02090078 (2) CITY OF CUPECONTRACTOR INFORMATION:
• BUILDING DIVISIONSION PERMIT
BUILDING ADDRESS: PERMIT NO.
eT.JRT PhETSCHER Ree. _T
O 5 1E: APPLICA A E
02
1 PHONE: SANITARYN . CONTROL NO.
ARCHITECTIENGINEER: IBUILDING PERMIT INFO
w BLDG ELECT PLUMB MECH
to
i LICENSEDCONTRACTOR'S DECLARATION lob Description
I hereby alarm that I nm licensedthB unJg4sp d Pians of Chapter l(commencing
>y�w with section]000)of Division fthc Bu an Prareaaiana cane.apo my B«nrc REROOF
e m 2 is in full and of f 1.3 ? 6
4,a'
w v Licence C k
W<
u3_.0� Dat �TRCHITECr S Drat ARATION
:u
g Indcmmnd my plans shall W.,ad as public islands
�as o O Licensed Prvfcssi...I
_°•o OWNER-BUILDER DECLARATION
H 1 hereby or.In.,I on exempt from the Commmor's License Law for the
Cg?a fallowinguires a.permit
to
]03str Business and improve.
de oli Care:Any city structure
aFC
which requiresve,Rhoreearful(,pplicit forsu Demolish.ore repair g anystamen -
i3$ pro ( , - 1. y '<.thapplicant for such Penn unfleusigned statement
' ion
(hoalt }dpn nothepn srt3ofb Bmoa" noI lswona.Ca9 ` ,.r,,., Sq. F;[..FloorQref )i ` °'• , Valuation
(commencing heI,cwetlitmfoci'aofhe isis3ofthe Busonsaspron.A.ons Cade) y.i '< ( f• '(
or Nati he is e4empi rficicfmm and rite basis for the alleged caemprion.Any illation 3'5 6 2 6 0 0 9 . 00
-of Section 7031.5 by any appbcam for a Permit subjects the applicant to a civil couthy APN Number 'd ""'' Occupancy Type
Iofnot more than five hundred dollars($500).
01.as..at of the property.or my employee,with..,a,as mei,sold compcnanaan, 305 - FRAME
will do the work.-ced'the saacmrc is not intended or offered for sale(See 7014,' 3 0 7 - I N U T 'r:s. :,r. r:
'ebsineii and Profcsslons Cade:The Comr:car's License Law does not apply to an fired Inspections''
awns
r of property Who builds or improves thereon,and who does such work hhnsalf 601 - ROOF TEAR OFF
or through his own emploet,t.provide)that such immm I,sol arc nm in, dedyear or .._. ._ .._ -602
._._ _ ...___._.. ....._...
offered for-Ic:If.M1owher,the building mem is sold within one car car 6 0 2 - ROOF'-PLYWOOD -NAI ' '""
sat gni,reprove Y ,IU 1 '.: .......-n::r'r�l ���
caripletion.the owner Wader will have the burden of proving that he did not build or 603 - ROOF BATTENS
improve far Purpose of Sala).
_ ❑is a der nn<ptoPcrtyawascheii<lycomraclingwithllansedcontractorsto _6O4 --- -ROOF--IN-' PROGRESS _-__.._—_. in -i u•,ir%:C=T' _._. _ .
- = consumer the project(Sec.7014,Business and Professions Cnde:)The Comranor's ,,;Ji.. 1 r :.ac I,
License Law does not apply t r offmolsely who bu 1J:or improves thlumn
ardf%ho,cmitracts.fisor such projects with Ir emarterms)beemed.purstral to the
COnit t s Iptc<de Ser S .
