02080080 (2) CITY OF
TINO
ILDI c DIVISION PERMIT INFORMATION:
BUILDING ADDRESS: PERMIT NO.
QQ10YYEE277tt$65 E ESTATES DR LOS GATOS ROOFING 020800y�80
ZIMINA'fABA 1771 SMITH AVE . APPucT9N1`r?7�002
( PHONE: SAMTARRY25NOOO. CONTROL NO.
(408) 298-9399
C O zo ARCHITECIYENGINEER: BUILDING PERMIT INFO
,m C BLDG ELECT PLUMB MECH
<a o u u 1- 71
z LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby aRnn that I am licensed under provisions of Chapter 9(commencing P
wim Section 7")ofDivision 3 of the Bushiness sod Professions Code add my license REROOF 5
am y:1 is in full force and c t35. ® In
z s z< Licenu Clazs — Lic.x Glp' O A°p1l
u 3 R y Date {Ssp i Contractor c
ARCHITECTS DECLA 1
C l understand ery plans shall h um i as public records AUG 2 6 2002
r
a i p C Licensed Professional
OWNER-BUILDER DECLARATION
DLL 1
ad
'= 1 hereby afro that I am exempt from the Contractor's License Law for the B�11,,T`D'�k 1� $8000
F z< following person.(Section 1031.5.Business and Professions Cade:Any city or county 1�I
C which requires a permit to construct,alter,improve,demolish,or repair any structure
a 310 prior t ts' e,also q m applicant for such permit to fl signed statemente.
aha nekrompedimportant oth of nsof me the Business and
law(Chapter9 6 p�' 4d'0' •a. Valuation
(commencing resect cull rDivision or(ealligoe dP rgnyvi Code) 'l,l",]'3F._,,, ,. �.,. _r,, eaf,,'`,'.4� r r"r,•
or aero He is exempt beneficial and or canfm the allege)cxemant to Any violation
of Section e than by any applicant for a pcmlit suM1jttrs the applicant to a civil penalty
of not more Than five hundred dollars lasoBl. 3 0 5 AFNNUdlilla Occupancy Type
❑LaxoducroOhepopeny,orm'yemployeeswithwagesastheirsolecompensation, 307 - INSULATION
Beiiine therid Pro and the IA Timome Isnot intended J or c icedLaw doe sale apply to an 6 01 - ROOF TEARecPHd inspections
euli do era work;
and the
Calc:Tim Cnmmnt n5 License Law ares ort apply (1 an ..
owner of pmpeny Who builds or improves therm,and who does such work himself 602 - ROOF PLYWOOD NAIL
or offered
through his ply ..provided Io t p- ooimprovementst ended or .. ___.. ....-... ... ...._ _... -.._.
..ref 'af r Ire .mb have
g p m i !tla m noeyear of . .. .....603.. ..-. .ROOF BATTENS
'improve fn the ownerbu Idv will have Nv burden affirming vthn hedid nrr build or
improve err pnmr5e ar.,ale) 604 - ROOF IN-PROGRESS
❑I as owner of the W.IlWy.lun ly.c.nmapi 4th d1.used convenors to
construct the does
(Sec,4044,Business and property Professions
who
Code)The C s theror's 1
rand nsewh Low does nal apply man owner with,
conty who holies or improves Hereon,
.:: .: „and who.comraas for such pmjecta wim.a,comraclurts).liccnud.pursuam tome -.. .. _ . .-..-.__...._____ _..... ...... ....... - ._ .-.._
ConlLicense Law.
