02100055 (2) CITY OF CUPERTINO ,Ia "
BUILDING DIVISION PERMIT 'CONTRACTOR INFORMATION: "
Bun@11(2kIMTLLER AV PHRMI"rNT2100055
9ONGHUAI LU APPLIc-I.T I 1TY2002
IONS SANITARY NO. CONTROL NO.
ARCIII'D'.0 /ENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECII
L-7 O O O
�00 LICENSED CONTRACTOR'S DECLARATION
as u p I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing Job Description
�« witnsemiana^xx mDivhn,n3ofineBar,n VmlPmfeaa as Code,, i rbcs ria REROOF
full lane feet J
ZOYJ= Lis Class I.ic.N 2
OZ-� Uat SDr.or
�0'I rkRCHITECsS Dx T N Q
ono IunJcrsmnJ my plans mall he used ax puhliv'rccnrJs
cpdU C V
w 3 a. Lienscd Professional
y.u.0a OWNER-BUILDER DECLARATION
ca 1 hereby
affirm that I ara exempt team the Commoors Liccros law for me $6500
Mti 6 0 o following reason.n.(Seen 7031.5.Business and Pedesvions Code:Any city or county
x Q which re'eures a permit m aonaruaL altar,improve,demolish.or repair any slrocmre
prior o its issuance,alsorequires the applicant Bnsech pemaiuo fleasignedaammem
that he is licensed pursuant it)the provisrmsofmhe Contractor's License Law(Chapter 9 3SA5142(l1i"Al0k Valuation
ptF$ (commencing with Section 71MM1)of Division of the Business and Prnfessums Code)or
c 3- that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant o a civil penalty ofUkPN-NENTE Occupancy Type
not mom than five hundred dollars Ss0(y. 307 - INSULATION
I.ka owner of the peopeny,or my employees with wages at �111heir oir sets compensation.
will dothe work,and the suuaum is not immndedor offered for sale(See.78 ,Business SgACJI�
LnS
and Professions Code:The Contractor's License Law does not apply to an owner of 602 - ROOF P ZT1ll n IVH-LI
,open,who builds m improves thereon,and who does such work himself of mbmugh his
own employees,provided that such improvements are not intended or offered for We.B. 603 — ROOF BATTENS
however,the building or impnrvement is sold within one year of completion,The owner. 604 - ROOF IN-PROGRESS
builder will have the burden of proving That he did not build or improve for purpose of
ole.).
❑1,as Owner of the property.am exclusively enntmaiag with licensed contractors to
aonswtr Ne project(Sec.7(W,Business and Professions Code:)The Conoactor's Li-
cense law docs not apply to an owner of properly who luilds er improvca thereon,and
who contracts for such projects with a contractor(s)licensed pursuant o The Conuacmh
License Law.
O 1 am exempt under Sec. .B S,P C for this reason
DamWORKERS COMPENSATION DECLARATION
I hereby affrm under penalty of prjury one of the following declarations:
I have and will maintain a Ccni fit of Consentto self-insure for Worker s Compen
Iner
on,as provided for by Section 371X1 of the labnr Code.for Ne Performance of the
k for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section1 of Ne Lahr Code,for Nc performance of the work for which this Permit is issued.
Workeri C{,mtytsalin� �e �r'd Pr icy num(mb raga�4Orier, e7.IT�s's'IYvn- 1]--lrJ.l-1.L��. 7.
CERTIFICATE OF HXEM OM WORKERS'
COMPENSATION INSURANCE
('''his section need not he completed if the permit is 1prone hundacd dollms(511X1)
or Icss.)
1 certify Ohm in the perfimmance of the work for which this Permit is issued.1 shall net
employ any Person in any reannerso as it)leccome subjeenothe Workers Compensation
Laws of California.Dale
Applicant
NOTICE TO APPLICANT:If,after making this Ccnificac of Exemption,you should
become subject m the Worker's Compensation provisions of the LaMn Cmk,you must
OO forthwith comply with such provisions or this Permit shall he deemed revoked.
z CONSTRUCT ION LEN DING ACT NCY
(-. = Iherehy affirm That there is 3 eonsnvmion lending agency Tonne Performance of
[� 7 the work for which this Permit is issued(Sec.31N7,Co,C.)
W Q Iznde,,Name
7a Under,Address
U O I cenify Nm I have read this application and some that ths above information is
W F umecL I agree m comply with all city and county Ordinances and state laws relating to
0U building construction,and hereby audonvc representatives of this city to enter upon the
W above mentioned pmpeny for inspection purposes.
(We)agree m save,indemnify and keep harmless the City of Cupertino against
Hy liabilities,judgments,costs and expenses which may in any way acerae against said City /
U in consequence of the granting of this Permit.
^s Date
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
S URCERE UI.ATIONS.
r l ln/j/ Re-roofs
Signature of ApplicanPConoacror am
IIAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will thc applicant or future building occupant store or bandie harardnus material
as defined by Ne Cupenino Municipal Code,Chapter 9.13,and the Health and Safety
ode.Seefmn 25532o.)! 1 All roofs shall be inspected prior to any roofing material being installed.
U Ycs `Ct Nll
Will the. scant or future building Occupant use equipment ordevices which If a roof is installed without fiat obtaining an inspection,I agree to remove
pP d by pan
emit District' tie air cnmamiwnt[as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes r
Ihave read the haizrdousmamtlzlsmquiremcrosuntkr .Chapmrfi95ufthe Califur
niallcalta w255115. J a.Iumkrslding
-2—
fres mntumntly hasrawnant.Na it is mymsNmibility to nodlhe'ac.'arm of Nc
re ant[wninmaal¢melptiarwissaanecaraccmba.mora ylo%I ignatureofApplicant Date
at mo`'Q' `oI"b 1e'e' All roof coverings to be Class "B" or better
Owner or authorv.ed agent Dam
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY 0 F= (408)777-3333
.CUPEIiTINO
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 V"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: 00/✓GHLVA 1 L L!
Address: E,--2
Reroofing Company Name: . V-� a/ C,v(
Applicants Signature: -- 4/, W Date: -7/ 2
Joe Antonucci
(Chief Building Official)
6/25/01