02110006 (2) CI'T'Y OF CUPEWHNO '
BUILDING.DIVISION PERMIT CONTRA,CTOR'INFORMATION:
Bu185(J9A3)DRPRESIDI0 DR PERMHN02110006
DWP4VNA1'JLEY JAMES R AND AGNES S APPL1CNIT'IsYU)ITY2002
ahk
TONE: SANITARY NO. CONTROL NO.
ARCHI'ILCT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MICH
0 0 0 0
wop LICENSEDCONTRACI'OR'S DECLARA'T'ION
z�F I hanebyalrrm that lam licensed underprnv nnsof Chapter 9(commeneing REROOF Job Description
nulllure aklice nrmee„inby�d t ma.,i,macnee.and+myu<enki. T/0 SHAKE ROOF, INSTALL 1/2 " PLYWOOD
Eisen c Lic.N ` tdlgS J
at 0'. L Com sur 30LB FELT & CAGLELITE LIGHT WEIGHT TILE
�OwU l understand my plan shall M used I icceorda + r-
r LC p� p,
A
icensed Pm@,,mare f IiVLED
OWNER-BUILDER DECLARATION
�ap I hereby affirm that I am exempt from the Comfactor's Licenm law lou the
o reason.o following ren.(ScOlon 7031 5,Business and Professions Ca1w Any city or county NOV 15 2002
°'K 2 E which requires a permit m eonitrucl,alter,improve,demolish,or repair any nmemre
'o pour In its issuance,also requires the applicant for such fermiuo file asigned statement
�SSi6 that he is liccnsed pursuant o the provisions of the Commcuars License Use(Chaptcr 9 Sq. Ft. Floor Area $12U0fitlon
'6-m (rommoncingwithSection9AkpofDivision3(ifthel3usinessandProfessionsCode)or BUILDING
i 3$ Nat he u exempt therefrom and the basis for Ne alleged exemption,Any violation of Y�./ 1�I
Section 7031.5 by any applicant for a permit subjects the applicant to a civil pcaahy of bAW NJN;epOccupancy Type
not more than five hundred dollars($5007.
❑I,as owner of the pmpeny,or my employees with wages as their sole compensation.
wBldotTh
he A.and the structure is not intended oroffcrcd for sale(See704,Business .jfg���i�ed Inspections
and Professions Code: e Contractor's License law does not apply m an owner of 3 07 - INSHAr11jq V p
Property who builds of improves thereon.and who does such work himself or through his
rwnemployces.provided lhalsuch impmwmcntsare not intended oroffcred forsale.If. 601 — ROOF TEAR OFF
however,the budding or improvement issold within one yearofcompletion.theowner- 602 - ROOF PLYWOOD NAIL
builder will have the burden of proving that he did not Wild Or improve for purpose of
seta.). 603 - ROOF BATTENS
0 1,as owner of the pmpeny,am exclusively contracting with licensed contractors to 604 - ROOF IN-PROGRESS
construct the project(Sec.70G ,Business and Professions Code:)Tre Contractor's Li-
se law does not apply to an owner of progeny who builds or improv thereon,and t
who contracts for such pnajccB with a comracmr(s)licensed pursuanuo the Contractor's
License Law.
0 1 am exempt under Sec. .B&P C for this reason
owner Dade
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of Perjury one of the following decimations:
I have and will maintain a Cenilicotc of Consenuo self-insure for Workers Compen-
sation,as provided for by Section 3710 of the labor Civil for the TCBmmancc of the
work for which Nis permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3700 of Ne Lahr C de,for ode performance of Ne work fm which this Permit Isis
My Wnrkers nmpesmio In.umnec vier and policy numb rate
Ca <r. Policcyy--yy L
CF-RTIFICff OFE) MPTIONIGK 1\(
COMPENSATION INSURANCE
rints.aanion need nm b:completed if the permit is fnrone hundred dollars(S 1(Ny
or less)
I certify Nal in the Performance of the work for which this permit is issued,I shall not
employ any Person in any manner so as in Mcome subject to the WorkersCompensation
LawsiffCalifornia.Data
Applicant
NOTICE TO APPLICANT:If,after making this Cci ilicare of Exemption.you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
O O forthwith comply with such provisions or this Permit shall be deemed revoked,
z CONSTRUCTION LENDING AGENCY
I--r ^ I hereby affirm Nat there is a construction lending agency for the pcoiumance of
a, 7 the work for which this permit ixissucd(Sce.3097,Civ.C.)
ul 23Lcndcr'x Name
a Innding Address
V C) I certify Nal 1 have mad this application and state that the above information is
W Pcorrect.l agree m comply with all city and county ordinances and state laws relating to
V buildingConstruction. hereby inmeCHofieerppresenmtives of this city reenter alum the
abrvomcminned property for emnify an keep W
F d (We)agree tu save,indemnify and keep harmless the City of Cupertino against I
h liabilities,judgments.costa and expenses which may in any way aceme against said City /
V z in consequenecof the graining Itthis permit. i ��,�
nPPLI T UNDERSTAN SAND WILL COMPLY WITH ALL NO Issued by: Date
50 EGULATIO - /
( Regoof5
Igwmrt ofApplicaanwor —1
'AZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant Note or handle bvsNnus material
as defined by the CoNnoo Municipal Code,Chapter 9.12.and the Health and Safety
Code.Section 2553200'. a,��� All roofs shall be inspected prior to any roofing material being installed.
❑Yes ' '-f'"d t
Will the applicant or future Wilding occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit haeandous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
E]yes /fy Nu
I haw read the hwmdous matcrialc refinements under Chapter 6.95 nd the Coli for-
mallcalth&Salcty GWe,$duns 25515515511 and 25535.1unokrstanJ thmiflM building IA ( V
doe
rcurrently haw a Mn no.that it is my res,wroibiliry m noddy the oecupanl of theUC�IAs�
mts which mux N, mmSr, e
ictpnissumccnfacc ,nr pa^cy. 4aiturZeoFlApp]icant Date
mauthmixpd agent D(a)te All roof coverings to be Class"B"or better
Building Division
10300 Torre Avenue
rv� Cupertino,CA 95014-3255
` Telephone: (408)777-3228
CUPE�TiNO � Fes: (408)777-3333
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
Wand 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.
• S. 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 V"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
nspectionWe understand the above policy on reroofing and will comply with this policy.
Homeowners Name: 1
Address: Uy%`� res .Cy i C� �
Reroofing Company N ll X C 1/ 7
� e TJ 1C /
Applicants Signature: k) v Date: ( I' L
Joe Antonucci
(Chief Building Official)
6/25/01