an par
❑lam exempt under Scc: ',B&PCfor this reazan
_ Owner"
Data
WORKER'S COMPENSATION DECLARATION
I hereby affirm under perally of perjury one of me fallowing declarations:
-;� ❑ 1 hale and will maintain a CerURae .1 CUnscnt 5o uif.houce for Worker's
Compensation, az provided for by Section 3100 of dine labor Code,for the
peRmmmnce of the work for which this permit is ixsocd.,
_ 3I have end will maintainaz Worker's Compensation Insurance, nquirM by Section
00 of the LAnar Code,for me kiformance of me worlkfor which this permit is
issued,MyWorkers' Compcnsai on Insumrre c J Pol cy number are- '
. ... -
cam SjA?& h/ND" erher ^ zg5Z27Styr is . .ir +,+' " �t,I
sr 1 i
1"{CERTIFICATION OF hX EMP'f10N FROM WORKERS" - { i t�J{t (1
COMPENSATION INSURANCE' -' I 1
_ . . ..._.. .. .. .. -- -------__ ......_—......__.___
t
(This'scetion'heed not be comple¢d if the permit is for one hundred dollars ,• - ----- - _-
($100)or le,"I
:. .. _ >..
,. I epedif,ydam'n theperformance of the ill f rh 11 h h pc 5 ensued I -
shall n t - Pl Y Y R n n Y aero as m becomesubject to the Works..
Compensation Laws of Collision..Dam -
_Applicant ^
r NOTICE t0 APPLICANT If after pe k g N ov si leve Q Exemption,y shouldt
bee subject the Wok Compensation p th ns of the Labor Code n you mo 'Q fonhwh rompill, with. hp wic ons or trop(+error fiull bed creed revoked.
F"ti CONSTRUCTION LENDING AGENCY
aLs7i Q
1 hicishy affirm that thouramiction agency fa r the prtremunee
ofth k for had, p,.it i dS c JW Civ.C)
Loder N ... _ . ...._.._ _
z:z nde s _.- .... _. _.. ...._._ _ .....- , .....
,
AtldrcS.
kT+ OU1 earruf,that d m a I J.11 hot b informationt
Fcorrect. aacomply with all
city I Ire ordinances unit t laws relating
to building rnswcr n,unit hereby lhmoereprcacnet vcs of thio city
10enter
upon
the abn(We) grid)pmpenyfor ityand onpmpnses,
(� L.
(We) B eto's Jcm pensee ph I ache Cry fC P against aid
Jv Cliabilities,judgments,c.t and pensee which en y'n any Y gain..said
U Airy 9 B rwacofthn p t I�
APPLICA e Rf DK' MPLYWITHALLNONPOLNI" Issuedby< Date /
UR LA' [ I f�
J�Z
Signature M Applma tComnaor; S 'Dam Re-roofs
HAZARDOUS MATERIALS DISCLOSURE �.
i
applicant o rot building acapans store or handle moment mvedal Type of Roof.
Will the pYP
s de dined by theCupertino Municipal Code,Chapter9.12.and me Health d Safety
-
Cod Section]353?Tal ..'\ 4
❑Y. .tie. . . . ..
' __All-roofs.shall_be inspected prior,to.any roofing material.being-installed.-
c
eing installed. _
rdoWill usair iintaminantsamore hamieg«apaBayAeaAirQulit Management If a roof is insialled without first obtaining an inspection,I'agree to remove
emit hazardous w contaminants u ddncd by the Bay Area Air Quality hIDnagcmem
°LtnLf! all new materials for inspection. Applicant understands and will comply with
❑res ;." :.. all'non-point s ons. ,
1
have read the hazvdous materials requirements under Chapter&95 of the i -' t'
California Heahh&SafetY Cade,Stttians 25505.25533 and 25534.1 understand that
ifine building does nolcunemly have amrmar,mmitismymsponsibilirytonmifythe
omupaor of the i ie8 si N`met prior r issuance of a Cenificam of ` ���aJ 0 `.
Occupant
o
- � _ Signature of Applicant Date
-
x -
aamrnacd agent. �� Date . 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) Preinspeciion 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: Q bc(-
Address: 102- LS
7/e /
Reroofing Company Name: L o s6
-a/r OS
�0 0
Applicants Signature:
% r Date:
Joe Antonucci
(Chief Building Official)
6/25/01