02080059 (2) OF
CI BUILDING DrnSSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10660 GASCOIGNE DR ECKSTROM ROOFING CO 02080059
oM1191�fEDORSEY 363 HARRISON AVE APPLICATION
PHONE: (408) 370-1628 SANITARY NO. CONTROL NO.
0 0 ARCHITEC"DENGINEER: BUILDING PERMIT INFO
FF BLDG ELECT PLUMB MECH
z 8 w= LICENSED CONTRACTOR'S DECLARATION Job Description .
O z 1 hereby affirm that I sum licensed under provisions of Chapter 9(commencing REROO F
En with Section]OWI fDivisionJof the Easiness and lhofessinns Codc,and mylicense
yy in full force and c r.
s.w.t Date C ss 3� see.r S 2-45/
O EE U Doe Conwcmr
3 a ARCHITECT'S DECLARATION'
O g
YI understand my plans shall he used as public maims
O�
O Licensed Professional
OWNER-BUILDER DECLARATION
p� m 1 hereby Se tM1 t 11. .Business rept from the Com,n s C s :Any c Low for the
toll g (Seca t ] S almr. and improve,
de Professions Code Any city or county 0
O
which requires a perm t t construct,alter,Improve,dem°bsh,or repair any structure
Q -P on u u a.a l req hespr appnnnrthe Cmunirsmuoicense Us.(Chapter
mem - - - - - - - - - - - _.__.._ ____
4 _
tMtF ming with Seaman
ea atotltepof rasion the CommcmraL cense Lowons Cd.) Aa a V Valuation
or n he is
Secy n]IIDO)of Division o the alibied
Prof Any v Code) ���}\y.l yJ./'��+y 4'O'Y�ri"�1'il�Ol Ttl't��,rO.'
or Sect he m ei1i5 b therefrom and the perm for the subjects
the emmant to Any violation '
of not mo th n iv any applicant rs a permit subjects the applicant So o civil penalty'
.°r not morernanB.ahundred epnarslssWl, 305AP1V jslJEJ�¢E ........ . �. Occupancy Type
°Lasownerof Shepropeny.miny employees with wages as their sole compensation, 307
"will do the work;and the"stNLNte isnot Intended or offered for sale(See:]Wa, 6O 1 — ROOF TEPR�gQ�&IDSpeetloDs•'>`"'' '-"'
`Businessrof
and Professions Code:The Commear's License Low does not apply to an
owner of properly Who builds or improves thereon.and who docs such work himself 602 - ROOF PLYWOOD NAIL
or through his awn howevcecs,Provided Sem mch improvements arc not intended or
completion,ucd for sale IL eowevec the Wilding or improvement is what within one year of 6 0 3 - ROOF BATTENS
impvfor puryou ofsoiic'r will have the Wrdcn o(proving that he did nd Wild or 604 - ROOF IN-PROGRESS
°I. sowner of the m. rt .. ... " ..._._..
Pattie y i elm cont acting with licensed Contractor's to .
calms,othew does
project f5 ]041 Business pad se fess ons Code)The C°nthe mr's „
L¢ewh Law does not sac t Wer of p pent'who).Ids prove thereon.
_ -Cmunico's Lici m for.such prolects.w th ntmctor(s)fkensal Pursuant to the.
111 m cle is code S p�
❑I m enempt undo Scc. �®
Ow a . ., Data AUG 19 2002
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: l 1 t�1
A ° 1 have and will maintain a Certificates Consent to sel&insure for Worker's BUILDING
Compensation, in provided for by Section 37W of the-Labor Code, for Ne
C'performance of the work for which his permit is issued.
�1 ham and will'mainmin Worker'i ComKnsa ct.Insurance,ei required by Section
9]00 of the Labor Code,fur the performance of the work for which this permit is
l
is u My Workers k Compensation Insurance m
e taer and Policy W
�TffTE Policy N. � I f67 OaUNfT000 g -
0741- -CERTIFICATION OF EXEMPTION FROM WORKERSI f_ 1'`a t. tr S S S)G si4 tl�i q�1r .t J]f4s.
