03010206 (2) 5 CITY OF CUPEWFINO a* e $ f;�'"
BUILDING DIVISION P> RMIT CONTRACTOR INFORMATION-'
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BUB.DINGADDRCSS: CAL-PAC ROOFING PERMIT NO.
10300 RICHWOOD DR 03010206
OWNER'S NAMH* 36 RAILWAY AVE APPLICATION SUB DATE
PATRICIA CODDINGTON 01/31/2003
ZONE: (408) 874-0784 SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MPRH
0 0
w00
LICENSED CONTRACuOR'SDECI.ARA' Job Description
P 1 hcrchy of Brm that 1 am licensed unJer Provisions Chap of Chapter 9(commencing P
�zd.8 with Section 70(goof Division 3uf the ltuonem.I,Prafcssigi Code,appJ my h.roo is
o(tin in full force and e' 't.5� 9 Z !D REROOF
zo}az Li cense Class Lic.M
Datc / "o comraemr T/O SHAKES, ADD COMP. SHINGLES
ARCHii1:1 SDECLARATIOf �r�a�Y
ne, I understand be used nd my plans shall as public records FIIOIALG
KOyU
=�a Licensed Professional
OWNER-BUIL A7 DECLARATION
ei y 1 hereby affirm that 1 am exempt from the Contractor's License law[or rise FEB 112003
w
00 following mason (Section 703 L.5,Business and Professions Code:Any city or county
o'ads 2 E which ma unce a pertnit m conium,uhct improve,demolish,or repair any strucntre
w�'^ prior to its issuance.also myuirCa the applicant for such Permit to rile a signed statement
fC that he is licensed pursuant to the provisions of dee Contractor's Licensc Law(Chapter 9 Sq. Ft. Floor Area Q�1Ya'�fI��1O�
(commencing with Section 70l of Division 3 of the Business mad Professions Code)tor {yr7t' L■g'F�R71VA V
W�S that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7071.5 by any applicant for a Permit subjecls the applicant to a civil penalty or APN Number Occupancy Type
not more than five hundred dollars($500). 36908021 . 0 0
C] 1,as owner of the pmpeny,oemploy. 4h my employwith wag.as thele able compensation,
will do Ne.6.and Ret a0umure is nm intended or offered for We(Sm.7044,Braine.
and Professions Code:The Contractors License Law dors not apply in an Owner of 305 - FRAME Required Inspections
pmpenywho huildsor improvws thereon,and who doeasuch work himself or through his
own employees,provided!that such improvements are not imended or offered for sale.If, 307 — INSULATION
however,Be building or improvement is sold within one year of completion,Ne owner-
builder will have the burden of proving that he did not build or improve for purpose of 601 - ROOF TEAR OFF
6d1t) 602 - ROOF PLYWOOD NAIL
❑1,im owner of the propeny,am esetusively contracting with licensed contractors to 603 - ROOF BATTENS
Cons mer the project(Sec 7844,Business and Professions Co tc:)The Convectors Li-
ComeLawdoesnorapplymanownerofpmpcnywholavdeorimpowasRemain,and. 604 — ROOF IN-PROGRESS
who contracts for such projects with a tvmtractnr(s)licensed pursuant to the Contractor's
License La-
0 l am cxcmpr under Sec. B&P C for this mason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I be-and will maintain aCer ificatc of Convent to aeff-hro a for Worker's Compem
station,as Provided for by Section 77(X1 of the Labor Code.for the Performance.1 the
work for which this permit is issued.
1 have and will maintain Worker's Compensation Insurance,as mquimd by Section
W of the labor Code,for Ne performance of the work for which Nis permit is issued.
My worker, C� ppr`p9y,pstar Insurgyptt certierand Policy number a2:
Carticr.ya4AAI �"' ^� Policy Nn.:W3OI'40027 (z
CERTIFICATE OFHXIIMPr1ON FROM WORKERS'
COMPENSATION INSURANCE
(this mction need not be Comple¢d if the permit is for one hundred dollars fS IM)
less.)
I ttnify that in the Performance of the work for which this Permit is issued.1 shall not
employ any person in any mannerso U Io become subject ho the Workers'Compensation
Laws of Cslilorms.Date
Applicant -
NOTICE TO APPLICANT:If,after making this Cenificate of Exemption,you should
become subject to the Worker's Compensation provisions or the IaMm Calc,you must
O O forthwith comply with such provisions rat this Permit shall be decmed revoked.
Z M CONSTRUC ION LENDING AGI7NCY
Fr Iherehy affirm dot there is a constmmion lending agency for the Performance of
(.Yo the work for which this permit is issued(Sec.3097,Civ.C.)
C) Lcndcr' Name
0 Z
UQ I lender's Address
V ttnify that 1 have reatl Nis application..it sore that tM.have information is
ammo l agree m comply with all city and county ordinances and sate law,mining us
QU building Conduction.and hereby amhorire mpmsentarives of this city to enter upon the
ahoy mentioned property for inspcotion purposes.
a (We)agree m...indcmni fy and keep harmless the City of Cupertino agar nst 1
h liabilities,judgments,ensu and expenses which may in any way acerae against said City
U incnnuyucnce of the granting of this permit.
APPLICANT UNDERSTANDS AND WILL CO LY WITH ALV NONPOINT Issued by: Date
SOURCE REGULATIO 1 51 A-
-
Re-roofs
Signature of APplieuIIAZA DO S m
IIAZARDO MATERIALS DISCLOSURE Type of Roof
Will1 applicant or furoharard
re building occupant sort Or handle ous material
as defined the CupeninO Municipal Gale,Chapter 9.12.and the IIcaIN and SafetyGwe.Section
n 3ss3l(a7 All roofs shall be inspected prior to an roofing material beim Installed.
❑Y. r�+ltf` P P Y g g
Will the applicant or furore building occupant use equipment ordeviccs whish If a roof is installed without first obtaining an inspection, I agree to remove
if hazardous ale onmaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yes ❑�
I have mad the hanNousmaterials requirements unJer Chap¢r6 H5 of Ne Califor-
melicarchaSafctyGNc.Secticnu25505,25533and 25534.1undammadJwifdr building
does not curmnlly pace a tenant that it is my maIwasibility m notify the n upanI nr Nc
mquomho i musthemetph, iissmenchoraccnificamofacup cy. Signature of Applicant/ Date
O�
owner Or aumgri d agent Date All roof coverings to be Class "B"Or better
Building Division '
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CI 0 Pax: (408)777-3333
CUPEkTINO
Building Depaent
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 nnand will comply with this policy.
Homeowners Name:
Address: /0 3�0 ��- •� ,� ,�
Reroofing Company Name: &e_ r�
Applicants Signature: d -Q�/ ' Date: ?1 03
Joe Antonucci
(Chief Building Official)
6/25/01