance Of
ai 7 the work for which this permit is issued(Sec.3097,Ci,C.)
W Q Lenders Name
G Lendcr's Addmss
U 0 1 certify that 1 have read this application and sure that dre above information is
W f+ correct.I agree to comply with all city and county ordinances and stale laws relating lac
D Vbuilding consWaion,and hereby anthoriae representstives of this city to enter urym the
W abovmmentioned property for inspection purposes.
G (We)agree to save,indemnify and keep harmless the City of Cupellum against 42
y liabilili<s,j ,c and expenseich may in any way same agarose sale CityV z AP on CANTCUNDEgr TANDSthr WILL COMPLY WITH ALL NON-POINT Issued by: Dale
RCE REGUL ONS.
LRe-roofs
S4hZ.rff AppiwanVConuacom 11 Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant or fulurch ' ng cecupam smrc or handle haasNuus material
u defined by the Cupertino Mun' al Code,CNpmr 9.12,and the Health and Safety
Code,Seerinn 25532(:)9 Na All roofs shall be inspected prior to any roofing material being installed.
Ves
Will the applicant or future buildicupaor use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit haasrdoua air common ntsu ed bythe Bay Area ABQuality Management all new materials for inspection.
District?
❑Yes o
I haw mad}bNrar nus marc' Is"rimremcnu under Chapter 6.95of the Califon
nia Hcaldt5 1 yet Coa cmw2 5,25533 and 25534.1un&.,d that if the building
dons qm emly haws neral,! lis art espnmihiliry m ramify tM oncupons nl he
ON enuwm<n rot Ire me dr mcamar.ofacenincam err 0.cupancy. Signature of Applicant Date
27-
oathmived agent m All roof coverings to be Class "B" or better
f.
Building Division '
" 10300 Torre Avenue
i. Cuperdno,CA 95014-3255
` Telephone: (408)777-3228
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'✓"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:
Address: 1 U Z `l.Q C-c� r � n—•r-- `fir ,
Reroofing Company N
Applicants Signa Date:
Joe Antonucci
(Chief Building Official)
6125101