03010078 (2) CITY OF CUPERTINO ' :t s
BUILDINC DIVISION PERMIT CONTRACTOR,INFOR *ION l
BUILDING ADDRESS; DAN ELLIOTT' S ROOFING CO PERMIT NO.
21053 CHRISTENSEN DR 03010078
OWNER'S NAME: 2669 COI T DR APPLICATION SUB DATE
LEE SIMON AND SYLVIA 01/14/2003
ONE: (408) 559-7327 SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
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p00 LICENSED CONTRACTOR'S provisions
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y1 V' 1 hereby affirm that am licensed under of Chapter 9(mmmcming Job Description
with Seetion 7000)oroivision 3 of wa�usine.samd Professions Code.and my license is REROOF p
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OWNER-BUILDER DECLARATION �D'�
u� f I hereby affirm that I em exempt from du Camracmr's License Lew for the ' I G
w—p 0 following mason.(Section 7071.5.Business and PmRssions Code:Any city or county v
e' $ which requires a permit to construct,alcor,improve,demolish,or repair any structure
za prior to its issuance.also requires the applicant for such permit to rile a signed ststemem
that he is licensed pursuant to the provisions or the Contractor's License Law(Chapter 9 Sq.Ft. Floor Area Valuation
$ (commencing with Section 70)(B of Division 3 of the Business and Professions Code)(it
..
that he is exempt thorefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number cy Type
not mom than five hundred dollars(S500).
0 1,as owner of the propeny,or my employms with wages as Back sole comperuation,
will do the work,and the suuctom isnot intended orolfered for sale(Sec.7060,Business 32654004 . 88
and Professions Code:The Contmcmrb License Law does not apply to an Owner of Required Inspections
propenywho builds orimpreves thereon,and who dmssuch work himselfor through his j
awn employees,provided that such improvements art not intended oroRered formic.If, 305 — FRAME
however,the building or improvement is cold within one year ofcompletion.the owner- 307 — INSULATION
Wilder will have the Which of proving that he did not Wild or improve for purpose of
sale.). 601 - ROOF TEAR OFF
0 T,as owner of the progeny,am exclusively contracting with licensed contractors to 602 — ROOF PLYWOOD NAIL
consumer she project(Sea 71164,Business and Professions Code)The Conuumrs Li.
came law dors ma applym an..,of property who WBdsm improv ft...and 603 — ROOF BATTENS
whoconuacts for such projects with a confactons)licensed pursuant to the Contractorb
License Law, 604 - ROOF IN-PROGRESS
0 I am excmp under Sec. .B k P C far this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury oro of the following declarations:
1 have and will maintain a Ceniricau of Consent to ulpinsure for Worker's Compeo-
sation.as provided for by Section 7701 of the tabor Code,for the performance of the
work for which this permit is issued.
0 I have and will maintain Worker's Compensation Insurance,as required by Section
3700of ile labor Carlo,for NC perfomlane,of the work for which Ibis permit is issued.
My Work o pens on 1 sumntt carrier enJ Policy nun am:
Certie I POlic .:
— CERTIFIC •OFEXEM TION WORKERS' '
OMPENSATION INSURANCE
(Thissectim need not becompleudRrite .if is fo mm hundred dollars(SI01)
or less.)
I certify that in the perlommnce of the work for which this permit is issued,l shall not
employ any person in any manner m as to become subject to the Workers'Compensation
Laws of Calromia.Dau
Applicant
NOTICE TO APPLICANT:If,after making this Ceniricate of Exemption,you should
hoaome subject to the Worker's Compensation provisions of the V hor Cale,you must
OO forthwith comply with such provisions or this permit shallW deemed revoked.
z^ CONSTRUCTION LENDING AGENCY
t—I I hereby affirm that there is a construction lending agency forte performance of
Ci > the work for which this permit is issued(See.3097,Civ.C.)
GQ Lender's Name
Z Lenders Address
V C I certify that 1 have read this application and slaw that the show information is
II. F correct.l agree to comply with all city and county on imnces and suis laws relating to
O V building consionction,and hereby andarrine representatives Or this City to enter upon the
shove-mentioned property for inspection purposes.
C (Wc)agree to save,indemnify and keep harmless the City of Cupertino agairst
rA liabilities,judgments.costs and cxpnaus which may in any way gimme against said City
C)7 ANT
cnnuq Oof the granting of UNDERSTANDSIAND WILL COMPLY WITH ALL NON-POINT Issued by: Date
F7 S R TI N
Re-roofs
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HAZARDOUS MATERIALS DISCLOSURE Dare Type of Roof
Will the applicant or future building Occupant store or handle hazardous material
as defined by Ne Cupertino Municipal Code.Chapter 9.13,and the Health and Safety
code.Sm es3ss33(.)? All roofs shall be inspected prior to an roofing material being Installed.
❑res P P Y 8 8
Will the applicant or future building Occupant use equipmeru or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit haeardous air constomm s as dchned by the Bay Arca Air Quality Menagcmem all new materials for inspection.
Dimrict?
Cl Yes
n
I have read Bac Wurdnus materials requirements under Chapter 6.95 the Calln ..
niaHondo♦k Safety Code,Sections 355115.35577 and 3557d.lundcrsland that if ifthc building
en=
oe s c n h e tenant, it is my moponsihility to modify IM Occupant of the
reui u i sI hem Twismanceofe Ccnificate fOccapancy. Sig attire of Applicant ate
.. ✓ X03
Yo ne,a th.f,.d agent Date All roof coverings to be Class"B" or better
Building Division
10300 Torre Avenue
i . Cupertino,CA 95014-3255
Telephone: (408)777-3228
Pax: (408)777-3333
CUPEF�TiNO
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 VV 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: C' l.Y~ A v� 0 tvt.
Address:
Reroofing Company Name:
Applicants Signature: Date:
Joe Antonucci
(Chief Building Official)
6/25/01