02100192 (2) f CITY OF COPER'CINOwl� `- •'
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUI1]D&(1691Gs0ASS PL PFAHLER' S ROOFING & WATER M9f7002100192
OwWOORK ROY K AND SYLVIA I 377 COLVILLE DR APPLICATIPnsl"'Y2002
All
14 1 ZONE: (408) 224-9013 SANITARY NO. / CONTROL NO.
ARCHITECT&NGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
On. LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing REBOOT Job Description
1XXf0
<("o� with Section 70oivision Sof the Business ofees ndPrssions Code,and my license
F m full fn e a deem. ' 69 6
,,n6 License Cl f-R Lic.
G ut i- ate G Cna" lar
F� ARCHITECT'SD ATION
qq O a��)
2 - 11,x unenJ my plans shall u.¢J eT(Rt tc rotes',
dOyU _/�</////
un�at, Licensed professional
S OWNER-BU ELDER DECLARATION
o� 1 hereby ufrom that 1 am exempt from the Contractors License Law for the $10000
w—p0 following mucam.(Section 7031.5,Business and Pnsfeseions Code:Any cityor county
s $ which arquires a permit to conswa,,her,improve,skmolish,nr repair any strumme
prior to its issuance,also architect the applieml for such permirt)file a signed smtemem
�SS'�xx< that he is licensed pursuantn the provtsinoof the Contractor's License Law(Chapter 9 3*71AHO"A&G Valuation
yFm (commencing with Section 7q00q of Division 3 of the Business and Professions Code)it
$ Nn be is exempt stateroom and the basis for the alleged exemption.My violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of PN N Occupancy Type
not more than five hundred dollars($50f. 3 07 - INSULATION
I,ea owner or he property,or my emplmyecs with wages as their sole compensation.
will do One wart.and the structure is not intended or offered for sale(Sec.7044,Business ��µf
and Professions Code:The Committees License Law does not apply m an owner of 602 - ROOF P p([,J n fMCl i2ns
property,who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements the not intended marmot for side.If. 603 — ROOF BATTENS
however,the Wilding or improvement is sold within one Pur efcompletion,the nwoer. 6O4 — ROOF IN-PROGRESS
builder will have the burden of proving that he did not Wild or improve for purpose of
salt.).
❑ h as owner of the property,am exclusively contracting with licensed ccoom to s fm
construct the project(Sec.7044,Business and Formosa,Code:)The Contracmrs V.
cense Law deo not apply m,an owner of property who NEW or impmvxs Hereon,and
who contracts for such projects with a conumucrof licensed pursuant to the Commerce,
Liteng Lew.
❑1 am exempt under Sec. .B A,P C for this reason
Owner Dare
WORKER'S COMPENSATION DECLARATION •
1 hereby eRinn under penalty of perjury one of the following declarations:
I have and will maintain,Certificate of Consent m self-insure for Worker's Compere t
anion,as provided fur by Section 3900 of the Labor Code,for the performance of the
work for which this atiremain is issued. a
❑1 haus and will maintain Workers Cone of e w loumntt,h hisacqcod t I Section
ssu d. III'Ifl e,� j'
471X1 of Ne Ichor Code,for Neperfmmence of Ne work for whish this permit I,issued. P Ste/ 1
My Workers Compensation Insurance terrier and Policy number art: se+ r 1
Ca er:�� Fv.. ��`,y1�r`J�NO.: ___
CE1 FI ATE OF E%EMr(}nn FROM WORKERS'
COMPENSATIO INSURANCE
(This settinn need nm tic cumplemd if tM permit is for enc hundred dollars(511X))
or less.)
1 certify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner u,as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Workers Cumpenamion provisions of the Labor Code,you most
D ,Z forthwith comply with such provisions or this perm if shall W deemed revoked.
z O CONSTRUCTION LENDING AGENCY
(r I hereby affirm that there is a construction lending agency lot he performance of
pi > the work for which this permit is issued(Sec.3097,Civ.C.)
UJ Cantles',Namc
az I<mdar's Address
U Q I cenify that 1 have read this application end sum that the aWvc information is
L6 correct.l agree to comply with all city and county ordinances and state laws relating to
O V Wilding construction,and hereby authorimrepmmnutivesofthis city toenter upon me
W above mentioned property for inspection purposes.
(We)agree to save,indemnify and kelp harmless the City of Cupertino against
y liabilities,judgment%.costs and expenses which may in any way accrue against mid City
U `z in consequence u(me granting of this permit.
�+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE REGULATIONS.
D /- Re-roofs
ig rose of Appli,an o carr O,Ic
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant or future building occupant store or handle harudous material
o defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Stettin 25532(a)a All roofs shall be inspected prior to any roofing material being installed.
❑Yes �c
Will the aPplicam,,or(uwre buil aaupunf mecyuipmcnl m device which If a roof is installed without first obtaining an inspection,I agree to remove
9
emit har..does air cntn,minanu as into by the Bay Arc,Air Quality Management all new materials for inspection.
District?
❑Yes No
1 have rend the hamrdous materials requirements under Chapter 6.95of the Califon
.is llcelthbi SWcty Calc,SCNnns 25Y)5.25533 it 255J4.Iunderstand thmiflhc building
deco nm eunc which
a tenant mm it is my nce rfaibility m notify the occupant of the C 5�
archuiarmenu which muvbecon prionnissuance este Conifxatc ofOmupancy. IgnalHre Of Ap�/1Cant Date
o eraramt mind agtml ma All roof coverings to be Class "B" or better
Building Dtviaion
10300 Toga Avenue
Cupertino,CA 95014-3255
` Telephone: (408)777-3228
0 Pax: (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
Wand 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 roofmg 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.
nAPORTANT:
1. Flat roofs must have a minimum of Ya"per foot slope and demonstrate that
there is no ponding.
2. An LC.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�v Y eOzE�/
Adder: CSA s s 014 c.E
Reroofing Company Nan4_Z�,�// s �eri FiuL
Applicants Signatt* / a�
S ,OP Azq--� •
Joe Antonucci
(Chief Building Official)
MUM