02100106 (2) CITY OF CUPEWHNO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:"'
BUIf142ApI9uasPALO VISTA RD COSMOS ROOFING PERMrrN02100106
ow,T4ll SEVIG AND GUNER 1901 OLD MIDDLEFIELD WY APPLICAPPOSYT14TY2002
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ARCIII"IECTIENOINHER; BUILDING PERMIT INFO
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LICENSED CONIAACI'OR'S UF:CLARAI'ION
Oilep I hereby at that l am meitedander provishmsof Chapter v aommencimg REROOF Job Description
=N with Section 700(def Division Sof the Business and Professions Code.and my license is
in full linrec nnJ if orN�At. �
�Z I,iccnvc Cl's J ( I.ie.« ��( ra �p'fkQ
F? W Dale_/� �% 0�—A Gtmraz�I� .
ARCIII'11i6T'S UECLARATIOD ��
sd9 rc a I understand my plans shall be used as public rhvvJ, I C U 0 A 2002
�oau Y L
0.l;; Licensed Professional
FLLOa OWNER-BUILDER DECLARATION
ul<S I hereby affirm that I am exempt foam the Conorclor's License Law lot the BUILDING $18200
a p 0 following reason.(Section 7031.5,Business and Professions Culc:Any city or county
Y'm which requires a vcmtit to construct,alter,Improve,demolish.on repair any structure
slicensed iu per a requires thovisio sof for Comm veuLic ns eLawJ sthtemcm
t_za that me cing pursuant 7to the000)provisions of theCommoveBusiness and Professions
(Chapter 9 33y7El1IFl('k1.(dA@Q Valuation
a�p (commencing with Section 71XM11 of DivisionJof the Business and Pndcssinns Gslc)or
i that he is exempt therefrom and the basis for the allcgcd exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Bar applicant to a civil penally of IDN NWAW Occupancy Type
not more than five hundred dollars($500). 307 - INSULATION
0 1,u owner of the f mberty,or my employees with wages as their role compensation,
will do the work.and the soucmm is and intended or offered for sale(See 7044,Business 681 R1111
�I}r �n�(�f�
and Professions Code:The Conlmclor's License law dos not apply m an owner of 6 0 2 - P F P W V nWA 1 Tns
Property who builds or improves thereon,and who does such work himself or through his
sun employees.provided that such improvements anoumended proffered for sale.If. 603 — ROOF BATTENS
harc not
the building or improvement is sold within one year ofcompletion,the owner. 604 — ROOF IN—PROGRESS
builder will have the burden of proving that he did not Wild or improve for purpose of
mlc.).
0 1,as owner of the property,am exclusively contracting with licensed bontncmrs to
Construct the project(Sec.7M4.Business and Professions Code:)The Contractor's Li-
nnm law dos not apply to an owner of property who(wilds or improves thereon,and
who contracts for such projects with a conoactorp)licented pursuant to the Contractor a
Lion.ne Law.
0 1 am exempt under Sec. .B A,P C for mix reason
OwnerDate
WORKER'S COMPENSATION DECLARATION
I hereby aI1Bm under penalty of perjury one of the following declarations:
1 have and will maintain a Certificate Of Common to self-inwR for Worker's Compcm
sation,as provided for by Section 3700 Of the IaMm Code,for the performance of the
work for which this p.it is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
IX)Of the labor Cock,for Be,performance of the work for which this permit is issued.
My Wnherk Ira a n more cortico and Policy number am
Cartier:_ Polley NoS/
CIiRI(PIC OMPE KITION INN FROM WORKERS'
COMPENSATION INSURANCE
(This.xection need nm Be completed if the permit is hrone hundred dollars o IIXU
I ecroy that in the performance of the work for which this permit is issued.1 shall not
employ any person In any manner se as m become subject to the Workers Compensation
Laws of Cuifomia.Dec
Applicant
NOTICE TO APPLICANT:IL after making This Certificate(it Exemption,you should
Become subject to the Worker's Compensation provisions of the LaborCode,YOU must
O Z forthwith comply with such provisions or this pera it shall W deemed revoked.
zO CONSTRUCTION LENDING AGENCY
'r. 4 I hereby affirm that there is a construction lending agency for the performance of
ni > Nc work l or which this permil is issued(Sec.MAD,C iv.C.)
(11 Lender's Name
Isnder's Address ^
U Q I certify dmf 1 have mad thirty and coon and sure the the above automation m V —
(•-' building 1 agree to comply with all bey and county natives of and sec laws relating t e
�U
buildingconstruction,and hcmhyauthon' mpocmma,ivcs of Nis city minter urym the
} abnvo(we)a re to rty
for inspection keephs.
(We)agree Judgments,Cove.indemnify and keep harmless the City of Cupertino against /s
UN inconsequnceofthecosuang of this expenses which may inany way accmc against mid City /
U z. A consequence UNDERSTANDS
nl this Permit.
r. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N,t POINT Issued by: Date
SOURCE REGULATION' 6
_ Y Re-roofs
Signature of ApplicaHA IA .. Dad
HAIA RDOU. MATERIALS DISCLOSURE Type of Roof
Will theeCupertor futureipal Cgic,Chaptsorenr handle Health amaterial
as defined by the Cupertino Municipal CINC.Chapter 9.11,and We Health and Safety
O,ae.secnnn 25532001 All roofs shall be inspected prior to any roofing material being installed.
❑Ycx
Will the applicant or future building Occupant use equipment or devices which If a roof is installed without first Obtaining an inspection,I agree to remove
mil hvamors air contaminants ax defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes ppr
1 have mad the hazardous materials mquirements un @r Chapter fi 95 of We Culifor -
niallcalth.ft SWctyctxk.Sesunns 25516.2551Jand 255J4.IunoknunJ than We building
docs nal curtunty have a tenant,War it is my .resp edibility w nitrify LMllpuOp1.� l of the •,'
requirements is msl Bemdtpn misman"Infacenircacofa /n Signature of App cant Date
ower rapmori age Dale All roof coverings to be Class "B"or better
Building Division
C14
10300 Tom Avenue
` Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY 0 Fac: (408)777-3333
CUPEkTINO
Building Department
Subject: Reroofing policy for the City of Cupertino.
I. 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 "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
1
1
Reroofing Company Name:
Applicants Signature: Date: /C)//,-//O 7,
Joe Antonucci
(Chief Building Official)
6/25/01