02070131 (2) -ITY OF CUPERTINO '
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDM ADDRESS: PERMIT
2071 MC CLELLAN RD CAL-PAC ROOFING 12070131
oMMONG 36 RAILWAY AVE APPLICATIOn4SUl ff72002
d PHONE: (408) 874-0784 SANITARY
VNO.
/ CONTROL NO.
'G
u ec O ARCHITEC(ENGINEER: BUILDING PERNIIT INFO
u p BLDG ELECT PLUMB MECH
C-1 Li U
8�2LICENSED CONTRACTOR'S DECLARATION
;M thealer,affim ;hatIam licensed under anoision:ofChapter 9(eommencfng REROOF Job Description
with Secti�o{n7000)of Division 3of the Busincys and Professions Cmd! androylieenu
0 U Licenis in ulC/lsgg�..nd'eRc'cl_ ,
E, F 41T�a�.aCL J r C T U LILA
E,O Q Jig - ARCHITECT'S BE RATION
'` I am1m land my plans shall be used as public records
z p O Licensed Professional
M
OWNER-BUILDCR DECLARATION
I hereby affirm that l am exempt from the Contractor's License Law for the $12000
following mason.(Section 7031.5.Business and Professions Code:Any city or county
E e which requims a permit to construct,mbar,improve.demolish.or repair any structure
ct 3$ prion.its issameaalso amoiro me.pdinm lwsmh .it m file a signdauudmi g _ ____ _
Nil he ii liccbRd puisuliti wthe prbeslons of the Contr«tars Linnu law lChaq<r9 3 P'60� �„ Valuation
(commencing wim,genion]000)ofDivision3of the Business antl Profession Code)' f( �1 Si'r\1
or Irk,he is
rAdmpi therefrom and the basis for the alleged exam%ion.Any violation
of Section]031t5 by any applicant for a permit subjects the applicant to a civil penalty
rofnotin.mme.fivehundreddollars(s5W). 30 PN , '. r ]>:r' Occupancy Type
❑Las owner ohne property,or my employees with wages as their sale cmnpansaron. 307 — INSULATION
will do the work.add the duudtbre-ik hoi'imindN brolfered for sale(Sec.]Ma, bUi - ..._ .. ...
-Bu,hvo;add Prdfesi.as Codc:The aCoamnar's License Law docs not apply to as 602 - ROOF PL l eke ons
owner of n Who builds or improves Immon,and who docs such work himself
or through his own employees.provided mol such impforcmcms are not intended or
coffmad mpletion,
the IChowuildetheWilding orimpd of prods sold wiain one ild or - -" 603 - -" 'ROOF- BATTENS --r - - - - -- - -
cmna n firr me owner-wither will have me wmen or prorins m,l he did WI Wild or —
improverorpnryose.rm)e.). 604 ROOF IN-PROGRESS
❑1,as ow«r of the pr.pmy,oro exclusively contracting wird licensed commcton m - - - ��—� -- -� � -- ---� � �� �--�_ _ �'.,qr�I'_ ,-- hrn - -
- - construct the project(S«.7044,Business and Professions Code:)The Conlnctor i �'A p /�A ®
License Law does not apply to an owner of property who wilds or improves thereon. �!9
and whoconwns-for.such.pmj¢ta with.a.conu«I«(s)licensed pursuant.to the ...__________--_._ ._._..__.. ........ ..._...__._
--"--
Conus 1 L Law
❑lane pt nd' Sc ....at_e ' BBPCohson JUL q L '.t
Owner .i
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following decimations: BUILDING
d ❑ 1 hive and will maintain a Cen{ficat of Consent t0 self-insure for Worker's
- Compensation, as provided for by Section 37M of the tabor Cade, for the
performance of the work for which this permit is issued,
❑I have.d will maintain Workers Compensation Insamnce,a iequlkd by.Secli.n
3700 of the'lab«Coca;for the performance of do work four which this permit is
issued My Worker s Compc a von Insurance cander and Polity number are
N « `j�Q'EQ.FK�r/� Pokey t3 Olktl e 1
/V ! CERTIFlCATION OF.E%EMPT FROM WORKERS t;
COMPENSATIO NSURANCE.'.
(Thv Seim.aced nm be<oinpletcd if the permit is for one hundred dollen
(SI00)ar lass.)
'u I artily that in me perform,.e of the work for pose this pdmtil at issued,1 1:.. ;1' •, t r�i'ti
Cmarpitot employ ono person in any manner solo to become subject m the Workeri '
Applicant cnurian Laws
of Califamia.Dere
Applicant, ... . ... -.
NOTICE TO APPLICANT.If.after making mis Certificate of
Labor Code.you
r
Z bowmen compywito t Workers Colons;or
is Permit shall undecided Code.you must
Z O f.nhwith.amply with sato provisions or lois Permit shall h deemed cooked.
E-4 a �ICONSTRUCTION LENDING AGENCY '• r "-
+,� ' Irk by (r Irk t th C d g agency f Irk performonce " .. \. I'
VI "" Lie work for hi2hihi it it issued
(S'(SCI09] C C.)
Londne N e . .., _..,-._ nw.:. ...tr ..... ... ._ .._ ._
�:).:z LenJ Addrt s!,
V' 1 modify that 1 have mad this application and nate chat the above information is
k+•E•t corral.l agree m comply with all city and county ordinances and slate laws relating
to Wilding construction.and hereby authoniempresinutives of this city to enter upon
the above-mentioned,property for inspection purposes.,.. •_
fg..wr 96 i (We)dime to ue:vindemnify and keep hamaas the 6ty of CUpcnino eg.imt
'r VJ liabilitiu,judgments.costs ed opener which may in my way ma.c,eilad to amid
U Z City m consequence of the gr,t ng of lois peon t " ' � J
Stipp 7f UNDERSTANDS'AND WILL COMPLYWITHALChON iNr" Issued by: Date r•/�/
g'patxd<orlpPli ogre Re-roofs
as ¢ p=at store or handle hazaldou:material..
HAZARDOUS MATERIALS'DISCLOSURE
deny t evCucsal f taro ip led' '« ety Type of Roof -
Cdef d by the Cupertino Municipal Coce Chapter 9.12.and N Health,d Safety
ode S«to 23532(4)? �o
❑Yes- Y, .1. s 1. i_;' _..All roofs.shall.be,inspected.prior to any.roofing.material being.installed._--.
Will the applicant or future Wilding«capmt use equipment or devices which If a roof is installed without first obtaining an inspection,I agree:to remove
emit haradous Insertional nmts is defined by the Bay Aiea'Air Quality Management
District' ': all new materials for inspection. Applicant understands and will comply with_- ..
q uvea ,n P . all non-point source regulations.. .
I have and the hoz it..m q cli under p695 of m
Col! Health&Safety Cod Sections 23305 15533 and 25534,1 undonlana mael
_
ifmpbmldmgd.esn«cu which must ant mt us yresppn ib fly to notify the \^ �-Z0
A: Oc c n to u! -
od<p antont oe uimment which be eat n r t. G OZ ignature of Applicant ate
p j p sxuand of a Cenifin
41 �0
Y 'i reg^— .. .. - _
thonzcd age t one All roof coverings to be Class"B"of better
o -
1.
"OFFICE...
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CI OF Fax: (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 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: &4 L4 FL�,i U
Address:
Reroofing Company Named �'4G
Applicants Si tllre: Dat
Joe Antonucci
(Chief Building Official)
6/25/01