02090088 (2) OF
CIBUILDING DIIVISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
20941 PEPPER TREE LA JACK MYERS 02090088
F�NAYER S APYLIC09/13/2002
thSUB 0
TE
f� PHONE: SANITARY NO. CONTROL NO.
Diaz ARCHITECT/ENGINEER:
BUILDWG PERMIT INFO
P S.) 4 BIG r�6LE PLUMB MECH
Etc�+'It`X initd L_I L:
�6a
Z u y Z LICENSEDCONTRdunder S DECLARATION lob Description
o:=`-'e Section
affirm thmlam 0aasee under arcus:inn:nr enap,er9uammencing - REROOF ((ssIT / 2002
yF-w with Senion]000)of Division 3 ofthe Business and Professions Cale.and my license o1i1 J.
m$ is in full no.and)ellen.
-a z a License Class Lic.M
oma Date GDECLA BUILDING
3 c ARCHITECT'S DECLARATION
ve g 1 understand my plans shall be used as public records
,2wY
se O O Licensed Professional
OWNER-BUILDER DECLARATION
w--' I hereby aRnn that 1 am exempt from the,Commerce's License law for the
t Z< following reason.(Section 7031.5.Business and Promssions Code:Any city or county $7000
�F O which requires a Permit a t,alter.improve,derooli%lb,or repairy stmeture
n
3 Lpct m'., uanc Wren vpal ,
es me f a ch pemt, fl gmd statenent- -... .. ....
that haslcen.edpu at ba ilk!provisions ofNeContractor s License Law IChapmr9 r 535' 4 1)�j9ocp ea i Valuation
(commenscariW„hSec7on7")ofDiviin 3 of the Bucincss and Professions Corer. Q_'v`?1\ Ilse. U.+ A'. •-0 ,+t iii 91'!1 fl'•. '
or that he is exemp,therefrom and the Wsis for'he alleged exemption.Any vialauon '
-of Section 4031.5 by any appliumn for a Permit ubjects the ap dean,,o a civil penalty-
lofnot more than five hundred dagars(s5an), 305APN} r4Fr P`n'.aT.-1 Occupancy Type
❑I.as owner of Ne prnpeny,or my employees with wages as their sole compensation. 307 - INSULATION nim
will do the work,and hestmetim,Is'nm'Intended'or offcmd fre-ost,(See:lost:
601 - ROOF TEARe(Atr(itl l❑SpCCt10I1$('+"" I'.D,I I
Business oraPP7ofao.ns Calc:The Cummcmr's License Law docs no,apply anon
owner of limpcny who Wilds or improves Hereon,and who docs such work himself 602 - ROOF PLYWOOD NAIL
or through his own employees.provided that such improvements art net intended or
'for sale.If:howeveq Ne buildin sir im-ruvemcnt s sold w-unn-one car of ---- - -- - -� '-----------
-offered ---'-"""--
g p r - 603 - ROOF'-BATTENS-'_'-'-_"t= I.fu: ',iil,•:L',::
ins,mv,iorNeewaerfwuderwmhavemeWmennrpmwng,wtneaianaWdaer 604 - ROOF IN-PROGRESS
improve puryeu of
_ coLuownen ofthe Pmpen%am exclusivelyil contracting ion,Ca,:)Theonuanorsm ...'l3
_
construct he present(5«. to a Business and Professions Code:)The Commna i IY. t !'.ri" VL''.3
License Law does eat apply,o an owner of property who builds or improves therton,
-and-who contracts for such projects.with,r convacmr(s).licensed pursuant.,o the.
sC Svac, I L<enseU
//gQ�\\II p,undg c '1' � "s' pJt '91 r• /<39&/�P/,Crf f�oonhis�son
Job y`11:ii
1 W by (firm Jc Penalty of al ry f,h toll/owing dcclara,ions:
1 Wvc nnJ'will'ro man a by Secti of Cnn o m sol bourn for Workere
Compensation, u provided for by genion 3700 of he I�Wr CMc, for the
performance of the woh for which,his perms,is issued
❑I ha cane will ma , W rk"{Comps i n lnsuranee required by,Section
q 3700 of the Labor Cam,for i W pcifarmangor
e of the wk for which this pains,is
is: dCi,in,cm.dion'Insurance c, ler and Policy ........�....�.-
.. == Comers (s:d;, ret Ii-+)ati
Policy No r•, ',� ra1.. :1 fur 7
`` ( 1 p sr {{ i 'Y ,ill O,:J
+ti, t,iCERTIFICATION OF.EXEMPTION FROM WORKERS'r ' 4/', i • ., a i S., 1: i�,{ i.y5..-y' .°lbw\�:
,� ..
