03010092 (2) CITY OFCUPERTINO -
BUILDING DIVISION PERMIT m,CONTRACTOR INF'O.N.AMN:.
BUILDING ADDRESS: PERMIT NO.
6559 CLIFFORD DR 03010092
OWNER'S NAME: APPLICATION SUB DATE
COOK CLEATIS L 01/15/2003
HONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INPO
BLDG ELECT PLUMB MECH
0 0 0 0
�0 0 LICENSED that
I amCONTRACTOR'S DECLARATION
top I hereby affirm thus 1 am lift Bu under and
of Chapter 9(rommenseis Job Description
�u with Section 71XXpaf Divixion J of dm Business end ProfcssinnsCmc,evd my license is
zoN thorn roma awe t.� $D7 S83 ter REROOF
gZ Liccnxc Cl s Lic.p
oz-o Dare Conn.,., � - __ T/0 COMP. , INSTALL 50 YR. COMP.
q�q')` ARCHITECT'S DECLARATION
a 1 u dersl d my plans Nall be used as public recofds
dO�U
W LL 4O F Licensed Professional
OWNER-BUILDER DECLARATION
is p 1 hereby efBmt that l am exempt from she Conwctotn License law for the
100 following maxim.(Section 7031.5.Business and Professions Cmlc:Any city or county
°�$� which requires a permit to construct,alter,improve,demolish.or repair any structure
FZi prior to its heeuaace,also requires the applicant forsuch action no fdcasigncd ttstsmmcm
mm� fin he is licensed pursuant the provisions of Contractor's Law(Chapter Sq. Ft. Floor Area Valuation
F (commencing with Section 7(XXB of Division 3 of the Business and Professions Code)or $3250
99
9 Nat he is exempt therefrom and Be basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty of APN Number Occupancy Type
nut roam than EK hundred dollars($500). 36926004 . 00
I I,as owner of the properly,or my employees with wages an their able compensation,
will do the work,and she structure is not intended or offered for sale(Sec.7044,Business
and Professions Code:The Comractmes License law does net apply to an owner of 305 - FRAME Required Inspections
property who builds or improves thereon,and who does tech work himself or through his
own employees,provided that such improvements are not intended oroRered for aide,If. 307 — INSULATION
however,the building or improvement is sold within one your of completion,the owner-
Wilder will him fthuman ofprovingthat he did not Wild orimprove for purposeof 601 - ROOF TEAR OFF
sate')' 602 - ROOF PLYWOOD NAIL
11,es owner of the pmp xty,am exclusively contracting with licensed convectors to 603 - ROOF BATTENS
construct the project(Sec.7044,Business and Professions Code:)The Command'.Li.
came law does not apply to an owner of property who Wilds or improves thereon,and, 604 — ROOF IN-PROGRESS
who contracts for such projects with acommcmrts)littneed paranoid,
ursuam to the Co mors
as,Law.
an
exempt tint _,11P C for is rear n
Otgny/ am C
Jr/ WORKER'S COMPS ATION OECLARM�IN
I hereby athrm under penally of perjury one of the following declarations: �'� /� 1 D
I 1 haw and will maintain a CertiBna,of Comenno self-insure for Worker i Compete �+,
aatinn.u provided for by Section J71X1 of the IaWr Code,for the pedormantt of the 2U�3
work for which this permit is issued. ,s"
I h8K Brld WII maintain Worker's COmpe1168110n IIISYfYa'C,a3 RQYImd by$Cf1111n H17
3701 of the Labor Cade,for the performance of the work for which for .it is issued.
My Worker's Compensation Insurance carrier and Policy number are: BUILDING
Cartier: Policy No.:
CERTIFICATE OF EKEMPTION FROM WORKERS'
COMPENSATION INSURANCE
rnis scctlon account W eomplewd if Ilse permit la fnr one hundred dollars(510)
or less.)
1 ramify that in the perfiand c f thew k far which this permit is issued,l shall aot
employany iftabn imany mann m mcorac suhieeun lW Wnr� keri Compensation
employ Califomia.Dam 6 CJ
Applicant NOTICE TO APPLICANT:If,after making this Godricate of Exemption,you ahnuld
becoma subject it the Workers Compensation provisions of the Labor Cock,you mica
OO forthwith comply with such provisions or this pennitshnll N deemed revoked.
z 55CONSTRUCTION LENDING AGENCY
(—t I hereby affirm that there is a conswction lendine%cocy for the performance of
�(. the work for which this permit is issued(Sec.JUH], CC)
0 Lender's Name .
z Leader Add..
U 0 1 certify dust 1 haw read this applic n and state that the above information is
Hcarte...l..rote b comply with all city an badly ordinances and State laws relating 100 U building construction,and herchyautt eampresenlalinsofthiscitymenefusmithe
{t•1 abovnmenlioned property for inspe npurposes.
Ps (We)agree m save,one y and keep harmless the City of Cupertino against
y liabilitica,judgmcnts,ends an po....hich may in any way accmc against Said City
U in con dome of the gr gof this permit.
APPLICANT UNDE DS ND WCOMPLY WITH ALL NON-POINT Issued by: Date �V<Z,7
SOURCES GULAT S.
Re-roofs
amre ofApprnnt/Con mean o,m
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle haamdous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
cwascams zss3zy)? All roofs shall be inspected prior to any roofing material being installed.
❑res Ja No
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit havardaus air contaminants as dcftned by the Bay Area Air Quality Management all new materials for ins ectl
District?
❑Yes ]Nn
I have mail the haaardous materials requirements under Chapter 695 of the Califor-
nia Health&Safety Code,Sections255(15,25533 and 25534.1 understand that ifthe Wilding
does not currently ban a temmol that it is my responsibility to notify tW sccup-I the
myuim`=emu s. a oraiceuanccofu Cerificate of Oc(u�hcy, fat , Signature of Applicant Date
Owner or authorind agent / DaIE All roof coverings to be Class"B" or better
j Building Division '
10300 Tone Avenue
Cnpeslno,CA 95014-3255
Telephone: (408)777-3228
Cl F= (408)777-3333
CUPERTINO
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. y
• 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.
IUTORTANT:
1. Flat roofs must have a minimum of V"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 t-r—g ia� i C-Z>0
Address: 5 S� C-U .F-F•Z-ZD l5Z C
Reroofing Company Name:
Applicants Signature:
. 9
Joe Antonucci _
(Chief Building Official)
6MI01