02080090 (2) ' CIBODSI c DIIVIISIONNO
BUILDING CONTRACTOR INFORMATION:
T6N�g `5ABTREE AVE GROMO ROOFING PERMIT 02
BSr080090
Tnt�"EWILSON 121 W WASHINGTON AVE APPLICAnQN$o) M002
(408) 746-2075
( PHONE: SANITARY
2N5O/. l b CONTROL NO.
G p ZO ARCHITECf/ENOINEER: BUILDING PERMIT INFO
a U BLDG ELECT' PLUMB MECH
a 1_U CI LJ O
8y= LICENSED CONTRACTOR'S DECLARATION Job Description
ZO Z_C 1 hereby affirm that l am licensed under provisions of Chapter 9(commencing Job p
F=h-m wiNscclion]000)ofDrvision3oflhc Busmn sa dProfessions CWc., mylicenu
<mvsm
y is in full force at eff .
i a,6 v License Corsa C-)t9 Lic.a 77y T'
Date mr
LL ARCHITECT'S D LAR TON
0, 1 understand my plans shall W nada abbe records
�N
w i O O Licensed Professional
OWNER-BUILDER DECLARATION
g^_ I hereby a(Trm I am exempt form the Contractor's Professions
oil :Any c Law for Nc
ae Z a following reasonpermit
(Section construct.
Business and Professions Cole:Any city or county $6200
E F r� which quirts a perm t t styes,aper,Improve,demolish,or rcpmr any swcture
an 3 pnor to its-issuance.also requires the applicantfor such pe un file asgneddamna nl
c_m 9l gidpurtuton7") ifN t BusinsandProawonsCee) .37�2$tOH6ar@&a I ' a Valuation
or ng with Section]OW)ofheDivisionl fN Business atamdicm.An vi Code) �`(i1 '� 1'n."L^:: i a�., ..4:J 5. .7.11 A�- (t)IN
or Nat he v 31,5 b N y s,,fi and the basis for the alleged eAbmpti"o Any l violation
of Secnot mo than v any died doll for a pcmm subjects Nc applicant to a civil penalry-
1grwlmprcNanewnalWrtdannars(ss0o). 305ARNIVPJ31D6E ..-���• Occupancy Type
El 1.as on,of use Property.orm'y employ«s with wages as their a ole compensation, 307 - INSULATION
will do din work,\and the structure is not intended or offered for (Scc.77044 6 O l - ROOF TEA 9� 'Ins ections
owner of andpini Professions Wilds
Code.The asses theor sreon.
.and wcense law dors now apply m an 602 - ROOF PLYWOOD NAT L
owner of property Who Wilds or he Cont Thereon,and who does such work himselftoan
or through his own empluytts.provided In.,such improvements are now intended or
';gdee.e for sale.If,Wwcwr:Ne building orimyrovemens is sold'waWh ane>ea:dr -- -. ..-_..603 -- ROOF BATTENS..completion, ---'--
she owner Wilder will have the burden of
for of sale.). PmvingNmhedidnolboildor 604 - ROOF IN-PROGRESS
improve purpose a
❑I;as owner of the Pmpeny.am Business
vela d Professions
ng with Code.)
licensed common m
construct Lathew
does
(Sec ID44.Business and ery who
Cady)The improves
Contractor's
n,
u'
License V d nota I w owner of p pent' no).Ids proves Merton. "
. Ow apply p ) Done Ih co I t r(s) d pursuant m Ne-
.-midwit. nt m.fu h ro mr _
❑1 JrI ,kers - '' B&PCf this mason
s
WORKER'SCOMPENSATION DECLARATION
AUG^ /p ry 9
.t I M1erebY a1Rrm under penahy of perjury one of the following declamsi sort ^ / 2002
❑ I hand will m n a Ci,nificran of Consent to Lief insum for Worker's
Com,taxontion. sts, powided for by Section 3700 of the Labor Cade for the ICD'
ptifiormance of the work bor which this pept is issued. pg�
Rl have and will mermih Worker s Coml'cnsmmn Insurance,as m,uimd by Section /M
37W of lhe'Lasor'Code;for the.performance of Ne work for which this permit is
'ss W My Wo k is C pen n Insumnc gam and Pnl cy W
.. .
