02090077 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUIfDING ADDRESS:•• PERMIT NO.
` Ow'NER'S NAME: APPLICA 1A E
` PHONE: SANITARY N . CONTROL NO.
ARCHITECT/ENGINEER:, BUILDING PERMIT INFO
e U f
11 - BLDG ELECT PLUMB MECH
g« D u u u
v=Ni i LICENSED CO NTRAgOR'S DECLARATION 11
`Job DCSCCI hon
1" I hcRby affirm Not I am liccdcr provisions of Cbapmr 9(commencing
m t-.c with i fullSection 9 )of Division 3 of the nesse d Pmfessionl Caas,,r ody license
Smf- is.n Nn r, �j1I''ccff��cc r'l 7 6 REROOF - lllJJl I1�;J(p'a[�aLa
z < Liccnsc °0"L� Lu, J U�
o a.O Date „fanar OCT 0 3 2002
i e u.'N p ITECf;$ CTR 10
a O S air„ I understand my plans shall be used as public meord.
i�Y,f
a i G,O Liccnxd Professional
' or '• L ',I OWNER-BUILDER
xemptto..DECLARATION BUILDING
h
I hereby.(Seth the 1 1. Hemp)from the Contractor's e.Any c Law for the
?a following mason. er(Section LA Bualtess and improve,
demob Code:Any city.,,.Only
which requires e. n construct.alter. mpmvc demolish, p y structure
n 3= Pno s t issuance. Iw re the applicant for such Permit to file it mmem - Q.Q.. ...__
thiit h s 1 can. d j rs a t 16 dic poesisions of the Contractors License La (Chapter 9 ,S Ft FIOOI Area
,i nun th Sm, -7000 of • ”' .. Valuation
8 )p is 3ofe alleged
and Processions CpdcJ 7 tI' t ,p t• ( i,
ofS thenciempt 31.5byh ' t and the bxxronbectstheee pf nAnyvolndo, ` 3592`6038 .'OOs, I k I_. .
ofSection ci pit Ooh LS iv any apPbcam for a 50)). subjects the applicant,o a civil penalty
of.1 more Nan five nanarca apuars asool. APN Number Occupancy Type
❑I,as ownerofthe Property,or my employees wiN wages as their sole compensation, 305 - FRAME
will do the work.and the amccom is not intended nr offercd Ibr at,(See ]Ona,' t „ It
,will
and Wpfession,Code:The Contractors License Law does not apply to an 307 - I NSU T I wired Inspections 1i,
p net of property who bunds or impoi Nercon.and who does such work himself 6 O 1 - ROOF TEAR OFF
or through hi....employee,.provided that suchimprovnoema m
s enot intended '
offend for'szle.If.however.the builNn rim tissoldwithinone- e - - - - - 602ROOF'--PLYWOOD NAIL"-
im"'rove for the owner-buildersesuee) will have the burden of proving that he did not build or 603 - ROOF BATTENS
.
improve puryouo
r. ::, ❑ii as pwner,pime prnperir.�m e,clp,i,dy eo�Lacrng is iaccused contractors in- _ .._._..... .604--- -ROOF-Z'N-PROGRESS ----- - -------- - '- --- -..----
-:ILrv,. ccr;
- comtiva the does
n(Sa, 1.a,Business and Prof whion,Code:)The ves damor'x
Licerim Law dyes not apply m an owner of progeny who builds nr improves Nercon, ••
` 'Contrano,ronwctor s ar,c L such ¢with a.contractor(s),IicetuM.
. . .. proja pursuant.to No- ___.....____-_-----.____.._---.._..._._..__...._._..._..._....
Olein excan ptunder Sce. r` '•3 BAP C far did mason
WORKER'S COMPENSATION DECLARATION
Ihereby Offician tinder Penaltyofp<rJury one f.th following dechinamns.
C) 1 h e and "II'maintain a C,nificam of,6asent to self natim for Workers
Cmar,vermation, Provided how by Section 37M of the labor Code. for the
pertrr a ofth work for which this pc i is issuol
Y.