COMPENSATION INSURANCE 1 __.-.. _ -.__. __........_ __.__ V. — __ _.... ............
i
i
s I (f his sen
on need no,be completed-f the Permit is for one hundred dollars s '
151 W)or less.)
1.
nf)tht ,h pert m ft k�rwh Ih pe isi dl ..... . • .1 1 i i) ( yil silt
\.
.shall t pl y w' pe so y 5 t n W d
Co
,APP pen1t Lo s fClf D� _ - s- _ f _
'p'0 CLTOAIPLICANT If ,1 r k g C ritrl fE a pi you ho W
W.,. a bl a, N Wod< C pe , 0 'nf th IoW we You t'
Q Q forth ,he ply i,h uchp on.o perm, hot]bed cureked u_ _ - -
7�. ...
F:ry Ys " J'IICONSTRUCTIONLEN DING AGENCY.
d - f , I 1. M .,
1 h by Iron N t t W con, i 'I d 8 .C.)Y f ,W perform tt -'
ertbe kf hch,hpermit s.ud(Se< t09T Cv C)
W'Q 'Lind rs Namc'^ ' i _ ... ._ i..' s •.. ,. .__ ..._ .._. .. _ _
. . _._. ..._. ..... .._. ... .. ._ _ . .. .. _ - -
L u
a,z is der Addre. - IOi 11. CI..:!' s• I
[cimifyfluir ehave maidth.,,madimizoad
,nt flmatW.bomiafmmmfim.c1
correct.Igeemconnia N 211 City al ,Y darn dtam lawsmlating
O-U ,ob J construction, ntlh hereby authorizerp - iv of this<,y, enter upon
,he Gcgmetond
property for nspeamn Pur,. . , .. -
E„ 6. Iwo g ems ndemmfy'andAep hartnlesitheCty fC.1r1mo-9ens,
(A liabilities.judgmentse J pease which maylin any y against said
L).Z Cty coaeq en<e hhe g',,ng ohh pcmtu ,
AFpi sfUNDEPSTAN IL*COMPLYKITHALLNON-POINT ISSnedb Date
501' CP GDL� N f. Y
S' w .fAPp,cmdCommmor' .-. '.am .. ' Re-roofs
.1 i ATERIALS UISCLOSU[E
... VJ 11 the aPPl t ft 'Id ng occupa,s, ooh JI h 'J .mmol -Af ROof-
-Type __ _._.__..... ma.,.._�,_.._.,. ..............................
1 d by theCupenmo Municipal pal Cade Chapter 9.13 mW theHealth rid Safety .
o a 1
HA \R
Section 35531_(a) a 11 ` I. + 'I
❑Ye ^ /,�,�y�N , + t. i _ All roofs shall be inspected prior to.any roofing material being.installed
- Will m _ppl t fnmm Wild) g p m aaerq p t.,devices which If a roof is installed without first obtaining an inspection;''i'agree to remove
em,h m ren, , defiructby he Bay Area Air Quality Manag ,
District? all new materials for inspection; Applicant understands and will comply with
❑Yea 1 - ' allrion-all regula[io :�,. x l ,� •�'„ 1,l> Y '
1 have read the ban",?"
n o�' alc 1 requirements rants nd r ChepmN.ti9 of be
California Health&Salary Cade Sections 35505 25533 and 25534 1 malecaparral Nat _
it the balding does no,currently hsatenant;that tis anyresponsibility to notify the -- - - ", -
a p 1 of the require ns w 'chi ,he et pniir m I: ce oto <ni0ihto of
° ature of Applicant _ at
� .
All r coverings to be Class"B" o otter
'
` •. V.
. -"- OFFICE - -._..... ..._ _.. . .. .__
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
` Telephone: (408)777-3228
CITY 0 F= (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 YV 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:
C) 72
Address: /Lem_
Reroofing Company Name:
Applicants Signature: Date: 3 h9
_y
Joe Antonucci
(Chief Building Official)
5/25101
OWNER-BUILDER VERIFICATION
1. (Check one) I or my immediate family(parent, spouse or child) will perform:
A. _� AB the work authorized by this permit
B. A portion of the work
C. None of the work
If B or C is checked,complete 2 or 3 below.
2. A state licensed contractor will be hired to do:
A. _ All of the work
B. A portion of the work (complete section below)
Contractor Address/City Phone# State License # Type of work to
be performed
• 3. _ I willutilize unlicensed person(s) other than my immediate family to perform all or
portions of the authorized work. I understand that I maybe an employer (see reverse side). A
Certificate of Insurance covering workers' compensation must be on file at the City of
Cupertino Building Department office.
Person/Firm Address/City Phone Number Type of work to be
performed
.....................................................................................................................................................................................
I declare under penalty of perjury that the above is true and correct. I have read and understand the
Owner-Builder Information (reverse side). \ /
Property Owner's Si"a . re: b4e:
Job Address ` L� ��� �� Permit#
Any changes to the information provided on this form shall be submitted to the City of Cupertino Build
Department.