COMPENSATION INSURANCE' _ _-__-- ._...
0" (Thii'senlan'area nm be camplemd if She permit is fm one hundred dollars
IS 100 nr 1pas.),
1
cent ft'IWS a the pert mnmrce of,u woe for which hispc,.is is issued,h , I
'shall not em to r .!he
employ any person in any ma as m necume sub)cn Warken'
Comucat on Laws of California.DamnM
-AP ICH _. .- - . . ____ . . .._._ __........ ._.._. _.. .
NOTICE TOAPPLICANT;
Workers
aftermakingthis Citrons o oe Labor Code.you
'•-'�L' "' •' .'.
Wceineh comply
the Worker's Comns or this
Permit shall the Lobar Code'you must
Q Q - forthwith comply with such provision or this pertnit shall be deemed rcvokN.
CONSTRUCTION LENDING AGENCY' - ^'r' -'
hereby affirm thai there is a constmnlon lending agency for the performance
Q nd r N me permu s uaued(Sec 3(197 Civ C)
I
�L mt rlsund that l have mad thrs application . . .. .. ....... . ...... ... ......._...._ ..._"...._- .." - _... ......... .. ...._..._......
of the work farwh ch his
U Z
q, Y and situation rhe above information is
'ta+'E. correct.I agree to comply with all city and county ordinances and state laws relating
U t to building construction.and hereby authorize representatives ofthis city to enter upon
� r� ,tM1e uhnve-mentioneJ pmpcny for.inspenion purynses., ,
914 IWc)agrce to save;indemnify and keep harmless the City of Cupertino"against
Zi Cl!) liabilities.judgments,costs and eapcns which may in any way accrue against said ,
`• Z City in consequence of the printing of this permit. i
fAPPLICA?T U\ ER. V SAND WILL COMPLY WITH ALL 'ON INT
=I SquRcpR� n � Issued by Date
imuurr;ofApphcantiContractor - 'Da`ttee, Re-roofs
,.i HAZARDOUS MATERIALS DISCLOSURE.
Will She`applio to rte Wilding store or handle hezanloas material Type of Roof—
s d f ed spine Cupenmo M nicip"al Cade Chapt -9 13,a d th x Ith and sar ry y`p " y ,
❑Yes myv'' +.(Jll s 1{.r tl-
Cod S coo 255J2(U
Pp a Yeapanty.eequipmentQ ' Y.;a _All roofsshall be inspected prior,to-any roofing material being installed _
a
,
wRmea applicant future rchulda Wren If a roof is ihstalled without first obtaining an inspectioin': 'agree to remove
emn heWillthe contaminant,asdefnedb the Bay Area vain Management -
District? all new materials for inspection._Appli1.can_t understands and_ will comply with "
°v all non-point source regulations. , ,,.
if the Wddin does the etyCo e. muton larcq iremems and Chapter eoft
heI eve repo
if he mm mil lthde s Safety Code,Sec a tenant,
o 25505 t it
and 25534 Ionounderstand th t
g not c trendy hph must ant that it my responsibility m notify the
` Occu a poor to issuance of a Cenif a¢bf
raQutn rraed /,�/Q1- _ Signature of Applicant - Date.
Ow Date All roof coverings to be Class "B"or better 'a
occupant o a regw m is 'nice must W t
sq-so
P Y'
g
-OFFICE
Building Division '
10300 Torre Avenue
't
410 Cupertino,CA 95014.3255
Telephone: (408)777-3228
Pax: (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*+•+t*+t**+um 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: &[-Ey D43E N
Address:
Reroofing Company Name: c Iq SRO o Fl N 6 CO
Applicants Signature: Date:
/Joe Antonucci ~1.
(Chief Building Official)
6/25/01