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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 Awk 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 C 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