02110080 (2) CITY OF CUPER'11NO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION: '..
-.. .
BUIUQjN4/.s1)0RFsS.LSNViEW AV SHELTON ROOFING Pr:RMrrb0.2110080
ow@E'4VB1'SWORTH DONALD E AND JOAN 1988 LEGHORN ST APPLICAT101I f9D1T,2002
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vpZONE: SANITARY NO. CONTROL NO.
ARCHITECTlENGINEF.R: BUILDING PERMIT INFO
BI.DG ELECT PLUMB MECH
0 0 0 0
00 LICENSED CONTRACTOR'S DECLARATION Job Description
<U UI hereby affirm that 1 am licensed under provisions of Chapter 9(commencing REROOF OCSCfI p
zo' with Section TXXE IIITIMMon3of NCBusinessand Professions Cade.and my license is
in man force r6l 6 C? _ ZLIo q1
License Ol y, G H LicCml�roclar FI• aALeo
F.=o Dalt /�o
AR.shrll use DECLARATION
IundcmanA my Plans shallWuscJ as public rcauds
nowD APR ) 3 2003
FLLOI" Licensed Professional
q OWNER.BUILDER DECLARATION
ai u�a7 1 hereby u(Sect on 11. exempt Intro the Cnnws Co License Law for the -Q q G �
a a c O following retsina(Section 7031.5,Business and Professions Code:Any city n,county VW —1yy,
x m� which requires a Permit m cnnsuuc6 allcc improve,demolish,or repair any structure '
poor it)its issuance,alit)requires the applicant for such permit to file a signed slalemem lmlt n n.n
t=�< that he is licensed pursuant In the provisions of the Contractor's License law(Chapter 9 Ft�pIk3 ARQ Valuation
at (cum menci ng with Section 71kXhIII Division 3 of the B usineu and Professions Code)Or
y Nn he is cxcmpl thcmfrom end the basis for Ne alleged exemption.Any violation of
Section 7831.3 by any applicant for a Permit subjects the applicant to a civil penalty ofOCCUpaney Type
not mom than rive hundred dollars($W). 3 pfd INSULATION
❑I,as owner of Ne properly,of my employees with wages as Nair salt compensation,
will it.Ne work,and the an calm is nm intended or offered for sale(SCe.7 H .Business �p�saaa�
and Professions Cade:The Contractors License Law does not apply to ea marc,of 602 - ROOF PllY'VYC7l7 l rMTjgns
property who builds or improves thereon,and whodces such work himself or through his
Own employees,provided that such improvements art not intended ofoRered for ole.If. 603 — ROOF BATTENS
however.the building or Improvement is amid within one year ofcompletlmn.the owner- 604 - ROOF IN-PROGRESS
builder will have the burden of proving Net he did not Wild or improve fur purpose of
ale.).
❑1.as Owner of the property,am exclusively contacting with licensed contractors to
construct the project(Sec.70gd,Business and Professions Code:)The Contractor's Li- .
cense Law dons not apply to an owner of property who Wilds or improves themnn,and
who contacts for such projects with a contractor(&)licensed pursuant to the Contractor's
License Law.
E]I am exempt under Sec. .B&P C for this reason
Owner Date
WOR K ER'S COMPENSATION DECLARATION
I hereby affirm under penalty(if perjury one of the following declarations:
❑ I have and will maintain a Cenifcau,of Consent to self-insumfor Worker's Compen-
ation,as provided for by Section 3700 of the labor Code.for the performance of the
work fm which this p.I,is issued
tttave and will maintain Workers Compensation Insurance,az myvired by Section
mf Ne Liaor Code,for the performance of the work for which this permit is issued.
My Worker Cramp��tayr n.�lnsamnC�e Caricr and Policy number am:
Ca,rier.�Policy No.:S7I_O�-�/aO o t0
F.RTIFICA F.OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need nal becompleted iftW permit is forone hundred dollars($100)
or less)
I cenify that in the performance of the work for which this Permit is issued.I shall not
employ any pera o in any manner m as or become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenilicate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
O O forthwith comply with such provisions or this permit shall W deemed revoked,
z rt) CONS'1'RUC1'ION LENDING AG EKEY
[r thembyaffirm that there is a construction leadi as agency I or the performance of
the work lar which this permit is issucd(See,3017,Civ.C.)
(3t 0 Lender's Nor
Z
4L Lender's Address
a
V ,') 1 certify that 1 have read this application and sum ordinances
theand above information relating is
W Uconed I agree m comply with all city and county nNtives of and sate laws relating t e
V building eonswctinn.and herebyamhmim representatives ml Nis City 10 enter upon the
r above-(We)a ai pmPcny for emnify an keep ha.
(We)g me to cost,indemnify and keep harmless the City accrue
Cupertino against
HabiUy inconse;jodgmenhegranind expof enses Pemitchmayin anyway raceme again&acid City
V zincon.ICANT NDERraTANDSthis Permit.
APPLICANT UNDERSTANDS AND WILL COMPWITH ALL NOp'PgHT Issued�l�sby: Dale
SOURCE REGULATIONS. �T91^ ra /
Signature ofApplicarvComactor Dear — Re-roofs
HAZARDOUS MAT/RILOSURE Type of Roof
Will the applicant or future building tccupanl store or handle haOmdous material
az tlerinetl by Ne CuI unit Municipal COMB,Chapter 9.17.and the Health and Safely
se
code, ction zss3xan '��,/• All roofs shall be inspected prior to any roofing material being installed.
ya
❑Yes ms
Will the applicant or future building occupant usecyuipment or desks&which If a roof is installed without first obtaining an inspection, I agree to remove
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hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District'
DYa No
Inow&SaCread Nahavardnusnmleriulsrcyuiantcrosunder Chapurfi95 n,of the boldin -
niallca10,Carmdy CosaS CII mutant,that
I,is
and 25534. on diund thmiflhertal dig
dm&nm curtently hove n tenant,Nm it is my,res1ponsibility m nndly tW OccOPant of Nc V
myuircmenu whichm hem nu issua lcafacerifremeaf Occup my. Signature of Appli nt Date
�l L All roof coverings to be Class "B" or better
Owner or euthori agent ale g
Building Division
10300 Torre Avenue
Cupertino.CA 95014-3255
Telephone: (408)777-3228
COF Fax (408)777-3333
CUPERkTIINNO F
Building Department
Subject: Reroofing. policy for the City of Cupertino.
I. Prior to permit issuance,YOU must agree to comply with 1997 UBC Standards
and manufactures specifications on reroofing.
Z -New roof coverings Shall not be applied withoutt obtaining taining all inspection
'and written approval from the building inspector.A final inspection and
approval shall be obtained from
completed. the building inspector when the reroofing is
I
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 ande/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 inspectio'�
n can be performed.
IMPORTANT:
I. Flat roofs must have a minimum of VV per foot slope and demonstrate that
there is no ponding.
2. An LC.B.O. report is required to be on the job site at the time of inspection.
We understand the above policy an reroofing and will comply with this policy.
Homeowners Name: /.) — ,-2 — , y i W
Address: /C) C/I�C) r,
- Reroofing Company Name;!!,
Applicants Signature: Date:—//Z/ L_ O_z_
Joe Antonucci
(Chief Building Official)
05101