02080151 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
OWNER'S NAME: APPLICATION SUB DATE
MARY WHITE 12SIO FOOTPTLL AVE n?.
PHONE: SANITARY NO. -CONTROLNO.
(408) 683-2551
ARCHITECTIDIGINEER: 4 BUILDING PERMIT INFO
m BLDG ELECT PLUMB MECH
L= G7 r__t G_I
-6 y_ LICENSED CONTRACTOR'S DECLARATION Job Description '
Z_O I hereby affirm that I am licensed under provisions of Chapter 9(commencing
wt ad withSmdon7W0)ofD,eon3a Buy ssandProfessionsCod,ardmylicenu REROOF
O is in fulljaree.nd effe[ j J 3b9�7z
1 rc < Lice la Lic.p A �e
Ume' Contmc or _ F I a Bi L Cr D
aO ARCHITECT'S'TNiLARATION mala a"'i Ire 14.E
a1 ua erstand my plans shall he utied as public remrds
3-°'0 0 Licensed Professional SEP 0 3 2002
a OWNER-BUILDER DECLARATION
=�m 1 hereby affirm that 1 am exempt from the Contractor's License Low for the
Follow
n reason.Section 7031.,Business and Professions Cods:Any city or county
Z f II q permit n,alter,improve,demolish,or repair any structure
E o hchrc requires trot mcont B11 �5_ 00
prior- I t [ also I the applicantl r such ,mon to fileasigned statement � � - - ai illi Y . ._ _._...-_ -------------
that
__ _ _
thath .cenim uauuntl ilio r n l the Contactors License Low.Chapter 9 p aS' IFt: FlgoriAfea? tai Valuation
fico rp int;with Sectio 71100, f Divin..3 of the Bus nes,and praf.mm.s Code, ('�j s'y S ( qq s r. - 1:'1 k I f•:'t:
nr that Re Is exempt therefrom and the Tunis for the vlldged.cinnuip ki,Any vroletinn -3'1'6 0 2 016- 0 0
of Section 703).5 by arty applicant for a pemtit subjects the......cent m a civil penahy'
of Got more than five hundred dollars($503). APN Number ,-,. fs Occupancy Type
❑I,ns rof the propcny,mmy employttawith wages os their sole compensmian.' 305 - FRAME
-will'doldam work:end the'idowl.rc is not intended or of rad for sale(Sm 7004." -
`Busiins'vnd Professions Cone:The Contractor's License Law does not apply to aa, I� Inspections'
owner of property Who builds or improves memo,and who does such work himself, 601 - ROOF TE r' ,
or through his own employees.provided that such impmvctnen¢arc not intended or ROOF--PLYWOOD-NAIL
;bRcmd for file:If.however.the Wilding or improveriem is sold within ane year of' ..__ ,. "•'_ ...__.
0 --
danpletion,mprathe owner-builder will have the burden of proving that he did not Wild nr _ '• c- I'a_n'
refarpupaa .f,mej. 603 ROOF BATTENS
_ -604—. .._.ROOF-•I N-PROGRS S S---
- _...
msed
construct
her nfthe pm�edyam cxsiness and
tions Com:)
F {'� v;l
congruci the project(Sm.7tk4,Business and Professions Code 7 TTe Contractor's ,• 4 _:!G ,t
License Law does not apply to an owner of property who Wilds or improves thereon,
and who contracts for.such projects.with...coon itch sl.licemad.pursuant to the: .-.._.___..—_.._..._.___.___.__.__...__.._.____.__.___..'..I-,,...__._.__._._...._.______..._.__.__._---
Cnnwnofs Licenu L.w.r„ ;;,i 3.u;.Df:..'.!""�
❑lam exempt undo Sec:"''' .B&PCfarahis reason. � 7+10 i);',�+C'I
'Owner r i.Ilam .., -, ,•.n
r,IWORKERS COMPENSATION DECLARATION
•` I`hereby affirm mole,Many of perjury one of the following declarations:
@� ❑ 1 no.'and'wilh maintain`u'Cenificme bf'Consenl m self-inmre far Workers
3k•Cnmpensstmer, es;provided for by Section 37M of-thc Labia Code: for the
performance of the work for which this perm: is issued.
