02070082 (2) CITY OF CUPERTINO
i)+UILDINO DIVISION PERMIT 'CONTRACTOR INFO TION:``
BUILDING ADDRESS: PERMIT NO.
22076 LINDA VISTA PL J. TOLENTINO 02070082
OWNER'S NAME: APPLICATION SUB DATE
DON PEGGY L AND BILL TRUSTEE 284 BURNING TREE DR 07/15/2002
PHONE: SANITARY NO. CONTROL NO.
(408) 578-4141
O ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUM MECH
y LICENSED CONTRACTOR'S DECLARATION
py 1 hereby aR Nat I am licensed anderprovisions mf Chapter 9(commencing Job Description
pyt� wiiSenimn]B00) fDivis' m3nnneea9imeaa aProressmasemae.andmrReense REROOF
< i9 is full force ff<m , 3 �Cp, pu
a License Class n Lic.✓ O
D Contra..
vS 3 0 CHITECT'S DEC
u O S 1 and fund my plans shall be used as public ords
�T
6 Licensed Professional
OWNER-BUILDER DECLARATION
—�'w 1 hereby affirm Thal 1 1. exempt from the Contractor',o License Law for the 9 7 Q O
tZ< fallowingreason.(Section]onstm Business and Professions Code:Any city orcounty
O which requires n Penni)re conffmm,alms improve,demolish,or repair any statement.is. prior try its cenlece,ah)requlres theapplicantfor C,amsuch mu',Limat to rile Law
aw( hapter
that RE if lianseJ pungant 1p Urp PRNmons of the Conlmcm(v License tf (as Coar9 ! {y py�� {pyo r {� j Valuation
(comm'Shes ewbht th.6 I of adtebasisor the uj)I'Inmes 1Ishh. lops Code) ��0:`.i Iklshilf 16_gInd VRZ1,'I'X ION: 1
or thatSectio 1703 L5 b, a,t,li and the basis for Ne al,sgre ar deaf,I. ny viP at realty
of Section 703 by anyvpplicvm for a permit subjceta The applicant m a civil Penalty �t�au�t �
;ref not more mb*Wj9��
an five hundred dollars 305 AeN 47✓ �CS%41":A Occupancy Type
❑1,as owner of the progeny,ur In,employees with wages as their sole emmpemminn,
and the sin c[ux Is'act inttmdetlbr oHertd'for reit Stn.'704,4.' "— - t --'-'--
1ownease dProfessions ho builds
The Contractor's License Low docs not apply t an 601 - ROOF TEA)I&;gQRB'Inspections
ownermfh property
ow employees.
Idsor midedt [hereon,and mprwho Does such work himself 602 - ROOF PLYWOOD NAIL
or through his own<mployees.provide)that such improvements mems are not intend_or — ; _,offered _—
completion,ste.1,noweilde,wllheoWilding arlmpmvemeivin sthe,he did one Wild.,
60.3 — ROOF BATTENS •:I _ w„ -o
' Ne owner budder will have the burden mf pronng that he did fiat W Jd or 1�"
improve for purpose of sale.)' 604 - ROOF IN-PROGRESS
- — - ---- ------ _ .-
,41 f the properly,am"elusively c [ t g with Ime sed nvncmn to F 1' 1 h
Z L em tru t the project(Seo 7041 BtaimaS and Professions Cotte)The Contractor's i;l,l v i--r-
4. r License Law does not apply to an owner of progeny who builds or improves thereon, 1d'
_and who,comeacts for such
Commences License Lew...,,
a 'a 0 am eaem sunder sec:. 9'R PC•for his reason ,h 1
owns Dare F9NALED
MPENSATION DECLARATION
' RKER S CO
='1 -I hereby carat anihnIpim,ry of p lcI ry one oLthe following Jeclambomsr--
❑ 1 have uod 'will ammuio'aCerifiente bf Conum"m self.msum for Worker's •11 11 2 4 2002
Compensas;provided for by Section-37M of the Labor Code:-tor the
_ S L. pelfarritance of the work for which this imam,is bound,i'f t s BUILDING 1 @ (y
❑I havesand will ren tan Workers Compe aticie�Insurance,as required by Sectidn B v ILDING
3700 of the labor Code for the'performance of the work for which thispermit is
Sittts,L My Worker's Compensation insur a carrier and Policy mbar area
aMers . . :C
Policy Nm. '.� GZa. A r { .t tl!:i:'IC•P
iJr (tl-,CERTIFICATfONO2XEMPTIONF WORKERS) d, �i g.a.a L�I-A�:'lE dNrl)R1R.1_ (v10"
- '" COMPENSATION INS NICEf�'a
is
'04fi(Thisiection need not belcmmPle¢a if ie Penni)is for one hundred dollars ':^.\ai•It. ,::Ll,. �`('�
(3100)or les9.) '
-
1-111 . . ... .._....... .. .. _
1 rely that-la-the person'
rfo emhhew kfrirhi hu Pettvisa dl,
'Compensation e ply any pe sun y manner t heenme files t the W ken,
laws of Cal f' 'a Dnte '
,'Applicant NOnc m.k g prion.y.....
