02080152 (2) CITY
BUILDGINDIVISION PERMIT
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
1153 ELMSFORD DR SAADATI TAGHI S AND LOUISE W 02080152
OWNER'S NAME: APPLICATION SUB DATE
SAADATI TAGHI S AND LOUISE W 08/26/2002
( PHONE: SANITARY NO. CONTROL NO.
z Z ARCHITECT/ENGINEER: BUILDING PERMIT INFO
F e BLDG ELECT PLUMB MECH
<U f-'-U I-'-t =ILICENf_J
Z o IherebymeretnaS;DmONT CTderproEcL;ocnoder9lcnmmencing Job Description
Fn!:w with Section 70001 of Division J ofthe Business and Professions Code.and my license REROOF
ca m f is in full force and effect.
z s a License Class Lis.N
°' n 0 Dae Cunuactor
O G ARCHITECT'S DECLARATION
g I understand my plans shall be used as public rteoNs
or�
is.app Licensed Professional
OWNER-BUILDER DECLARATION
n, I hereby affirm that 1 am exempt from the Contractor's License Law for the
t < following mason.(Section 7031,5,Business and Professions Code:Any city criminally
$7300
se F O whieM1 inquires n permit so conswd alrar,improve,demolish,or repair any swcmre
i3 m„poo tot ' meta also«q res the plrant for such permtto file gned nommen.
dlmin sreensedpun noNeprf Ao of the Contractors eLicense ICs pt 9 1Sor a r Valuation
(r mm ,' gw4h5 d ]lipid The as J fthe B sdes.adhon.A ns Cad): 1 lilt 36y`Va`!v1o�•h i{13ii:lr� Y�1B2 '
or that Section
is exempt therefrom and the hens for the subjects
the
zeicant t.Any t violation
-of an,. 7031.5 by any hundred
applicant for a p<met subhas Mc applicam to a civil pcnmty-
larnammetnanm.wnareaaanarsfssool. 305APN � ';',::•:: '.r Occupancy Type
p 1,a owner of the property,or my employees with wages as their sole compensation, _307 - INSULATION
-will do the work,'and the structure is not armored or offered'for sale(Sec:]OW:-
Buiinns wdlPr ,m ufe•siuGide:The Contractor's License Law does not apply to an 601 - ROOF TEAIEegG&B Inspections' ""' a'J`
wino( m,1,Who build,or improves Lamour.and who dues such work himself 602 - ROOF PLYWOOD NAIL
or tM1mugh his on wemployees.provided that such imprevemems art not intended or'
___.._______... . ____ _.
ate arme . ,4xidd.ow&ear < r e. etjor rmenoor rvd old withinoneYemof 603 - ROOF BATTENS
iampinion,N<owner-W ilder will have the buNen of proving slut he did no,build or -
mprovemrpurposeofsale6 604 - ROOF IN-PROGRESS
-, p1 � e or m<propenr.am excln, ly t <r gwmr . d t ter,to .. ..----.--.-. . ..
wct the",.act f5ec ]Bd4, and Professions Codc:)Th Comment's
n'...c c , .,t,
r. License Law does no a, ly m nr of propenY who bu Ids or improves thereon. `
nc
..and ho contracts f c u.w th a.<onvazmrls)I ce sed pursuant acne: _ _ -. _—__—
"' antro"', -en ---"'- --'- -"t�" '�o"'--"
- ° �Ianex< no
r5 `II%. ' t. B&PC for thisre 3}.eep� Xm ssca�� ''
it
< O LR SCOMPENSA ECLAR ON
. . - SEP 1 2 20D2
• cl by Rw de Penalty of R 1 ry -of the f 11 ng dedarativm: -
❑ 1 h✓ d will 'n t aCeniOc t 1 C si I'm self' . rt for Worker's ��'1 rsy'pl^
Compensation. as provided for by Section a]W of-thelab Code, for the LV ,v{�
-_ perfowonee of the work for which this p<emI is issued.
_ ❑1 have mini will maintdin Worker's Cumyensaiion Ins6mime,as required bj Section
3700 si Lanoi Codc,for the peiforni of he work(atboththis permn'i,
issneJ My W rk i Con,emiation Insurance -rad Poliry ounivir
Carte I.r 4 /.1:SSa ..... - _ ...._ ,..,..._,.
