02120047 (2) CITY OF CUPEWFINO
BUILDING DIVISION PERMIT CONTRACTORjNFORMATION '
Bua°wG ADDRESS:
WESTERN REGION ROOFING PeRMIT"°,
10554 LONNA LA 02120047
OWNERS NAME: 231 N 12TH ST APPLICATION SUR DATE
MC AULIFFE GEORGE F AND HAZE 12/12/2002
ONE: (408) 360-9111 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECII
C aaZ I� I�
ag Lm that IDCONTRACnderpDECLARATION Job Description
¢�p 1 ncrchy firm that 1 am licensed under provisions of Chapter 9(commencing p
�SXj with Sec n7lygl)of Division 3uf the Dv.`ifxund Professinne Cnde.and mylicen¢is
„ in mu re afi erten _ ✓_ REROOF
OZ-Z Liccnm Lic.N
p__q
Datc_� e REMOVE REMPLACE TO 1 2 11 CDX+� S aN .E V.
� //�1 A IITECfS u 1 30 YRS COMP.
06ow� lumbr3(e(td my plans shall beuud as pontic recerds
LL00 Licensed 11 rulnnal JUN 0 9 2003
OWNER-BUILDER DECLARATION
'u� Y 1 hereby wittrm that 1 am exempt from the Contractor's License Lew for the
w—pp following much.req (Section 7131.5,Business and Professions Code:Any city or county BUILDING
n $ which"ours a permit to construct.alter,improve,demolish,or repair any structure
r^ Pathe its mnewd ezlsorequires provisions
for suchpmmilo filrese La (stxmmcm
that me cing wd pursuant lnlhepnwiviens of the theBusiness
License LowlC ode)9 Sy.FL Floor Area Valuation
st. (cat he
(commencing therefrom on
of Oivislnf rth toeged exempton.Anand y
Code)or
6�$ that he is exempt Therefrom end the basis for she allege)exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects she applicant o a civil penalty of APN Number cy Type
not mom man five hundmd dollars(S5ro1.
0 1,u owner of the property,or my employees with wagea as their sole compensation,
will do the work,and she nructpre is not intended or offered for sale(Sm.7044,Business
and Professions Code:The Contractors Liece.Law does not apply to an owner of Required Inspections
property who builds or improves Ihemon,and whadces such work himself ortrough his
own employes,provided that such improvements rte not intended oroReted forsale.If. 3055 — FRAME
however,the building or improvement is sold wilon one year of completion,me owner-
builder will have the burden of proving that he did not build or improve for purpose of 307 - INSULATION
sale.). 601 - ROOF TEAR OFF
0 I,as owner of me property,am exclusively contracting with licensed contractors to 602 - ROOF PLYWOOD NAIL
construct the project(Sec.7144,Beat.and Poetess..CAI The Conlrutofs Li.
cense law does not apply to anoswor of property who builds or improves thereon.and. 603 - ROOF BATTENS
who contracts for such projects wit a comraclons)licensed pursuant to to Contractors
License Law. 604 ROOF IN-PROGRESS
0 I am exempt under Sec. .B&P C for this reason
Owner Dat
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penally of perjury one of me following declarations:
1 have and will maintain a Crnifcm,of Consent m ulf-insum for Worker's Compem
scion,u provide)for by Section 3711 of the labor Code,for to performance of the
work for which tmit is peris issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
371)eftht,labor Cnde,for to performance of the work for which this pr W it is issued.
My orkcr's Compensutinnl ranee artier and Polis number ate �1 )
� Policy 6M WORK 2/
C IFICA OFEKEMP'fIQ OM WORKERS'
COMPENSATION INSURANCE
(This sullen need not be completed if tbe permit is Intent,hundred dollars IS Ikb
ur Isa)
1 certify that in the performance of be work for which this Permit is issued,l shall not
employ any pt,rasn in any manner se as to become subject n the Workers'Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:It,ager making this Certificate of Exemption,you should
become subject to to Worker's Compensation provisions of the Laber Code,you must
t7 z forthwith comply with such provisions or this permit shall he deemed revoked.
zO CONSTRUCTION LENDING AGENCY
[—r h I hereby affirm mat mere is a construction lending agency lin the perormance of
Ci the work for which this permit is Issued(Scc.3W7,Ci,C.)
12] 0 Iander's Namc
7 z Lender's Addmu
V Q 1 unify tat 1 have read this application and state that to above information is
correct.I agree to comply with all city and county ordinances and state laws relating to
Q U building conswction,and hereby autherivc representatives of this city to enter upon the
} thou mentioned prupersy for inspceion purposes.
(We)agree to save,indemnify and ksp harmless the City of Cupertino against
FF-t y liabilities,judgments,costs and expenses which may in any way accrue against said City
V z in consummate,of the granting of this petmh.
^' APPLI ANT UNDER DS AND WILL COMPLY WITII ALL NON POINT Issued by: Date
SO . EG
z Re-roofs
Sig natu Appliew untracmr Date
HAZARDOUS MATERIALS DISCLOSURE. Type of Roof
ill me applicant or future building oecupant store or handle IntAm oils Wou nal
as defined by the Cupenine Mu ¢ipal Cnde,Chapter 9.12,and the Health and Safety
,ddjLC.dr,Semen 25532(a)'� All roofs shall be inspected riot to an roofing material baso installed.
❑Yes Ne P P Y g g
or Will she applicant ant fuwm building occupant vu equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hazardous air conmminaMs as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes Nt
thaw mail me harard(ms mamriafs myuimmenm under Chapter6.95 of to Califor- t
nia Hslt&S�ety Ctwlc.S -6t)m25N)5.25533and2533.lunderstvtdt ifdtcbuifdin9 J.y� ,k� ase
does not cummlly have a moan at it is my responsibility to notify Illrr����. pgr�I of to C L 'L ��
neem, a whie at tet a rteiaauanaefacertifieme errx`p`C I ire of Af,606ant Date
wnern pmedagenl Parc All roof coverings to be Class"B" or better
Building Division '
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CI Pa:c (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 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 must have a minimum of l."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 compl(y� with this policy.
Homeowners Name: JQA 'E tA� i k eo
Address-
Reroofing Company Name: ll)•_ a a�
Applicants Signature: Date: / z Z—D Z
Joe Antonucci
(Chief Building Official)
60/01