0l h ve and;sit]"anufiA Worker',�Comlmian on lasumnce's requiQ by Section
37M of the L.1W Cod f the perfbnnan<e of me work for Inch th peimu s
issue My W Ike/s C pe t Imumi ecc ' .d Poi cy a be ve '-
efN,;:�l�d
ERTIFICAT(ON OF EXEMPTION FROM WORKERS
t COMPENSATION INSURANCE'
' IThrs act on neon nm betomplcuondifthepmnnisformmWndmddollers ';f•\ •' fI19"IY "ce r.Cltl't:.ia[ •t!'j:i
151001 or less)rn t it .:n -
v th donna c pf the"Afar which
this nnti ts' ..• •,.. .,_......._.._ ::-...
r Icon fy th tt pe °' pe i.issed_I' K'i,J al U 't-"!r;((,.
air I employ any n n an nncr w as t become sub est to the'Work re _
Compensation Laws of C hfomta.Da, "
..APPlliint1. ,r,,, ,i ::.. . ___._... ._.__ •_.__._........
z mg thisCertificate of Exemption,you should "''!i •t'1 .� 'F .\u
became sub*!rPthe,Wdrkerf Cmpeasetionprovtslon.4flad LOW Cod,you must,
00 fonhw Ili co ply wnh ch provisions or this pemut shall W deemed revoked.
te('CONSTRUCTION LENDING AGENCY _ '.0 P ff ,
It rtby ffrm th alio s [n t t nn tootling agency fon the Pedo o'"ce .,Ft 1' J
a of the w rk ftlr on this peen 1.s i ued(Sec 3097 C C j
W -Lend ra Nam r ..1 _.. ----------
Q _ _ _ _ ... ...._ .. _. .._.__.
UZ LeadersAddre
I can fy that I have read this applic tin and state that the above inf+rmet n Is
W, �eortest I agree to cumply with all coy and county ordiddrom,and stariaws rcleting t/
to Wilding cnnswction;and hereby authorize tepmsentativesbf this city to enterupon
y,W the W e me nt oned;property for inspection purposes.
-
gain.
a` (We)agree tome mrvu
detfy and keep hamtles t
the C y of C pen o a
V] liebtbue 1 dg cots,cowls anp rJJlpenses h¢h mvy any ay c,me pg!!nst said
yo
4.7 Cit n e n eq ce f ilia Bm h perm l
i_ yP�RfC -UND RS N WILL COMPLY WITH AL -POI T` Issued by; Date
n ,
mu of. !ic vC vat - '. m V Re-roofs
AZARDOUS MATE IALS DISCLOSURE �, -
;4, wW'l Plicanturf tare Wdd,.se pamstoie Handle hnrardou incl Type of Roof._____
es tlefined by,theCupemrroM .apaI Cade Chapta912'.ad me Health and Safety a „I• s;-(t••{`it {{st\I J'" j�•"is7e w _ - �ll111.J:f:"
QoEe SCLIa ;SSj3p) ,ti : s fY-. I' F 41•b ? "e' - e
n °Yrs All roofs shall be.Ins ected rior.to.an roofin material bei. installed.
in P P Y. g. g. _ ._
WIIth, ppl'enifuturch dinedaytherB use yAm.equipment deviceswhichIf a roof is in'stall'ed�piittiout first obtaining ad inspectioli;'I''a'greeto`remove
emit h and u man.mmanu defined by Ne Bay A e A Qu 1 ty Manage t •
D-at [t •r _. all new materials for Inspection Applicant understands and will comply with
. ❑Ye,, t t rvl.. a- � t t I, I e, y, t..t;,.'- r all,non- oin[source gu .tions ....n.
have:rced the hauN us materials requireme1.nts undef Chapter 695'of the
Ca i!a Health&Safety Code Sections 25505;25533 and 25534:1 understand that
6.. Y Y I'o libilily to notify the. _.
_.
's(ihe W Id da nnwu at h.v a tors m Ihm a is m res
i
occu t f the re uirement d n e t nor t ani¢arc n '
Occp nc 9,., P P �: ,.
r. . Sig attire Ap :cant D to _
/ .1 ...xs'a c of. Q., ... . .-- - ___. _.._.____ ...- __ ..
or dWaxed: nit Date; All roof coverings to be Class"B" of better'
.',&) {r . L OFFICE..... ...._,-._.... . .... ._._ ._ ... ...—_. ... .. _. ..__ -
' Building Division,
oclo
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Far.: (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
Wand 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 1/4"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 11111&L_ 111",,401C—
Address, /US�7 Z'41-x y
Reroofing Company Name: Off/iJLv
Applicants Signature: Date: JPI16 OZ.
Joe Antonucci�^_
(Chief Building Official)
6/25/01