_. �_. ..._ems _. :.e-.._-v. ........
C S_779 Fo rrV'✓N/�Pol o FROM RKS.7 s -
s l4CE__._ATIONOFEK�IONFROM WORK RS
y '. WMPENSATION INSURANCE �" t-'
. t ' - t ___.........._-..�..
or Ici wclinn need nin.bocnmplcwcd if Ne pemlil is for one hunJred Dollars
or
ISI W) lcssJ - •
1n fy Ih fin to pert nce'of the k f ' w hi h th Pe t Issued 1
r stiall I pl y may pc r nY..art u as an become subject to the Woken'
Narrow laws of California Date
_Appliealil ." .
NOTICE TOAPPLICANT.If after ortakingN CenificaI Exemption,you should
Z bectime subjct to
the
Writers
rk I Compensation provisions f the b Cade you :
forthwithconply with such p or thisPermit hall bedcbo
- r--.. , " '- -- --'— "-"-"--
invoked.
' CONSTRUCTION LENDING AGENCY _ I
1 h by affirm the,Ing is u construction lending agency for Ne performance
W A of the work for which Ms pcimlw is Issued(Sec.3W7,Civ.A.)
z
Le
ade., Address
o
Cy
I nfy that Ih mad this applicationdint thtN mo f hon is
(z.:F torrta 1 c I m Ply heall It' d countyordinances nil.state 1 Irving
Q tj W lobuilding-m construction, gM1 ht'' Ih 'z p enlist ve.. rN clY to cnmr upon
>,_:W the b nlee to save:K wt'for inepcci p rposcs.
y,iif)y. (Wjudgmcrocossadexprseskeep whichmayNeCayacommno against
Z liabilities,judgments,costs dna expenses which may in any
way acerae a,.ac said
U:Z Airyinconsequence ofNeNDS'AgofNisPermit.', 6/
APPLICFI REO-E STANOS'AHD WILL COMPLY WITHSLLL Nf -POINT '
Sty cexec Lions. kRe-roofs
bye Date
z
nature^Lir Appbc.rVCommcmr..,. r•. .. . .Date
1. HAZARDOUS MATERIALS DISCLOSURE ' , ,
. ', Will Ne-61mola - fturt Wilding occuprom store or handle ha>irdous mamdalf Roof ...,....
as
defined by the Cole Municipal Coati.Chapmr 9.12,and theHealth and Safety
Cad Snctio 25532(al - + •r '- - + - - I - ^
SOY. f"�'N 't ��hh° Li �" kl fs f e• t.y 7 v,l t� h ni a'-�, TI'S'•; ..
All roofs shall be-inspected prior to any roofing material being installed.
5Y I1 whe'. Pl•anlo tum W ldl�g cup w-=<eqn p e w a <px which If a roof Is installed without first obtaining an inspection, I agfee to remove
emit b sa contaminants aJfned by the 8,AreaArQ ltyMnagc t
°,`.' pYe It I_ 'Sn _all new materials for inspection,.Applicant understands and will comply with
al] non point source regulations. ,.
1 have read de hLardkxr:rcmmalx Iequtrtmeri and Ch pw c6.95 of the
colfo Health&Samy CodSections 2550525533 and 25534.1 understand that
if the building does n"wcommonly toxic a tenant.thtiti y responsibility 16 notify the
c enm^—w p tI'a
issuance ForfaCi fcme c pans fN requirea Iwhich most be ofSiWaijeGc _.
Da
_.
o -F.pr aumnrizeJ agenw;',: „e . All roof coverings to be Class "B"or better -
.;... .OFFICE'
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
= CITY OF 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 Y"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:
Reroofing Company Name: GU OZ OD
Applicants Signature: � ���� Date: �� Z
Joe Antonucci
(Chief Building Official)
025101