03030148 (2) ` CITY OF CUPERTINO t• '�'�' -ir? ' a- ;tr
BUILDING DIVISION PERMIT CONTRACTOR INFORMATTIOO s4
W rf x,e k1 .e.
BUILDING ADDRESS: LOS GATOS ROOFING PERMIT NO.
OWNER'S NAME: 1771 SMITH AVE . PERMrrLss A
NE: (408) 298-9399 SANITARY NO. CONTROL NO.
ARCHITECUENGINEER: BUILDING PERMIT INFO
BLDG ELECT - - PLUMB MECH
+�O O LICENSED CONTRAC TOWS DECLARATION O O O
1 hereby affirm that 1 am If. un r Pro
vi'ioru of Chapter 9(commencing Job Description
wit ScClion7 )of Di vision Sof NCB t mand Profcssi,!,C�de,andm liccnuu
zq� ua�t:c or la.a ROCS (� REROOF
Dela crso to` TION — REMOVE SHAKE, INSTALL PRESIDENTIAL SHINGLES
DOG Ire J plea all he reed assPu record¢
;u Lice dPmle a
3 0 ER-BUILDER DECLARATION
'<f I thereby affi thn I am exempt from Nc ConwctoYs License Lew for the
ieO Wirruingnaso..(Section?0313.Busieeseand Pmfcerm.Codea:Any city orcounty APR 0�7 2003
B which requirer a pewit m csm.net,.Iter,imprew:dcmnlish,or mitur any structure
Fly prior ret its issuance,else mrtires the applicant for such permit m Glc a signed statement
£�< Nat M is licensed p...Of to the pmvistom of the Cmdratem's U..Law(Chapter 9 Sq.Ft.Floor Area Valuation
y $ (commencing With Section 70(lo)of Division 3 of the Business and Profession&Code)or D"IL
e
that he u exempt therefrom and to beau for to alleged emmption.Any violation of
Section 7031.5 by any applicant for a Permit subjects Un applicant m a civil penalty of APN Number
not more than five hundred dollars($500A Occupancy Type
01,as owner ofthc property.or my employees with wages as their sole compensation, 34248033 . 00
will do the work end to auuctem is not intended or offered formic(Ste.7W.Business
and Pretensions Code:The Contracmrs Licon¢e Law dons ml apply to an owner or Required Inspections.
property who builds or improver firemen,and whodoessuch workhimulfor trough his 305 - FRAME
own employee[,provided that such improvements are not intended orortered formic.If, 307 - INSULATION
however,to building or improvement issold within one year of completion,me ewmr.
builder will have to burden of proving But he did not build or improve for purpose of 601 - ROOF TEAR OFF
we) - 602 - ROOF PLYWOOD NAIL
❑Les owner ej,I Progeny,,Business s and cmuximes with licensed mnvanort m
construct toes not (gee.]Otis,unrfandrty who Nicmc:)The Crtthereons Li 603 — ROOF BATTENS.
eeo contrdasnouppymen own arofpmpeny wbesed pursuant
to
thereon.and 604 — ROOF IN-PROGRESS
who contracts Lace for ouch projects with aconv¢tor(q licensed pmsmm to the Canwnoh
License Law.
❑lam exempt under Sec. ,B&PCfor tis noon '
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby aRw under penally of perjury one of to following decamdons:
haw and will maintain a Cenificate of Consent m u16inure for WorkersCompen-
don,as provided for by Section 3700 of the lather Code.fm the performance of the
work for which this pewit is iuucd.
1 have and will muntsin Worker's Oompemation Insurance.as required by Section
3700 of the labor Code.for to performance of to work for which this Permit is isswd.
My Work
A r. sCmY2rum Paond Polley
number
er ere
pmiPo
CEtTIFICATEOFEX P ( o: WOR ^
SCOMPENSATION IN
INCE
or lass.)(This lactim need not be mmplcmd If the pcwi is for one hundred dollars(S 100)
I Unify that in the performance of to work for which this Permit is issued,I shall not '
employ any person finny maomr so m to become mbjeel to IN wofkeri Compensation
Laws of California,Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Workers Compensation provision of the Labor Cmc,you must
.J.z forthwith comply wit such pmvi5nm or this Permit hall be deemed mmked.
zO CONSTRUCTION LENDING AGENCY
r
(-+ kNmby which
Nememisamntrvcd3W7,Mr. agency for the perfurmenw of
ai 7
the work for which tis pewit a issued(Sec.3W7,Civ.C.)
U A Lender's Name V
]z Under&Address
O Q I eeM1ee mal 1 hate read tis application and rtste that the show information ix
0 F bonen.I agree m comply with all uth and county nu inansOf and alae law¢r upon the, -
p C.) al,ow-g construction.oro am hereby a torte represemetive¢of this city to tour upon Nc
W imseq. oco progeny for n,of C11on pomit.eYa. �
0. (We)agree,to saw,indemnify and keep hawlesa the City of Cupertino agaimt
V) liabilities.judgmets,corts and expenses which may in any way accom agaiml mid City
J z in conuymncc of me granting of permiL
SOUR APPLICANT GULATI S St WILL COMPLY H ALL NON-POINT Issued by: Date
r Re-roofs
Signature of AppEcan on' t r Det
HAl.ARDTERIAIS Dlgrc RE Type of Roof
Will Ne,applicant or futon ding aeupanl store car handlchvaNuus malarial
m defined by to Cupertino Muni pal Coda Chapter 9.17,and the Health and Safely
Code.senior 25532(.)7 All roofs shall be inspected prior to any roofing material being installed.
❑Yes u
Will me applicant or mum riding occupant tau cyuipmont or dcvicos which If a roof is installed without first obtaining an in ection,I agree to remove
It Nu inns air contaminants dcfined by the Bey Ana Air Quality M...gcmcnt all new aterials for inspection.
strict?
p Ycs No
I have mad to hamodous maurudsrequirements under Chapur6.95 oftc Califnr
nia Hcolt&Safmy Codc,Scctimu255t15,25533and25 .lundcrsum lhmif Ne,building, �I /�
deer not ntly n a We tet it u my[cape ity notify the cocupanl of me
require n hi reA et pdorm issuame ourea f cuPancy,
S gnat re cant Date
d
n w.er. so a d$go. Date Al I roof coverings to be Cla�"or better
Building Division
10300 Torre Avenue
_ 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) 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 minimum 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:
Address: 1d3
Reroofing Company Name:
Applicants Signature: /
Joe Antonucci
(Chief Building Official)
6/25/01