❑1 hove and will mon tim Worker's ContpensiiionInsurance,as required by,Section
37M ,My Caber Cale•for the perfomwncc of the work(or which this pennii is
issued,M Wo k t C 1 I y he
Y pen p 1 endP
tTI ICATIO OFEXEMPTIOr ;O WORKERS ' s i\ u` 's• s
'V COMPENSATION INSURANCE" s __. ..__. .. _.,
-, t r -- .... ..._ _ .- 4__ ._ _..
rpt?,S (This section need not be completed if the permit is for one hundred dollars
15100)or less.)'
' 1cantfy that m the Perf a e !th _Wfol which N pF t sued.I -" -_ _. •�.- •,�, •�-.-�-,• -�• "' •-
'xh.11 t employ any penor, n any manner sb as to become subject to he Workers 31 '
Compensation Lows of California.Dae"
NUI Mt TO APPLICANT if Otter making this Caftificam nesof is pf you should v,. .a ,•, --' "-
z Bac omit subject anic with
such p Compensation sp A 11 the Labe Cod you- t \ J
0 fonM1 th c ply with uch p ns or thispermit shell be Jee d ukcd.
r ... -_. .._ ..
If Jird that
is
ONLENDINGtimleading
ea AGENCY
a 1 h by fTnn tM th rt d const t on I ❑ng agency for the perfomsance
Wof the o,kfor hch,b P�Tint s - el. (S 3097'C C)
.q ..lsnde . s.
.7z rsnde sAdd
1 inn fy Nat 1 have mad this application aM 1.11 dbut.he divive information is /Q
W.F coved I agree t mply th all c ry nd tY oM d int I rel t g �—
� U to bu lJ ngc nwciton tie b<rtny dmhoi epmsenta,iJes of ihiuity to enter upon
0
�„_g] she above-menooneJ pmpcnY Nrinepenion purposes,
{..'G', fw) g msec d fy Bk ph le stheCty fC pehinoigainst
k+ rn I'abd, Jag ms.costs aM Pc s h ch y n any ay
U Z at.ss said V V
City n q fN<8 mag (this perms '
-APPllCANTUDDE�5TA0 5ALD\VILLCOMpLYN5',vT\H�i,L.ouPoiNrkRe-roofs
by; Date
501 CE !✓R�CVJ "p r ✓0 at f ZY3 Z
Stgnaturc ofof Appbcalt a , .,1 .. .,I, ..Dine'
- HALkRDOUS MATERIALS DISCLOSURE !'�
mtc e .Roof
Def d by th Cupen no Mu c p I Cpd Ch p¢ 9 1] a d Ne Hcahh tl Scifecy •- - - - " - -- _
ode Sect 75532(a) t. . f t - ",A,, s- -s(k {.t i
❑Yes ( 0..�--ivl tl ,..t`tr� err r .`. t„
„ All.roofs.shall,be inspected prior.to.any roofingmatenal.being installed.___
.Olin W'llth header
ns a r ed it he B A ea�p Qmfl ty MoCn If a roof is installed'wlthout first obtaining an Ynspectton'T agrl:e.to remove
t PP 8 pant ae1. ich
• iR t for
artlo s A
l all new materials for inspection Applicant understands and will comply with -,. _•,
Celifomia Heare.Safer Code Sen,n'alx xis 2x533 end f aI]non-point
SOUTCe re u]atlOnS , •.I, r t
❑Y �aM-- p
i's roe Bg
Y Y responsibility co-notify f the ( /
that \✓7/V,
if the builds.,z does wurtentl have amount.t chat t s 3SSJa 1understand the'
1 ha d a d the.luzard s material,rt u mems under chapte 695'0
Occup tc of,din rcq tteme N h h musobe t grin,t to of
(Z
Signature
..-Applicant
roof coverings to be Class "B"Doi[better
_ nasure of
- -OFFICE-- -
.. ..._. .
Building Division
10300 Tom Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPE�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.
IMTORTANT:
1. Flat roofs must have a minimum of Y4"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:: l O
Address: /off
Reroofing Company Name: J e/ Y'
Applicants Signature: Date: lL
Joe Antonucci
(Chief Building Official)
6/25101