=NOTICETOAPPLICANTr'.c mhkm 1hsC nfha or
ouuho ld. ) •,G ,p :: ._
become suhjecito the Worker's Compensation pinion hoof thLitaireroid Cale,you muit
0
forthwith Ncomply—with hp .1 this pinion hot]the steroid --- 1 -- - -_ -
V] "t) :t •f CONSTRUCf10N1 ENDING AGENCY � � � -�
Ir^y f 1 hercor which
i that there t fi d Sec.'len I g'gen<y form p R mmnce [ f t
of wo k m hi h this perm t g e l(Se 909]Ci,C.) - 1
y C .,.Lanae s Name, u t u _...: —....__. __ _ — _ .... ..... .. ....
5'z —.act a Asa ex,',
Uic
tort
•r.t� Icmfy thmlha rcditsat o vd sum thanhc abs ainminims
ts1 [r en ree co
I agto TPly '[h fill city
ul and countyd
no o nce9 and soon laws
mining
� U thbuildingn aid he by ,home rep asi
nvas oflh ty t enupon
Mom
t� ,Neeabove-mentioned
b e-mwB e t recap p ny for insfe
po p rplee',
(We) llrmti sale"indcarrify and keep beinlcss the Ciy TCuper[itio egiitiat
y% ,'abam lud fano, t nd.expcnses htch may, tiny ay ac e gain;) aid
UZ City c ace df the Bas his t - -
ANT 1 aR3T A J (� MWLY WI]AIALI tf0 POLNTe !
•fi" Ptr.P' S r Issued by: Date
7 P P I C) Ch t 9 12 0l J the Health Safety,
w tAPPllcant/C no-nm t t 3 D e Re-roofs
1,, a fIAZARDOUS h1ATERIAIS DISCLOSVRE
Will the ppl'c t p fumrc b Ildnk cups t stor! hvndl hav1N us mal
and T pe of Roof,
as'defnW ti th C e t nn Mur ._ _. •"^'•` ••.�.. I L \ .. .
All,roofg shall be mspected,pnor tq,any.roofing,materla] bei ng,Installed.
IW11 J1- ppl pf fmurt WJd ny«apzm use cqutpment or devisees whim' 4 if a roof is in$Ialfed:without first obtaining P
2n•ins ecticII,,I'agree to remove
agementvim
emu h J m 1 f as defined by th B y Arca A Q I ty Man
all new materials for inspection Applicant understands and will comply with
-all n polio ce-egulanons ;( - .--
ltfom hH aW1&ie h m du i re¢ri q rcmenn and r Chapmn 695 of'fie
Ye
(N bu me,rxrnldy ha<a vomnam�h P^als my rdesspoo tbJu[o notify nd tthc"- - oll -
e t pf N immem h h must be t r t Bs once Ctmt Icale of l
G r�, - _ .of Applicant----- Date
G raatmm�. ageq me, All roof coverings to be Class 1`B" or better
__..-OFFICE.._ -_... _.. .... . ........ _ .. --._...... .... .. .- --...
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
410 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 Nam e: i.lo /
Address: 12-.676 L P'W-YA- U l ntA N'q cc
Reroofing Company Name: J a�^
Applicants Signa Date: 51- 6-2
SJoe Antonucci
(Chief Building Official)
6/25/01