02110129 (2) R
CITY OF CUPERTINO a� ✓ef' s "" ���adt --'� '%:
BUILDING DIVISION PERMIT O
CNTOR TRACINFORMATION
RU1I.J)WMIr3FsE ESTATES DR WESTSHORE ROOFING CO PERMIT N®2110129
owEVEil HIROSHI AND TOSHIYE 5869 WINFIELD BLV APPLICATIIN15MITY2002
IION17. 408 629-2100 SANITARY NO. / CONTROL NO.
ARCHITECTENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
w00 LICENSED CONTRACTOR'S DECLARATION
s w 1 hcrchy affirm that I am licensed under provisions of Chapter 9(commenting Ob Ip(1
NSC with Sectien70(XBofDivision 3ofthe Bu.sinessand Professions Code.and mylicense ix T/O 2 (2) I�RIIOOFII r��Ss�. LSD 50 YEAR COMP SHI
� �<e. Ill force anJcflCct.-bq Lic.N ��YV�Lbt�D
Class F?F,W Dateit a '� Cnmmmar .,,
�ffCC ARCIIITIi(.T:S DECLAR "r101
yas I nndo,oand my plans shall be used as public rcn,rd, DEC 0 9 2002
3`u
r LL G g Licensed I'mlcssional
ad
a
OWNER-BUILDER DECLARATION g I hereby alErm that 1 amm exempt from the Contractor's License Law lin the BUILDING
i o reason.O following ren.(Section 7031.5,Business and Professions Code:Any city or county ar/ $8861
w 2� which requires+a Permit tri construct.alter,improve,demolish,or repair any structure
FZy Poor In in issuance.also requires the applicant for such Permit o file a signed Statement
< that he is licensed pursuant to lM previsions of the Contractor's License Law(Chapter 9 33q9G12Df3b3AlQ0 Valuation
91c(commencing with Section 70(XB of Division 3 of the Business and Professions Code)or
y $ that he u exempt therefrom and the basis for the alleged eaemplion.Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penally ofPN'N OCCUdnC
not more than five hundred dollars($5(10). Occupancy Type
Las owner of the 307 - INSULATION
❑ the sent',or my or
compensation,
will Jo the work,and the swcmrc is not intended nr effcrc0 for sale(Sec.I0M4,Business
and Pmfessions Code:The Contractor's License Law does not apply to an owner of 602 - ROOF P S T]lJ nWAcJitnS
property who builds of improves Hereon,and who does such work himself or through his _.L
con employees,provided mat such improvements arc not intended or offered for aide.If, 603 - ROOF BATTENS
however,Of building or improvement is sold within one year of completion,the owner.
builder will have But enmenofpmvingthat the did not Wild orimprowfor purpose nf 604 - ROOF IN-PROGRESS
sale.).
❑ I.as owner of the property,am exclusively contracting with licensed eonlr6lorx to
construct the project(Sec.7044,Business and P ommums Code:)The Contractor's Li"
cone law does not apply to an owner of property who builds or improves Borman,and
who contracts for such projects with a eomractods)licensed pursuant to me Comracum's
License Law.
❑ I am exempt under Sea ,B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations.
❑1 have and will maintain a Ceniftcaic of Consent to self income for Worker'sCompcn-
sation,as provided for by Section 370d)of the IaMr CMc,for me Prif form.of the
week for which this permit is issued.
ave and will maintain Worker's Compensation Insurance,as required by Section
3 1X)of the labor Code,for the performance of Be work for which this permit is issued.
My Wurkcr' n Insurance icr and Policy number are:
Carticc _ ""— Policy No.:2 S-O 2—lG�D
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPF.NSAI']ON INSURANCE
This section need not he completed If the Permit is foroee hundred dollars(51(X0
Ica")
1 certify that in the Performance of the work for which this Profit is issued.1 shall not
employ any person in any manner so M to become subject o the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Cenificam of Exemption.you should
become subject to the Worker Compensation previsions of the Labor Cede,you must
O O forthwith comply with such provisions Of this Permit shall he deemed rcvoked.
Z N CONSTRUCTION LENDING AGENCY
[-+ I hereby allirm that there is a construction lending agency for the Performance of
the work for which this permit IS Issued(See.31X)7.Civ.C]
U4 Q LcnJcrF Namc
7 z Leadcrk Address
U 0 1 certify that 1 have read this application and stars tbar the shove information is
correct.l agree to comply with all city and county ordinances and state laws relating to
DU building concoction,and hereby awhoHm repmsentatives of oris city to enter upon the
try
} W above mentioned pmpcst for expenses purpowhich may
(We)agree to save,indemnify and keoP harmless the City of Cupenino against
U h fiabilinconsequence fthecos6aml expenses which may in any way accme against said City
Uz inconsequenceUNDERSTANDS
orchis Profit,
.. APPLICANT UNDERSTANDS AND WILL COMPLYWIT
—Re-roofs ALL NO P INT Issued by: Date
SOURCE.REGULATIONS.
Y✓✓7/YLL-- 11 0
Signature of ApplinnVCnmrvmo�"nn"lr Dmc
A�
HAZARDOUS MAT TRIALS DISCLOSURE Type of Roof
Will the applicant or futon building oecupam store or handle havardous material
as defined by the Cuprmno Municipal Code.Chapter 9.12,and the health and Safety
,dmLcede.S❑aYeana 25532ban ge/ All roofs shall be inspected prior to any roofing material being installed.
Will the applmont or future building..pan.Stu equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit haeardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
Diamine P
❑vex (pyI�
I have mad the hvardous materials requirements under Chapter 6.95 of thc Cah or-
nia I hold,&Sam y G,Je,Seetions25505,25533 and 25534.1 understand that if the building
deca ter cwrcmly have a benam.thud it is my m,miihlhty to natily da,lacy ant of be
onm
rcyuircn, mustbemn -nnnemofa Ccnlfcateol' up. .
07- Signature of Applic nt Date ( z
Owner ar apmafi eagent Date All roof coverings to be Class "B"or better
% Building Division
i 10300 Torre Avenue
t Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY Of Fax: (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.
. 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 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
nspectionWe understand the above policy on reroofing and will comply with this policy.
Homeowners Name: c �CL
Address: 20 7
Reroofing Company Name:
Applicants Signature: Date:
Joe Antonucci ^_
(Chief Building Official)
6/25/01 i