02070046 (2) c► of cure
BU CONTRACTOR INFORMATION:
BUILDING DIVISION
SION pFRMIT
BUILDING ADDRESS:
PERMIT NO.
10746 LA RODA DR CAL-PAC ROOFING 02070046
OWNER'S NAME:
FISHER KATHLEEN 36 RAILWAY AVE APPLIC$tJT}{]I•j$I1002
PHONE: /// U L
(40B) 874-0784 SANITARY NO, CONTROL NO.
Q ARCHITECT/ENGINEER:
BUfLDMG PERMIT MFO
O U BLDG ELECT PLUMB MECH
Z,,Zo LICENSED CONTRACTOR'S DECLARATION Job Description
ZO F til I hereby affirm that l um licensed under provisions of Chapter 9(commencing p
Fr.�_ with Section 90WlofDivisionJof the Bmimaar^a..,oaa;,,as CMaand myiicenu REROOF
a m� is in run mrea and rt
sag LicenmClss �' b Lic,a 86Z� T/O SHAKES TAR GRAVEL ADD DECRA STEEL TI
3 0" oat` y ARCHITECT'S DECLARATION I CBO ER 4361 &r DUROLAST ON FLAT SECTION.
�ny 3 1 understand my plans shall be used m public rtcoMs
6 j O Licensed Prokssio
OWNER-BUILDER DECLARATION
I hereby ofm.that I acxempt from the Con...Im's License Law for the
S?< fallowing reason,(Section 7031.5.Business and Professions Cote:Any city or county,
which recto purnall to consume,almr mpmrc domililh,o piny swctum
n -p rmits nce. )so reg the apphema,formed permitto file.ugtedsuadamra.
that rte I he sN pursLant s mgpmv s ons of dm Cont t r L c se In (Chalrter 9 S Ft:floor Area ,.
nenc g dn5nu ]g10).fOivisonJnfilm13. tiadPnfston,Cudel * r� q• r ','s-f-rnr, t $150bJAlua[ion
or,hat rte is cxempt there Flo' and the basis fnf the alleged exemption:Any s olmion 1' °1 �"1s-' '' a`s"` •t t d'1: `.�.•:. �.,P.1, I,
of Sttonn 7031.5 by any applicant fora permit mhjects me applicant m e civil penaby
.r nut mom than R,m handled a.uars(sSIIB), 3 6 9P14�E9'4Tb�S P'41 ::.Occupancy Type
O 1,os owner or the property,or my employees with wages as their sole compensation,
will the work;and the... tares not intended Or.Rend for sale(Sec: OW,] ' -- - - - - - - _ ..._
R .mess 'm,i res tan Came:'the Cmiloroves.ctors, ad w Law J«a not apply m an 305 - FRAME Required Inspeetlonsl
o rte fh his m Who l 'Id. r tmpmves thereon,anJ who does such work himself
or-offered
ugh his own ploy .provided that such torment is nts art not mended of 307 — INSULATION
dompld for sale.IL however,uilde the w'buiave t of improvement pr v n sold he did one- _ _ . . . ...
year of -' - .� .__._..._
completion,,he owner-builder will hors me rumen of proving mat he die not Haim or I 661 — ROOF TEAR OFF
improve for purposeofsate'). 602 - ROOF PLYWOOD NAIL
- - —
o5:uric o;artneptopny. xcwsivelye.ntmhogwimn«Rude.ntrnem' m' 603 - ROOF -BATTENS
—
constrvct a pmjm(Sac.]OW,Rosiness end Professions Code:)The Contrutor's -
awdosnotapt, itan owner 0fpmprdywnowimsorimprove, hercun, 604 - ROOF IN-PROGRESS
andOtn u o Licenseommns.Por such.projens wim a<orandor(s).licensed pursuant.m.the. t ,
cors LIM d Law.. ._-._, ..... -. .,..__. ._.__.__.__'._..
'I, j OI am cxempt arm La c. '• ' '` ,B&'PCfunhis__on - ^- - - -
c :p(#.'
