02110022 (2) CITY OF CUPERTINO " p
BUILDING DIVISION PERMIT CONTRACTOR�INF0RMATION:
is BUIL71703T+DROAK MEADOW CT EASTMAN CONTRACTING, INC PERMITNT2110022
GwItRNO D DE LEON 1418 DOUGLAS ST APPLICAT14N15`)`B64r 2002
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ONE: --T-4-0-8 77 1-9 0 0 0 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: I BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�00 LICENSED CONTRACTOR'S DECLARATION
a,roj F I hereby affirm That I am licensed under provisions of Chapter 9(commencing J r'
� V with Seem.70M)of Division 3 of Ne Business and Poolefunns Codc,and mylikenxi
6 in full form and L /� j
ZOaZ License Cl —` LicN _. _
OZ-0 Dam Cnmmco�l'y
F=1-£ty ARCHITECTS DECLARATION
Zi: C< I understand my plans shall bm used as public rccnrV_< IU'
,I"u
_a G Licensed Professional ._
y OWNER-BUILDER DECIARATION
Ka<F 1 hereby affirm that I am exempt from the Conuacmr's License Law;for the $18000
x600 following reason.(Section 7031.5,Business and Professions Code:Any city of county
which notaries a permit to construct.allot,improve.demolish,or minor any Monaco.
riy poior in its issuance.also rectums the applicam for such permiuo rile alignedsatcment
< that he is licensed pursuant odue provisions ofthe,Comoacor's License Law(Chapter 9 33C&2.ff"8AI09 Valuation
otFO (commencing with Section 70(0)of Division 3 of the Business and Professions Ccv1c)or
$ that he is exempt therefrom and Ne basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicanno a civil jamothy of 3 U.4PIx1NJW97EOccupancy'IType
not more than five hundred dollars($5001. 307 — INSULATION
❑I,as owner of the property,or my employees with wag"a their tale compensation,
will do 0,.6.and the stroctam is nm intended or offered for sale(Sec.7061.Business pQ�y(
and Professions Code:The Contractors Licensn law does not apply m an owner of 602 - ROOF P Z YV V 9 �2ns
property who buildsor tmpmvu themon,and who does such work himself orthrough his
own employees,provided Nat such improvements sm not intended reoffered for ads.If. 603 — ROOF BATTENS
however,me building or improvement is role within one your ofcompletion.the owner. 604 — ROOF IN-PROGRESS
Wilder will have the burden of proving that he did not build or improve for poi se of
sale.).
❑1,as owner of Ne properly,am exclusively contracting with licensed conte tom to
construct the project(Sea 7W.Business and Prefossions COde:)no Contractor's Li.
cone law does not apply to an owner of property who Wilds or improve 0remoa,and
who connotes for such projects with a cunbactor(q licensed Forstmann to Ne Coninnor's
License Law.
El I On exempt under Sec. ,B&PC for Nis rcaeon
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby aBfirm under penally of perjury no of the,following doclandin s:
❑I halword will maintains comm me of Consenuo nel6inme for Worker's upper-
cation,as provided for by Section 37M of the tabor Coda for the Nrf..an of the
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as.tui.d by Section
floe labor Code,fordm performance ofthe work for which lhispermit i issue,
My Work is Compeeriali.mi asuotnee cartior and Policy number am: 1
Center �w�sa _Policy NO.I b b9 a�T�'�
CERTIFIC EOFEXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Chis section need not W compintcd if the remit is intone hundred dollars($1OXO
or leas)
I cerlify that in the performance of the work for which this permit is issued,I shall not
employ any person in any manner on,as In become subject In the WorkersCompensation
Laws of California.Dane
Applicant
NOTICE TO APPLICANT:IL after making this Coni ficoto of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
OO forthwith comply with such provisions of this perm it shall he deemed revoked.
z CONSTRUCTION LENDING AGENCY
1 hereby off rem Nal there
CONSTRICTION
crnsUvetion lending agency for the perlojunce of
ai 7 the work for which this permit is issued(Sec.J(N7,Civ,CJ
W Q Lender's Name
G lender's Address II
V Q 1 certify that I have read this application and stone that the above information is
W F coffee,.I agree to comply with all city and county ordinances and stale law,re acing to
V building construction,and hereby authonmmprexnlatives of mix city to crime Oponthc
y W above-mentioned property for inspccdon purposes.
d (We)agree no save,indemnify and keep harmless the City of Cupertino against
r fn liabilities,judgments,costs and expenses which may in any way same against l aid City
V Z to consequence of dr granting of this Permit.
T UN STANDS WILL COMPLY WITH ALL NON POINT Issued by: Date
Fr S GULATI f
Re-roofs
ignmurc ref Apphc° or
HAZARDOUS MATERIALS DISCLOSURE OMi Type of Roof
Will tlm applicant or future building Occupant More or hanJle herudous mucdal
as tle0netl by me CuPerfno Municipal Code.Chapter 9.13,anJ the Health coil Salary
Cee.Scctk025532(id? All roofs shall be inspected prior to any roofing material being installed.
❑Yes No
Will Nc applicant or at c building eecupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit haeaNnus air contaminants J teed by the Bay Arca Air Quality Mani garment all poly materials for inspection.
District?
Oyes o
Ih"iffe" Nnusmamrials.quimmenuunWrCMpmr6.95ofthm Califon
pia F3calth&Safety et,, dons75M11ml6,l underamrM mmiftlm�WildingJres not curtcn0y x a narkmalitym nodfy,M rccupan,ofthel /�mqui ntsw melpnoupancy'. Signature of Applicant r Date
O croraul onvcJagcm ,� All roof coverings to be Class"B" or better
Building Division
10300 T=5 Avenue
OTY
Cuperdno,CA 95014-3255
Telephone: (408)777-3228
Pax: (408)777-3333
CUPI�TINO
Building Depaa.ent
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 musthave a minimum of'A"per foot slope and demonstrate that
there is no ponding.
2. An LC.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: -2,
Peroofing Company i�
Applicants Signa Date: 140
Joe Antonucci
(Chief Building Official)
eizsrol