02120008 (2) six CITY OF CUPERTINO �..- �7 "� ^s -
a BUILDING DIVISION PERMIT CONTRACTORd,m INFORMATION
BIHGbJtG00FssTANICE AV ADVANCED ROOFING TECHNIQU SRMfrN02120008
OWHOUAhgAULINE TRUSTEE 1179 MYRTLE DR APPL"ATT12sYU TY2002
ZONE: (408) 249-4937 SANITARY NO. CONTROL NO.
ARCIfITEC IENG INEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
00 LICENSED CONTRACTOR'S DECLARAIION
C F I herebyaffirm that 1 am licensed under rovixions of Chapter Y commando ,,IOb DCS.rI tion
M! with Section 70(rof Division Sof the East ne provisions
Professions Code,and my licenses TEAR OFF SHAKO rip
tion
inBdillle a elurel. INSTALL 1/211 OSB PLYWOOD & 30 YR.
c°zn4 Liecnsnch ._ `� COMP CLASS A
Zn : Dnlc Co c4rz
qq ARCHITECPS1 R ION
F: , I U Jerstand my plans shall M used as public rcenNs `
SpWV
m 3'-I Llccnscd Proleodinal
OWNER-BOLDER DECLARATION
YI1 hereby affirm that I am exempt from the Contractor's License Law Int the
tyu O o following reason.(Section 7031.5,Business and Professions Code:Any city or county
$E� which requires a permit to construct,alter,Improve,demolish,or minor any structure
prior ti its issuance,also requires the applicant Inr such permit to file a signed Aalement
�&< that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 SLI. Ft. Floor Area $1090&tion
I (commencing with Section 7")of Division 3 of the Business and Professions Code)(it
uty that he is exempt churchman and Ne basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant fora permit subjects the applicant to acivil penally of 3 bXWf4g@be Occupancy Type
not more than five handled deltas(S500).
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work,and the structure is not intended or offered for sal.(Sec.704,1,Business
and Professions Code:The Contractors License Law does not apply b,an owner of 3 07 - INSULArjlf@*ed Inspections
property who builds or improves thcfcon,and who ices such work himself or through his
own employees,provided that such improvements am not intended or offered fir sale.If, 601 — ROOF TEAR OFF
however,Ne building or improvement issold within one year of completion,Ne owner. 602 — ROOF PLYWOOD NAIL
builder will have me burden of proving Nal he did not build or improve for purpose of
able.). 603 - ROOF BATTENS
C]1,as owner of she property,am exclusively contracting with licensed contractors to 604 - ROOF IN-PROGRESS
construct the project(Sec.7096,Business and Professions Code:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves lumber,and ,
who contracts for such proems with a contractor(s)licensed pursuant o the Contmnm's
License Law.
❑ I am exempt under Sec. B&P C for this reason
Owner Dam t�
WORKER'S COMPENSATIONDECLARATION ] BNA tom®
afford41 hereby alirtunder penalty of perjury one of the following declarations: r9�(ea(�
❑I have and will maintain a Conti of Consent to self-insum for Worker s meCompen- LLV O 2002
s u .as provided for by Section 3700 of Ne Labor Code,for the performance of the
work fm which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for thBUILDING
e performance of the work for which this permit is issued.
M Worker's Cnm nsati Inmranccc(��rr'Icr and Pi l' matter am:
art r:� IF dl PnlIf Yi5-�Io�3
CGRTIFIC OMPEEXEMPT AN WORKERS'
COMPENSATION INSURANCE
(This section need not he completed If the permll Is Boone hundred dollars($IIX)
less.)
I verify that in the performance of the work for which this permit is issued,I shall not
employ any pemm in any manner so as to become subject to the Workers'Compensation
Laws of California,Dalc
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you teas(
OQ forthwith comply with such provisions or this permi t shall M deemed revoked.
z CONSTRUCTION LENDING AGENCY
t-� Ihereby all!rte Nat there is a construction lending agency for the performance of
the work fur which this permit is issued(Sec 3197,Co.C.)
Q Lender's Name
z Lender's Address
U 0 1 certify Nat 1 have read this application and foam that the above information is ,
W r correct.I agree to comply with all city and county ordinances and state laws relating In
0 V building concoction,and hereby autherive representatives of this city m enter upon sic
C' n.) above-mentioned property for mire purposes.
G (We)ag ve,Inde antl keep harmless the City of Cupertino against
rF—t Ln liahilitics,j rins. xsm an uses which may i n any way accrue against said City `7
in conew ncc of the rinti this permit. 7
F-t
,PP
ANT UN RST DS AND WILL COMPLY WITH ALL NON-POINT Issued by: Dale
SOU CE REGO TIO
Re-roofs
ore of Applican lContractnr Date
HAZARDOUS MATERIALS DI CLOSURE Type of Roof
Will the applicant or future building rccupanl sore it handle mandate,material
as defined by Ne Capital no Municipal Code,Chapter 9.12,and the Health and Safety
Code,secannzsvz(a)7 ��/' All roofs shall be inspecte for to any roofing material being installed.
❑Yes ^°�
Will the applicant it fig occupant use equipment or devices which If a roof ism a ith ut/first obtaining an inspection, I agree to remove -
emit lozoldro s air contaminants as defined by the Bay Area Air Quality Management all ne, m rials for in e. on.
Dislrictl
❑Yes �ftJ,l
I have mail erasion team1'i. rcyuircmenu ander fir"'. m2 cele,See m2q.s 25533and25534.1uMerswnd Natil'Ne building
docsnilc�yhave,Ry m, ( ;l my resWnsiM1ilitymnotify Ne rccupant of Ne VI ( L Q�'�Q�
rcyuircmc I bleb mat me to issuance trtacemficam it amtpancy. Signature of Applicant fDate
Owns of agent Date All roof coverings to be Class "B" or better
" . Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CI O Pax: (408)777-3333
CUPE�TiNO
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 V"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: _ /t/FS X)5 5" \
Address:
Reroofing Company Name
Applicants Signature ate•
Joe Antonucci
(Chief Building Official)
6125/01