02110013 (2) r CITY OF CUPERTINO - ter- i w
BUILDING DIVISION PERMIT i "CONTRACTOR INFORMATION:
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ARC[11TECf/ENGINET:R: BUILDING PERMIT INFO
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Lao) LICENSED CONTRACTOR'S DECLARATION
re1r Incmby,aOkmthatIamBcen.ed�rprovisionsofChapter9(commencing REROOF Job Description
E
whirsmin 7 B ur Di0e,hm3ofthe Busr J ^fc�.cainns Cafe. lid/ ,license is
in full lam eReats — ( G2 7 I
, License C� Lic.N
M,y'❑ Dam CupA
t<"—aCt-� ARCf11TECT' CI.ARATION
?r K�Q Jeeaoadnry platusball be usedaspuhlicreanda IA LED
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w 3u LiccnmJ Pndcssinnal
s_=0S OWNER-BUILDER DECLARATION JAN O L ZOOS
Ha n
y 1 hereby affirm Thal 1 am exempt from the Cimmnrs Lignac Law for the 9 O O O
a-00 following reason.(Scctinn 7031.5,Business and Professions Code:Any city or county
x a a which requires a permit m construct,alter,improve.dcmnlivh,or mpoir any structure I
"t—IA priors its issuance,also requires the applicant for such Permit o file asigned statement
7 that he is licensed pursuant mthe provisions it[the Contractors License Law(Choplcr1) Valuation
at (commencing with Section)IXAryof Division 3ofthe Rmin,a and Pmfesxians Code)nr
a 3$ that be is exempt Incmfmm and Ne basis for the allcgcd exemption,Any violation of
Section 7031.5 by any applicant for a permit subjecu the applicant")a civil penalty of PPIT NTnWWE Occupancy Type
not more than ave hundred dollars(1500). 3 07 - INSULATION
❑1,as owner of the property,or my employees with wages as their sole compensation.
will do the work,and The stmcmr,is not intended or offered for safe(Sec.704,L Business �Z qp&
and Professions Code:Th,Contractor's License Law does not apply m in Owner of 602 - ROOF P S1VlJ nWTcjinns
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvemcnu arc not intended or offered for salt.If. 603 — ROOF BATTENS
however,the building lir improvement is sow within one year ofcompletion,The owner 604 — ROOF IN-PROGRESS
builder will have the burden or pmvi ng Inas he did not hand or improve for purpose If
sale.). I �
❑ I,as awncr of the prupeny.am exclusively conuuting with licensed contracmra to
construct Ne project(Sec.701,.Business and Prufcssions Code)The Contractor's Li- t
cense Law does not apply to an owner or property who builds or improves Merton.and
who conuacu for such projecu with a contraaor(s)licensed pursuant to the Convenor's
License law.
I am exempt under Sec. ,B&P C far this..,In
Owner Dols
WORKER'S COMPENSATION DECLARATION
41 1 hereby eliom under Penalty of perjury one of The following declarations:
1 have and will maintain a Cenificam ofGmmnt m sel6insum for Worker'sCompcn-
ration,as provided for by Section 3710 of the labor Code.for The performance of the
work for which this P r mit is tamed.
1 have and will maintain Worker's Compensation Insurance,as required by Section
COX)nfth Labor Code.to Belciformanccof the work for whichmis permit is issued.
My Wr'r [,5�G1nW scion Insurance carrier end Policy no r am
C r. ✓t /U Policy N ..iG�f�=A?S—�
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This motion aced not be completed if de Permit is Throne hundred dolls I(Slap
or leis.)
1 certify that in the Performance of the work for which this permit is issued.1 shall not
employ any person in any manner so as to become subjeeno the Workers Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:1t.after making this Certifies,of Exemption,you should
became subject to the Worker's Compensation provisions m the"No Gide.you mesa
O O forthwith comply with such provisions or this Permit shall be d,cmed revoked.
z CONSTRUCTION LENDING AGENCY
E'^ Z) I hereby allirm that there is a coreametion lending agency for the Periormance of
(Y, 7 the work for which this permB Is issued(See.3097,Civ.C.)
lel QLcndcr's Name
c. ndcrs Addmss
V p 1 ceniry Our 1 have read this ii,rimatinn and sum tThe e alcove inforrlstsion is t
LL Fcorrect.I agree 10 Comply with all city and county ordinances and such,laws relating m
DU building construction,and hereby auNnrim mpmicnutives of Nix city to enter ulam Nc
,r above-mentioned property for inspection purposes.
(Wc)agree les save,indemnify and keep harmless the City or Cupcnino agama '141 1
nF+ Hhard itics,judgm,nu,ensu and expenses which may in any way acerae ugmno said City {'/ /
U Z inconmqu,ne,ofthegrarom fthisperZ"'
iIL 4
^` APPLICANT UNDF S"TA SAND WILL COMPLY WITH ALL NONPfCJT Issued by: Dat
SO�UyCE UN
NS. L
A ( � Re roofs
Signal of APD can✓Commcmr Data
IIA"J.ARDOUS MATERIALS DISCLOSURE. Type of Roof
Will the applicant or future building taeupanl store lir handle hrowdous material
as defined by the CuNnoo Municipal Code.Chapter 9.12,and the Trial and Safety
Code,Section 2s532r)7
❑Yes No All roofs shall be inspected prior to any roofing material being installed.
Will the applicant or future building resu t use a m,nt m J,wcea which If a roof is installed without first obtaining an inspection, I agree to remove
pP b pan quip
emit hazardous air conmminanu as defined by the Bay Arca Air Quality Management all new materials for ins c
District?
❑Yes ourmat
Ihave read NchvarJTanv erials...3 emcnuundcrderstarlibut95 h Ne Calding
doesione e:nmy Gale, mansork .2myresld25s36,l understand lenatth,huil the
Jtes roI c emly c n I nuns,that it is my reslwnsihil'ny In nntil'y the rx'cupum nl'Nc -
regnnt h last pnmmiamanceofaCeniocate v a cy. gat lure ofApplI ant Date
/ I
Dan orauth rmiligem Dai, All roof coverings to be Class "B"or better
' Building DiV ioa
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Fax: (408)777-3333
CURTINO
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 1/a'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 onreroofingand will comply
with this policy.
V
Homeowners Name: ! f77�l< / L- LA--st!� 0
Address: / ��K V 4,LLt---
Iger o ofing
c-$eroofng Company Name: �-� CO U N /<z 001%—
Applicants Signature• —3/-
Date:
• Joe Antonucci _
(Chief Building Official)
6125101