02070017 (2) CITY OF CUPERTINO
BUILDING DIVISION' PERMIT CONTRACTOR INFORMATION:
I
BHESS
10490RFLORENCE DR JIM KRAUSE ROOFING PERMIT N8.2070017
DYEM6&N TERRY A AND BRENDA J 2310 DIANA AVE APPLICAT�3,I'JbDLTJ2002
PHONE: SANITARY
11NO.
/ lJL/ CONTROL NO.
(408) 779-0704
•,CFI C O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
m u S BLDG ELECT' PLUMB MECH
,a'iE r'-U I_7 :j L-1
Sri LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing REROOF
:n-M xiih Section 7"nof Division3ofthe Businesx and Professions Codc,and myli,rnsc
in full fotec:me V B
ii«ore cla}r 5 / T/O SHAKE, ADD CLASS B SHAKE
e ARCHITECf'StDECLARATION �B� `�• '^a��
1 understand my plans shall he used as public records ;1 q
i oc Uoemed rrom,i,nm SEP 0 9 z0oz
OWNER-BUILDER DECLARATION
I hereby atfum Thal I an,exempt from the Commnar's L,mme Law for the
?a following mason.(Section 703 1.5,Business and Professions Code:Any city or county
which require,a permit m emmmm.alter,improve,demolish,or ne,en any snommre
BUILDING
1 11 i'1p Plf� 175 0
o_ Friona n, "nines.also,squim,lie applicant lot such permit m file a signed statement V L.6JIttl�.l __ -----
(commencing
___ _
lime h - licensed msmattoto,pro . softh,ComramesLicenseLowlChapmr9 Sq. Ft.,FloorArea - f Valuation
(com- n g Tb Sect 7000) f D cion 3 of the Business and Profess ons Cole) 'f 1 `s ! s I '`e `
,r thanh pi here( mud the baa,I... be alleged exe npmmaAny violation ' I3 2 6 3 5'0 S S . 0 0 L .. l .. ,`.: "
of Section 7031.5 by any applman,for a permit subjects the appfcant m a avd pcnalry Occupancy Type
of an,more than five hundred amus.(S5M). APN Number
01.as ms nor of mepropeny,ormyemployeeawithwages astheir sale compensation, 305 — FRAME
_
will do,Ile sok.and the lonturs is sol intended or offined for sale(Sec.7044,
Business and Professions Cede:The Contractor's License Law does not apply men 307 - ired Inspections '
... of nopeny Who hada,or iso arner,Ihomms.and isbe does such work himself 601 — ROOF TEAR OFF
or Through his own however.t building
(ban such inilsolimprovement
ore non intended or
ioffered omplelbr mle.¢howeilderw waveterhnen of Prov ng that within one year or 602 ="ROOF PLYWOOD- NAIL --:- - - --- -- '-- - -- --
,mplction.the owncr-builder will have the burden of proving mat he did not bails or
`mpreve tar p,q,nse moots.), 603 — ROOF BATTENS
604 --ROOF -IN—PROGRESS ------ —
Y ling licensed n,
Q h as owner of she pmpen,,am exclusive, c,mmnin -
conmmet the ossa (Sec. a-i —.oro and Proproperty
he
Coder The Ccrmines.
on. '
License law tees not apply man owner with
property who builds seimproves thereon, t
and who,,micens far such pmjam with a<ontractor(s)licensed pummm no she
Connor exempt
pt under
Law. '- -
❑Temeaempnunsersec. ;B&PC fn,this reason
Owner Date -
- - WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury no of the following declarations
1. ❑ 1 have and will maintain a Cenifcam of Consent to self-insure for Worker's
•Compensation. as provided for by Section 37W of the labor Code, for the
performance of the work for which this .it is issued.
s[T I hale and will maintain worker's Compensation Imuran m*as required by Section/37M of the labor Codc for the performance of the work for h' h tit s permit i,
issued.My or ors Co ,minsa,on Insurance currier and Polmy mumbe,am:
Cerdci 'k_'P,I cy No,
C RTIFICATION OF EXEMPTION FROM WORKERS r v' .l '. i i I) r'k
.., COMPENSATION INSURANCE
(Thu section need not be completed,f the person is for one hundred dollars .. ,
ISIoO)or less) '
•1 emir,iha in nue performance of the work for which this permit is issued,
shall not employ any person in any manner so as to become subject no the Workers'
Cmopor,nmo Laws of Calllbmia.Date
Applicant _
NOTICE TOAPPLICANT If. In Angor C n fcme of—Eve.pWo y should '
z hecnt hjccl to the WorI s Comper-lion pirmisions ofthe LatiorCode,you must
Znorhw ith comply wish such Provisions or thisPe.it hall be seemed resoked,
f "'' CONSTRUCTION LENDING AGENCY
I hereby affirm that mere is a commotion lending agency for the perfmotdnee ,
r
of me work for uhith his Penni,is issued(Sec.'3097,Civ.C.)
L 0 ..Lender's Nater` .. - , < ,.....
LD z Lender's Address
O , I certify that 1 have read this application and stake that the ibove information is
I:., coma.1 agree m comply with all city and county ordinances and state laws miming
U to building constmcimn,and hereby'authorize represemanves of this city to enter upon
rs] the ahove-mentioned property for inspection purposes.
F q d mave,
(Wo) and keep hamlets the City of Curimino against
Zi liabilities,judgments,cots and expenses which may in any way accme against said
U `Z Cin,in comequon<e of the'gramurg of obi!permit. �s
APPLICANT REGULERSTANDS Ayyy'fp�3tt��kL COA1PLV N'ITH ALL NO�'PO Tp
SOURCEREGULATIONS. y0Z Issued by: Date
Simalmc of Applic,ro—otmetn,' at'
defined b
HAZARDOUS M TERIALS DISCLOSURE - Re-roofs
Will insapplicant er fur building occupant we m handle ba..rd,iia mater;al Type of Roof
as y the Cupertino Municipal Code.Chople 9 13 d,h H hit and Safety ,. _ -
Code;Section 5532(x)'.
0 year,
All,roofs shall be Inspected prior to any.roofing material being installed. _
Will nu' e -n rm b Id'ng oc np n ue qpm r n ee hat If a roof is installed without firs[obtaining an inspection; I agree to7emove
it hzWN irteam and W'N by the Air costly Ma g cm
D"""oY all new materials for inspection. Applicant understands and will comply with
` - - all non-point source regulations, -
',1 have read she hazardous mamials requ remena under Chapter 6.95 of me
iflibe uil ing dos Safety Code:Sections ant,that
it
and 25534.1 ity 10 n of that
ifthebuildingeonnmments ybase a Roans,Ilia,it is my responsibility to notify the
occupanto...of rbc rcquimmcros which muzl be met prior,o issuance of-12 a Ce i I to of
' Occupancy.
7 bL Signature of Applica [ Date _
U-mar er rommutPlVarom Date All roof coverings to be Class "B" or better'
- _ _ OFFICE - . ..
„ Building Division
10300 Torre Avenue
H' IsJ' 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) Preinspectioit 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 1/”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 abovepolicyon reroofing and will comply with this policy.
Homeowners Name:
Address: X),V?o
Reroofing Company Name:
Applicants Signature: Date: G Z
,. Joe Antonucci
(Chief Building Official)
6/25/01