Ow'nci ., .... PINAL.E®
- WORKER'S COMPENSATION DECLq RATIO.'
a I hereby afflm under penalty of palimy oneof the following declarations: •t np n/
•� 0 1 have and will maintain a Certificate of Conant to self-insure for Worker's JUL 1 " `002
Compensation, as provided or by Section 3900 of the Labor Code. for the
;`IpseROromme.(the work for which this permit is issued.
( Ml have and will maintain Workers Compensation lniumnce:as required by Section BUILDING
IP00'of the Labor Code,for the perfmmantt of me work for which this permit is
issued.My Worker s Compensation Insurance artier end Policy number are:_
tCrt }' �- iPoncYN W3 Ol
QERTIPICATION OP EXEMPTION PROM,WORK6R3 Q. Y,Z I ' d i( J} �•ig�i t d6_Yi:
COM1IPENSATION INSURANCE' '• ��x'
' (This seciirin nceJ not be completed if the permit is for one hundred dollars
,C card,fyth ti me pef rnee I,- odf - '.. ,.... .'. .f:. .. .. -.::-.. _.._ -. - .. .
which th permit is iss ed 1 -' '-" - --
- _ _. ....
,hall not tion L s y perm t any manner s as to become subject to the W rk<ri' Imo•-s: �.[}; L
Compensation Iaxs of Cal fomta.Dam
Applicant
I
NCI ICE TOcto,thCANT if ft pens, gm,sCtfrsof tExa pt y Isnot lJ --
bechwithcoecnotheWorl, Compensation p ,mo sbf theWborCode,'y u oust s"
Z forthwith comply with s h p c ns or th penim shall he I einem revoked.
t"ti:� '•r''.•-.' -CONSTRUCTION LENDING AGENCY'.
�. I hereby ulTrm fti d em so construction lending agency for the performance'
yr. of the work for which thin permit is issued(Sec.3097, is C.)
'0 . Lender's Name
V.Z Iknd Add
0 •''} t
LL 1 ri fy that l h read ihi application and slate that the afro mformatm i
Q �i entre t.1 agree to comply with 11 City and countyOrdinances J tate laws relat g
,U hibuilding , fin t the by ohorimm,presenualive,of do,city,.enter upon
the Above-mentioned property for inspection purposes.
0.,: (We)agree m sam.indemnify and keep nmhe City mlal,tof Ci paries.
.gains,
COO liab ties judgments.costs and expanses which may n any ay ac me.gain.said
V y City" consequence of the emming of thispemt, ^
APPI ICANT UNOERSTANDS ILL CON' LTH LLL YO PO
SOURCE.REGULArlo`1 f l BZ Issued by: Date
Signam pf Applmam/Commnor - le
HAZARDOUS FI�LOSURE.' � Re-COOP$
'E delict dbjj be Cu rfw,yl e_buallCWo`Cheaiert grc'or hundly hazar loos metenal t
pp (ei " Type of Roof..,..
Cod 'Seco 3551 p` - P P _,o and Health and f ty '- _.'. --.. •m• •* r ,.._ .. -,. -_ ,..._
0", I1N� t-L s I t y 9 f' t k_. y)'•, '
All roofs shall be inspected prior to an roofing material being installed.
Will the pct! t future building o«un•nt use eq�p tent rode c wh ch If a roof is installed without first obtaining an mspec,ton°['agree to remove
emit h d nest t. f ed by me Huy'Au.k Q Toy Management
District
I,
Yes b�/ all new materials for inspection Applicant understands and will comply with
❑
all'non-point source reg'ulation3,• .
1hate seal the hasardous mntedms req.remenm under Chapter 695 of the -'' t �' s • '
California Health is Safety Cadc Sectio ss 25505,25533 and 2553< 1 understand tbe,
if the hn,lding docs not currently have a temnCtha,it is my«sponsibility m..,ify the - -' - "- - '_...Plantan y.the re ui once Of Cert�am of. --
Ottup.ncy.
'7 Z SignatureofA licant Date
m
_.. .
c must t p m mu
owre,m tu,n.rts d tgan, Data All roof coverings to be Class B or better
.., . ...... _ .. - . . .. - OFFICE - -
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEPTINO
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 VV 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: /0 7 h a. L wa n/1 .
Reroofing Company Name: C�4
Applicants Signature: Date: 7 O Z
Joe Antonucci
(Chief Building Official)
6/25/01