Big his season
Ownercimmin
Date ' •� ^ -�k
"'•"WORKER'S COMPF,NSATION DECLARATION SCrk Q @ 200
s _ "'' 1 hereby vffitm under penalty of perjury one of the following dmlamrions: SEP IG O
❑ 1 hase'ind'will mainioin u CeniGdmd of Concert to self-Immm for Works,'., I�Uj�®jjV
`k Compensation. us provided-for by Section 37W of the Labor Cade, for me 67
performance of the work for which this Permit is issued.,
"10❑1 have and will maimim Worker's Comycnsaiion'Inaura w,as iegvirtd eY Section
walk f which N perm t
l]00 f the Ichor Cod for tit dorm of Jte woPul
Issued My arks/s Co a sat, _
C e I CATION,O F.XFMPIt
s
' � (ITrs uatunneN our be compleieO if the Permit is for ons hunted Oollnrs
n'
(5100)or less.). ...r.p. , -.d,",...,a. r.; _ _ .. _............ ....
I certify Ihvl in the performaric of the stmOur witrh;his permtns ramedi'1 -- �-•• -• -^ ••_ !-I I I'dd h;, `( i.yl!\' •'M✓, ,
iti 11' r gmpl y any Penany biome to become sublen to the Workers Applicant '
'NOTICE TO APPLICANT:If.after makingttis CedI cam f Exemption.you should - J.`I
become subjectsubject..the Workers Compensation provisions of the Law,Code,you must
C O part comply with such previsions or this permit shall W date mad revoked.
Z ,ti V3 •CONSTRUCTION LENDING AGENCY
aof the kf h o I I heuby affirin that there 'a con.tad ]coding agency f rm'
the perfobe
Lend No lh tht permit issued(Sec 309] Civ.C.) a
.7 •Z0. Q Idcen0-11
Lade AdJe .,I'.
t)-0 y have mad this app)cation and state Not the above informilon is v
ks.�'a eos,eci.I time m.comply with all city and county ordinsu ces rand era.a laws Mining
ho ,
til to Wilding c tacit and hereby malumia mposamajoia;of ffifi city to enter upon
, 6
the W I dPropcnd f, .pea Proposes
.^_y (Wjedgu m dmmfyand keep h I . the anI a,cuperi oaganst
V1
liabilities.D dgmenr n d p(ift which may in ny ay1.cline gains sad
V'tiCity in consequence of the gmni ng of this permu
APp_GICNTJ�N11' T, DS'AND WILL C'O/MMPLYIWITH ACLNoN.POiNT' Issued by' Date
5 E G rl v, a
Slgnamu of Ap c on tot= Re-roofs
HAZARDOUS MATERIAIS DISCLOSURE
Will the appE t a future lam
W g au pmt sac or handle lwardaus main N .Type of Roof -.—_..
esdefinedby theCU fesn M pal Cod Chpt 912 dtit H lth andSfety '., „ { .,,It,
Code Section 25532(al _111ref 11 ','� 11, I h ,. s' t - 1 t�;l
All roofs shall,be inspected prior.to.any roofing material bemg.installed.
_
Will the applicant or future Ireilding occupant use equipment ordevicas w which If a roof is installed)without first obtaining an inspection,'I agree to remove
tonniz britmi s conecu is as define Bey Arc A Quality Ma age r
Dta e' all new materials for inspection. Applicant understands and will,comply.with .
oYa No r "all rion po/1nt source regyulations. p,
L ;l ,Ihaa dIh h vd i< 1 911 nd Ch pt 695 h
C mN f a alth&S Eery CM Seain 25505 a 5533 and 25534.-1 understand that
-6� - --
dthW
ead'ngdoesn a taly hae tven d t t Yresponsibilityt notify the a,�,
a.It ni f th��e,,k�Itrv'' 'e Is.wAich- tWbiip'o to,sp cep a ofd Cenifcva of
oat pa.a \J g ture __ pp Date
Si na of A ]icant
O -e o aurh reed g t - Date
All roof coverings to be Class "B" or better *
. ,
OFFICE
-
.w,
Building Division
10300 Torn Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fac: (408)777-3333
CUPEPTiNO
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:
Address: P I S rn 0� y1- C2 P
Reroofing Company Name: l to -E' S e,- h uL T<
Applicants Signature: ( .1 , Date: —� Z �L;;--
Joe Antonucci
(Chief Building Official)
6W/01