02110048 (2) CITY OF CUPERTINO '. n 1
BUILDING DIVISION PERMIT ¢CONTRAC'TOORINFORMATION
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BUI 1 A D ER TON PL ABOVE ALL ROOFING PERMITNO2110048
OWd+Ib'vi3ANT-SEN GONG J AND HWALIN H 700 NORTHRUP ST APPLICATP'IS}UTY2002
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IONIS: 4 0 8 2 92-418 8 SANITARY NO. CONTROL NO.
ARCH)MCrIENGINEER: BUILDING PERMIT INFO
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LICENSED CONnsed unOR'S DECLARA'1 luq
F I nemny arum mnI I on licensed under provisions of cnapmr v(cnmmenciup Job Description
with section tlux�-�siN�Broncaeand P�ex ions Cardboilutmr license is REROOF
in fa11In.and � c -7yy2,e,
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:4� A�CI'S DECLAR4,6�A e +I/ ' �S �L a
�O6u I underslandmyilunsshall Musedaspuhlicom dr, JUN 1 G
iLL; Licensed Professional 2003
.0, OWNER-BUILUI?R DECLARATION 1r
z <y 1 hereby affirm that I am exempt from Inc Contractors license law for IM1c B�,/'L®'(k g� $6500
MO S O O billowing reason.(Section 7831.5.Business and Professions Codc:Any city or county g V
'w$f” which requires a payout to nmstruct,alter,improve.demolish.or repair any structure
prior to its issuance,also requires the applicant for such permino file a signed statement
S< that he is licensed purxuant to the provisions of the ContracLor x License Law(chapter 9 39q2011F&�A@0 Valuation
,FO (commencing with Section 70000)of Division 3 of the Buxi ness and Professions Cvdc)or
y R R that he is exempt themfrom and the basis for Ne alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant Io a civil penalty of
not more loan five hundred dollars DWY 307P- INSULATION Occupancy Type
0 1,as owns,of Ne progeny.or my employees with wages as mei,sole compmeandra,
will do the work,and the structure is not intended or offered for sale(Sec.7041,Business
ep -
and Professions Code:The Contraaors License Law docs not apply m an owner of 602 - ROOF P nRAcl[i Tis
property who builds or improves thereon,and who docs such work himealf or mmugh his
hemployees,provided that such improvements arc not intended oro((end for sale.B. 603 — ROOF BATTENS
owever.the building or mprovement is sold within one year of completion,the ve owner- 604 — ROOF IN—PROGRESS
builder will hathe burden of proving that he did not build or improve for purpose,of
saic.).
0 1,as owner of me proper,am exclusively Contracting with licensed contractors on
construct one project(Sec.7011.Business and Professions Cade,:)The Contractors Li
lease law does not apply tar an owner of property who builds or improves memon,arn
nd
who contmcla for such projects with a connotations)licensed pursuant m the Contractor's
License Law.
0 I am cxcmpt under Sec. B&P C for this..,n
Owner Date
WOR KM S COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury one of the following declarations:
I have and will maintain a Ceni(cate Of Consent o aelf-insum for Workers Compem
cation,as provided for by Section 3700 of the labor tide.for the performance of the
work for which this permit is issued.
0 1 have and will maintain Workers Compensation Insurance.as required by Section
3701 of no labor Code,for the performance of me work for which this permit is issued.
My Worker' Cn x l(idBlasumnce money and Policy n<of�her am:
.mer:Se ah Na/ Policy Na:J 7�"G Z
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE.
(This section need not be completed i(tM permit is furore hundred dollars(510)
Icss.)
I eenify,that in the Performance of the work(or which this permit is issued,l shall not
employ,any KHOO in any manner ea as to become subject to the Workeri Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:1(,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you most
O z fonhwim comply with such provisions of this prrmil shall he deemed ms.k.d.
z O CONSTRUCTION LENDING AGENCY
F I hereby affirm thm there is a Construction lending agency for the periormance of
CC the work for which this permit is issued(Sec.3097,Civ,CJ
0. Q Under's Name
z Lenders Address
U O 1 certify that 1 have read this application and state that the above infofmmion is
(L F^ Correct. ree ct.l agto comply with all city and county ordinances andxtam laws relating to
OU building correlation,and hereby aumurim representatives of this city to enter upon the
anavo-meminned property for inspection which may
F'mow Om)agree to save,indemnify and keep harmless the City of Cupertino against
h in
fthecostsandvalid.,pe which may in any way accrve against said City
U APPLIyuencc of the graTANDfthis permit.
APPLICANT D STANDS AND WILL C MPLY WI i ALL NON-POINT Issued by: Date
SOURCE l SNS. ,
�� �/ 6 e Re-roofs
Signature of Applicam/CommCbra Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle mr ardours material
as dell tied by the Cupcnino Municipal Codc.Chapter 9.12.and the Health and Safety
aEgni,store.Section nvllarr
❑Yes All roofs shall be inspected prior to any roofing material being installed.
Will the applicant o mmre nodding occupant use equipment(it devices which If a roof is installed without first obtaining an inspection,I agree to remove
emit hasaNnus uit c"71,11'12.
ntaminants as defined by the Bay Arca Air Qu lit Marta emcm
a r s all new materials for inspection.
oilal me havaNnuxmamriaL reyuircments underChupmrfi.95 of the CulifU.LclyC Jc.SCNnm1,115.8533 anJ 2553i.IunokrsmnJ thmiftM huildingV[/ /ad ha a leant,mm o el my reslsmsi M1ililY m nI�W the rccupant til meu cmmpriorm xu cemtie purer ( ignatureofApplicant Date
d' fx// biurimd agent „e All roof coverings to be Class "B" or better
Building Division
10300 Toren Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
OCITY0 Fax: (408)777-3333
CUPEkTINO
Building Depari6ent
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 fust 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 musthave a minimum of i/4"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 on reroofing and will comply with this policy.
Homeowners Name: I m S V
Address: )�Uyl,kJ'Skjv� PIaCQ
Reroofing Company Name: Awc v
Applicants Signature:`%'`C?�2 G1/�c Date 1 D
Joe Antonucci
(Chief Building Official)
6/25/01