'Poky Nor slf
CPICfIFICATIONONATION ISURANC WORKERS i 1/� e .4(`s, y,... i-tc .su �l.t la j.kl,
COMPENSATION INSURAYCE """'O t'
r.
°" (Thi.iu'nion need not be compkied if the permit is for one hundred dollars
(SI(Kh ) /
_ I
in th -,viflich tM1is perms e'is 1 - - •• t
C II notem
Y YIn Y tnafl f�a J bcc rpp by t to the Workers 1 . . ; I. )(
..Apel ci vet .,.. '
O .:'NbcOcWorkers
„ Exemption;Certificate
-ld
T ANT,If,after' kg this C rt t
W C 0. is tfthe Lab Code,Tonh nthh ch Provisions a this pe t hall b de an d k d.O
CONSTRUCIONLENDINGAGENCY 4 ....
ai 7 1 hereby Rirm door there cont et lending ag y for,tse pdroimana
W of the crk forwhich thisPermit issued IS
c J091 C' .C) r
.Q -Led Name .. _ a...-. ..____ ._.._,_...-_
V_Z 'Le J< AJd e.a ar c.'Y IIL :,It,1C:i
W O 1 ttn ft'Nat 1 b d this city
application and stat that th d s ainformations
oruct I ogrtt t omply th 11 icy nnJ co ry N'wntts and sate laws rclaeing
!�: :m budding connon.
of”and hereby authorize repreumalve.s of this city to enter upon,
the la t ned p pent'f mI o P w_ .
p, I W)38mi is e d d keep harmlex dile Cry of Cupertino ngtinst'
F. W liabifinex.jud mant os asms which may,iany ay a gainst said
.V Z City Co., fv g fth - •7/�
'AP)PLICA, k J11 SAb DW
ILL<CONPLY H'ITHa�1,\ON P01\T"' �t/V•
O IRCE <F( r a - ,,, J8�2�DL Issued by; Date
igmt pplicanUC t t _ .. DoE _ Re-rOOfs
-HAZARDOUS MATERIALS DISCLOSURE 11S'
ill diapplk t or future building occuparrat store or handle haiardou;mate,ial T e of Roof_
As defined by theCupertino M pal Cod Chapter 9 12 d flHealth d Safety
yp
Code.S❑eY u33I r �. DfN I its ? YA 7' t`x f ' '.; I.
All roofs shall.be inspected prior to.any_roofing materia] being installed _
d W II M _it om m o f t building occupantBuse et' p t ser d ccs h h If a roof is i talled Fwithout first obtaining ani inspection;-1 agree'to.remove
t h z Nose t mdna t d fn by th Bay Arco i Quality Management,
Di'^01 - --( N .. all new m ri_a or ins ion._ Applicant,understands and will comply
°Ye all non- nt urce` aeons :
occ -I hof h d th ha dose materials requirements responsibility
ade Ch6p 6.95 of the '
13eeu i understand e
Cal!m H hti& Troy C en 25505,23333 d 25534
'ocapa II 'n do Itc i mount;the t s bltynnotF the "" '_'_ - --
p ui a hch men be tP o't iss once faCeriifct f - ��'� - _-
Occup
re of A licant
- - /Zd�oz_ - -pp- _. . _._ . -- Date
,';. mo,i,Na agentit
" , .,oae.f,. All roof coverings[o be Class B" or,better - '
OFFICE
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family (parent,spouse or child) will perform:
A. All the work authorized by this permit
B. _ A portion of the work
C. None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. _ A portion of the work (complete section below)
Contractor Address/City Phone # State License # Type of work to
be performed
• 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I may be an employer(see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
.....................................................................................................................................................................................
I declare under penalty of perjury th t the above i e and correct. I have read and understand the
Owner-Builder Information(rever si
Property Owner's Signature: Date: Z�joZ_
Job Address: �1� ��r��� �J. C'✓� � (-A 57%51y Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.
Building Division
10300 Torre Avenue
( Cupertino,CA 95014-3255
Telephone: (408)777-3228
Fax: (408)777-3333
CUP100
RTINO
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: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: TQC hi
Address: H-3
..Reroofing Company Name:
Applicants Signature: Date: 9-12102
' " Joee Antonucci
(Chief Building Official)
6/25/01