02100124 (2) I
CITY OF CUPERTINO " '-• fes%" -�- �•'
BUILDING DIVISION PERMIT CONTRACTORINFORMATION:
Bull26c" 41 51 NORTHWOOD FOUR SEASONS ROOFING PERMITN®2100124
owINOIRTMHPOINT HOA 645 HORNING ST APPLICATITVYB1DgrB 2002
Am
ONE: (408) 278-0330 SANITARY NO.!! // CONTROL NO.
ARCHITECT/ENGINEER: B ECT 1LEDPER
BLU PLUMB MECH
K
Z LICENSED w CONTRACTOR'S DECLARATION h F 1 herehy.from that I am licensed under provisions of Chapter 9(commencing f Z-(>2 ON
3 3. 2lb ft r 13t1Q b 5 1
�ZZu�
with Section 7")of Division 3 nfthe Busin3tro l Professions Code.and my license is +` R`���F"•'1 ('Ur' /L VV V4'I^'�,'7L UU
is= in full fnrec�nJ cffccL, l�f ��� �,..,, ,tit'
ZOYa? License Class Lic.N 1 J ;7
Da¢ Consr — •,1,•-•g/
gF— ARCHITECTSD ARATION '�—'"""�"
g Oz� understand my plans shall he used as public recede -�
a �
LL'l— Licensed Professional _ ,sva ``��'' Igf{
y<f 1 hereby affirm OWNER-BUILDER am exelmpt fromtheContractor's License Law for he r"�1_rftll ' X41 CT Ctl
�.t a o 0 following reason.(Section 7031.5.Business and Professions Code:Any city or county l 14 O O O
x$(L which requires a permit to construct,alter,improve,demolish,or repair any structure
vi prior m its issuance,also requires he applicant for such permit m rile a signed statement
�'E< shat he is licensed pursuant to he Provisions of he Commcmr's License Law(Chapter Y 3S1)613.7ft{E6DBAI@fl Valuation
H$ (commencing with Second 70(ko of Division 3 of the B usincas and Professions Code)it
14y hat he is exempt therefrom and dm basis for he alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of PIS N Occupancy Type
not more than five hundred dollars($5110). 307 — INSULATION
❑1,as owner of the progeny,or my employees with wages as their sole compensation,
will do he work,and he someone is not intended or offered for sale(Sec.7W,Business ROOF
and Professions Code:The Comr.cers License Law does not apply to an owner of 602 - ROOF P ❑ �G�IEnS
Property who builds or improves thereon,and whodoes such work himself or through his
own employee,provided hasuch improvements are not intended oroRered for aide.If, 603 — ROOF BATTENS
however,doe building or improvement is sold within one year ofcompletion,he owner. 6O4 — ROOF IN-PROGRESS
builder will have he burden of proving Nat he did not build or improve for purpose of
sale)
D I,as owner of he property,am exclusively contracting with licensed convectors to
construct he project(Sec.7614,Business and Professions Code:)The Conformities Li-
cense law does not apply to an owner of property who builds or improves hereon,and
who contracts for such projects with a comrutor(s)licensed pursuant to he Contractor's
License Law.
D I am exempt under Sec. .B&P C for this rce,um
Owner Dat
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury ane of she following declarations:
J705
I have and will maintain a Certificate of Consent self-insmefor Workcr'sCOmpcn-
ma,as provided for by Section 370)of the Labor Code,for the performance of he
rk for which his Permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Section
mU of the labor Cade,for the performance of he work for which his Permit is issued.
yWorker' om,Pensatinn lnsumnce camicr and Pulicy nYY�Ab(e}ere: lr'fn� ��f^�rtier: P91icy. /.: "`Z,� V O
CERTIPICA OFEXEMW6 ROMWORKERS'
COMPENSATION INSURANCE
(This sectio need not becompleded if the Permit is forone hundred dollars f ilf aq
nr less.)
1 certify that in she performance of he work for which his Permit is issued 1 shall not
employ any perm in any dru nerso as m become subject to he Workers'Compensation
Laws of California.Dam
Applicnt
NOTICE TO APPLICANT:If,after making Nis C.O ineme of Exemption,you should
become subject to the Worker's COmpensaion provisions of he labor Code,you most
�Z forthwith comply with such provisions or this Permit shall M deemed revoked.
OCONSTRUCTION LENDING AGENCY
[r hN—h I hereby affirm that there is a construction lending agency l or the Performance of
�i ;iv thewok for which this Permit is issucd(Sec.3097,Civ.C)
I[I Q Lender's N.
z Under's Address
U Q 1 certify that 1 have read this application and sham that he above information is
is, (~ correct lag=in comply with all city and county ordinances and suite laws relating to
0U building construction,and hereby maintain representatives of his city to enter upon he
{✓a ahove-mooch ed property for inspection purposes.
(We)agree to save,indemnify and keep harmless the City of Cupertino against
r y
liabilities.judgments,casts and expenses which may in any way.cane against said City
U 7 in consequence,of the granting of this permit.
A APPLICA DERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE U ATIONS�/
Re-roofs
SiesC+�re o ApPlicaHAZAR OUS MATERIALS DISCLOSURE Dec Type of Roof
Y_ Will he applicant or future building acupantstom or handle haaardous material
as defined by the Cupertino Municipal Cade,Chapter 9.12,and he Health and Safety
n
Code,Secti25s32(a)7 All roofs shall be inspected prior to any roofing material being Installed.❑Yes $3 No
Will he applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
mit hamrdous air contaminants as defined by she Bay Arca Air Quality Management all new materials for inspection.
District?
DYcs IV No
1 have mad he harallous materials mquircmen s under Chapter 6.95 of he Califor, — 1) ft
niaHcalN&Safety Glale,SCmlona25S05.25533 425534.1 undcrsmndhatifhc huiming % 1V -Yt(j��
Jres nm current
anl,hal' s sPansihilily m ngti(y the rccuPwl of ha
myuihact pr' ce rife Ccnifaatc d(COccuPancg � Si nature of Applic nt Date
Owner or autho / G 'Dee All roof coverings to be Class"B" or better
Building Division
YYY 10300 Tom Avenue
Cupertino,CA 950143255
Telephone: (408)777-3228
0 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 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: __ /Jo,4-L, iPo,n+ d -
Address: C) ' r > '3 12 T 61 0 i)
Reroofing Company Name. ®ur Sec.So j, f oax; i
Applicants Signature: Date:
Joe Antonucci
(Chief Building Official)
6/25/01