01050158 (2) CITY my SIONO
SINPERMIT CONTRACTOR INFORMATION:
BUILDING ADDIIE054 I GASCOINGE ECONOMY ROOFING,--= PFRMITNo.•,
n 01-0512N.,58-
APPLICATION
OWNER'SNAMIhULIE JOYCE -,.,f „ - .. �7-a1.'1=IZI k. 61RCI'.ENDR, RVE ' APPLICATION SU J%G.j.'�C:�7I I�S
+ PHONE: WW SANITARY NO.I V! CONTROL NO.
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Y4 O O ARCHI'I'E'T/ENGINEER: BUILDING PERMIT INFO
BLDG,' ELECT PIUMB MECH
as
=� LICENSEDCACfURS DECLARATION
lob Description
I lerchy uRrm that amlicensadroofChnp,crH
(wmmencing
yew yilnsenit,nvnoo)Jy otmeBuu,he„anaPar nim a rl e RERQOF: .
in mu fated aw 1'
OLicense Class Lie.u
KKK y
Data Comma
�';a• ARCHITECT'S DECLAIATION - F N n It r�
I understand m I hall be distri Nie records {t V b�s�t�I)a
6 p O Licensed Professional
OWNER-BUILDER DECLARATION JUN
O �, 9001
•w o, I hereby affirm that I am exempt ford the Contractors License Law for the -' J N N L
following reason.(Section 7031 5,'Ba sines and Professions Codd Any city or county
F which mquirex it permit to cnn to cL alter,improve,demolish,or repair any structure -
µorr3m prior to its issuance,also acquires theappliend for such permit to filed signed.statement
that he islicensed not tothe provisions°I the c°ntmetr'xLicense Law(Cnapor9 SqFtF1oorA Valuation
(commencing with Section 7000)of Division 3 of tire . .,c Business and Profeadoes Code) -
offer he is ecrelp,themfrnn and the basis for the alleged exemption,Any vio0aion
of Section 7031.5 by any applicant fm a permit subjects the applicant to v civil penalty
of nansure than Bre hundred dollars($500), APN Number - Occupancy'iVge
$.v0
❑1,as owncrofthe property,Decoy employer with wngu as theirsole rnmpcasmion, '" _
will do the work,and the structure is not intended or offered for sure(Sec 7054,
Business and Profession,Code,The Contractors License Law does nota 1 to an g iced Ins deutons -
manscof literary Who hadd,s or improves thereon,and who does such wo k l imsalr 75c8005. t� t" p
or,hmngh his own employees,provided that such improvements are not intended or '
offered for sale.It boweved the building or improvement is sold within one year of
completion,moowne-bullderwill have the burden of ropm
purpose dingtnat heard not builder 305J' =FRAMF_2
impve for pse of sale.).
❑L:is owns,of the property.oa,aseN,ively eoado,ting with licensed contract.,to' 307; -- INSUL:ATLONs"°K
construct the prtro
ied,,See.7044.Business d PruRasmus Cdde Ea Endpaper's ,
icenseLawdoesradapplytoanownerofpropertywnobnimsorimprovexmran, -'601 '- ROOF:•;TERP.r'OFF-., .
and who connotes bot such project.with a contractors) licensed pursuant to the 60'c — ROOF PLYWOOD 1'l NR I
Comment's License Law. t 4
'°lam exempt dude,Sec. B&P C mrthix reason 603 — ROOF BATTENS
owner ore 604 — ROOF IN—PROGRESS
-WORKER'S COMPENSATION DECLARATION
I hereby affirm trader penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Certificate of Convent in self-Insure for Worker's
Compensation, is provided for by Section 3700 of the Labor Cade, for the
pofonnanm of the work for which this permit is issued. '
°1 Inde and will beinwin Worker's Cam'soun ion Insurance,as required by Section
3701 of the Lahmr Code.for the performance of the work for which thin permit is
issued.My Worke``r'��(`))CC 1' mace cam lir a�l�t{f.Pe(J/icy number ore 7
AT,
Otto e
Currier' CERTIFI �ADON OF O URA M WORKERS' 0 / 0(, /
/ �� /
COMPENSATION
CE
(This section need not be eempIched if the permit is for one h malmd dollars
($100)in less)
I certify that in the performance of the work for which inis permit Is issued,I
shall not employ any person in dry manner so as to become subject m the Worse,
Compensation Laws of California.Dat,
Applicant
NOTICE TO APPLICANT.IL am,nursing this Certificate of prenatal. ,you should
heeonm srbjed n the Worker's Gnnpensatian provisions of the Labor Cole,you most
TQ fonhwi0,comply wind such provision,or this permit shall be deemeJ ranked. .
F^ z CONSTRUCTION LENDING AGENCY -
a ' I hereby uffi nn that thence;a constriction Icndrug agency for the scifomdaee
W of the work for which this permit is Issued(Sec.3097.Civ.C.)
Lender's Name
z Leaders Address - -
V 0f�•�t .I certify that 1 have read this application and state that brilliance information is
Pk P correct.1 agree to comply with all city and enumy orlmance,and state law,minting -
U to building cons..dioo,and hereby authorize mpresendtives of this city to enter upon „
iy r�
the above mnfmnedproperty fr-n.pef prp ,es -
Iy IW) gee fy vndk pl Isx the Cly o[Cupevi.......ns, '
rA II h 1'fe j dg t L d pens which y in any way accrue against said.
U z Cty' fty�o ftl granting ift , Period.
S PPI,Ich RT ON A'RSST�ND ND ILL COMPLY WITH ALL NON POINT Issued by: Date a
���
N31damfApphdnti oulbef Dole Re-roofs .
HAZARDOUS MATERIALS DISCLOSURE '
Will ,,
meapplicantorfrancbuildingoccupant, morhandlehanemen,,ndedal Type ofRoof
ro defined by n,e Cupenh°Municipal Code,Chapter 9.12.and ane Health and safety
come,section 2553200^ ,
El Yes °"° All roofs shall be,inspected prior to any roofing material being installed.
Will the applicant or Imam building occupant use equrimant or devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit fare'
dom air connnitam,as defined by the Hay Ad.Air Qmdiry Management
DisONd all new materials for inspection. Applicant understands_ and will comply with
°Yra °N all point source regulations. '.
11, I th h d materials q r I Chapter 69 0[the
- if he H nhh S f t C d S t 25505 25593 d 25534 lunderstand the
if nn, e t y d h ' tenant, t : r -2-1 -0 �
s v ' v a 'alter forme � 0I
tfth. e ¢suit chem and pr or mr : onto nfnCunifcmcof
occupant" a°y. Signature of Applicant Date
0 o ad,hrrhed ageof Data All roof coverings to be Class "B" or better
OFFICE
y, Building Division
10300 Torre Avenue
� a Cupertino,CA 95014-3255
• ���!!l 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.
We understand the above policy on reroof g and will comply with this policy.
Homeowners Name: JWL
Address: Al 46: a IN/
Reroofing Company Name:
Applicants Signature:
Fel VIP,
Joe Antonucci
(Chief Building Official)
6/13/00