02100024 (2) t CITY OF CUPERTINO Y ��
BUILDING DIVISION PERMIT �-CONTRACTORJNFORMATION: -
Bull-116GI^3181'-sPRUNE TREE LA PERM]F NT 2 10 0 0 2 4
Dw,42015M CHI PAN APPLICAT141lU1�Op9'F/2002
Ah
orIONS: SANITARY NO. / CONTROL.NO,
ARCIITI£CTIENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MEGA
°Oz LICENSED CONTRACTOR'S DECLARATION
° Job Description
SwF 1ion701)ffratlhallamliccmcJunderprovisionsofChaplery(commencing REROOF p
w withSmi„n]IYltyof that
3 of the Businssand Professions Cale.mul my license is
a
ire roll fnree anJ,9ff,cl 34 �
z O�Z Li'cns.L�IIta'
-�—0 Lic.N ��
o z Commctuy �F1q
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.02121 IunJccaanJmyplansshallbeueJa.puhlicrccnrds OCT 15 2002
FLLO� Licensed Pmfcsslonal
OWNER BUILDER DECLARATION
is<p I henry affirm hat 1 am exempt from the Convanots License law for the 1^{ $6200
w d 0 o following estrum Scott(Scatinr 7031.5.Business and Professions CoO,:Any city or county BUILDING
u%$8� which requires a Permit lot construct,alter,improve,d.molish,ur repair any.Vru.lur.
w—to pro,1,, iswanc.,al.so requires the applicant lor,wch permiun file a iigncdamemcnt
1p=�a that he is licensed pucsuanuo the provocons of the Convenor's License Law(Eapter 9 1Jll.613.3a1:0dAr” Valuation
y�a (commencing with Section]gp)it Division 3 of the Business and Professions Code)or
i $ that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of -3 U,4PN-NNkPWE Occupancy Type
not more than Eve hundred doll..055W). 307 - INSULATION
❑I.as an,of the protein,.1 my employees with wages as their sole compensation.
will Jo rhe w0 A.and the svucmre is not intended or offered for sale(Sec.7(W.Business
and Profusions Calc:The Contractah License Law does not apply to an owner of 6 0 2 - ROOF P i V`!V n LVH Lns
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended of offered for sale.11, 60.3 — ROOF BATTENS
however,she building or improvement is sold within one year of completion.the nwner- 604 — ROOF IN—PROGRESS
Wilder will have she burden of proving that he did not Wild or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed cnnvumm to
..awe the project(Sec.7W.Business and Professions Code:)]Te Conmseun s Li
cense law does not apply to an owner of property who builds or improves thereon,and
Who contracts for such projects;with a contracoo(s)licensed pumuantto the Commeruna
License Law.
❑ l am exempt under Sec. .B&P C for this reason
Owarf Date
WORKER'S COMPENSATION DECLARATION
I hereby O iern under penalty of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent m self-mium for Worker's Compen-
sation,as provided for by Section 37W of the Ichor Code,for the p KOMance of the
work for which Nis mo
Tir is issued.
p 1 have and will maintain Wmkfr's Compensation Insurance.as required by Section
"IXIof the Labor Code,for the perfm orme,of the work for which this permit is issued.
M Wmkcr's Compensation Insurance conic,said Policy number are:
S7H•7z f'//AIcin Polis ,n:�W", ^0Z
CERTIFICATEOFEXEMPnO OM ORKERS'
COMPENSATION ANCE
(This section need not W completed if Ibe pemtlt Is furan,hundred dollars(S101q
r less.)
1 cenify that in the performance of the work for which this permit is issued.1 shall not
employ any perum in any manner so as become subject to the Workers Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject In the Worker's Compensation provisions of the Labor Code,you must
O Z forthwith comply with such provisions ur this permit shall be deemed revoked.
?O CONSTRUCTION LENDING AGENCY
[—. l hereby ration that there is a consometion lending agency for the pmli rniann of
C4 7 the wok for which this permit is issued(Sec.31X7.Co,C)
W 0 Lemdc,'s Nam.
0 Z0. LcnJcis Address
U C) 1 cenify that I have read this application and sate that the above information is
D. I~ correct.I agree to comply with all city and county ordinances and state laws relating to
�U huilding nmsmtctlonand hereby..on..rio, ,,,c...Line.,it this city to corer open the q
W alarvcmentioned properly ho inspection purpores. Ill
(We)agree to save,indemnify and keep harmless On City of Cup.nino against
F' liabilities.judgments,costs and expenses which may in any way same against said City
U Z to eomegwncc of the granting of this permit.
^-� APPLICANT UNDERSTANDS AND WILL COMPLY WIT 1 ALL NON-POINT Issued by: Date
�RCER, GU TIONS.
°I3�� Re-roofs
fi OvammemrDateIAZARGOLIS MATIiRIALS DISCLOSUREType of Roof
WilNe tifid uam or foare huilding tccupam.store or handle h...Nnus material
u It by the Cupertino Municipal Code,Chapter 9.11,and the Death and Safety
Code.
It
All roofs shall be inspected prior to any roofing material being installed.
p Yes
Will the applicant air future building occupant use equipment or devices which IF a roof is installed without first obtaining an inspection, I agree to remove
.mit fir a dons air comaminaots as defined by the Buy Arca Air Quality Management all new materials for inspection.
District' •x r
❑Yes
I have mad the hamolous materials requirements under Chapter 6.95 u1 tine Califon /f
niallcallh&Safety CrocSections.Sections25915,25533 and 2554.1 madersund the the huildiif lng ./VI '� w,
does not currently has.a tenant,that it is my responsibility m notify the occupant t dm
require rB:PtswbicIt bet( etprinrtoisuanaofac,-- .atenr�s9p3`y� Signature of pplica t Date
�`,,hY�I�.`c�'t'�,.`y�AA TAS„ a,e_
bam,raauthtt ,dagt l Date All roof coverings to be Class "B” or better
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
` Telephone: (408)777-3228
CITY O Fos: (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 allinspection
-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 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 understand the above policy on reroofing and will comply with this policy.
Homeowners Name: YOVAv6 C-t4l VA41
Address: I pH'-;-mob IN VAV-
Reroofing Company Name: TF1)7(;O'N Co NST A vcl-/ i,
Applicants Signature: / I' Date 1�-3
Joe Antonucci
(Chief Building Official)
6!25101