01120091 (2) CI xmOFry DISIONP PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
22351 SANTA PAULA AV 01120091
OWNER'S NAME: APPLICATION SUB DATE
HUTCHINS EDWARD P AND EILEEN F 12/21/2001
\• PHONE: SANITARY NO. CONTROL NO.
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w O O ARCHITECT/ENGINEER: BUILDING PERM11'INFO
H 0❑�x B ELECT PLUMB MECH
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Z 5 i LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that l am licensed under provisions of Chapter 9(commencing
F=Z'mF- with Section?000)ofDivision3oftheBusinessandProfessionsCode.andmylicense T/0 COMP INSTALL HEAVY SHAKE
Ix In full 1'arcc and< cal. �� 0
c z a Licenu Ctax5 Lic.x
d
0,U U Dam �Z/�� Concoct. lf
uO ARCHITECT'S DECLARxf'ION
u`e,
g I understand my Dlans shall be used as public mcmd,
le
c.E oLiccnad Professional
OWNER-BUILDER DECLARATION
=w . 1 hereby offtm that l an exempt from the C°nvwlor's License Law for the, $200s00
following reason.(Section 7031.5.Business and Professions Code:Any city or county
o which requires a permit to construct.alter,improve,demolish,or repair any sssucmle
at 3 S. room its isaiaace,also reqund the applicam for such pumit m file a simed smlence,
That he iy licensed pursuant to the provisions of the Cantlacmts License Law(Chapter9 - ,-.�Cssfd,, 17 ��p Or fta. . 0o1 Valuation
(commencing with Sectlon7000)of Division 3 of the Business and Professions Code) ;35'PO4U�g_:1� Z :�1, 4 i
m that he is exempt dmrefmm mad the basis for the alleged ex'anptiom.Any violinum
of Section 0031.5 by any applieani for a permit objects the applicant to a civil penalty
of hot mare than five hundred dollars(E50)). 3 0 5A— Occupancy Type
C1 I,as owner of the propeny,or my employees with wages as their sole compensation. 307 _
wilt do the work,and'the nluctum is not intended or offered for sale(Sec 7U41, - -
Buiiness and Professions Code The Contractor's License Low bass net apply to an 601 - ROOF TEP1'Fg6FjHnspectionsl -,r.1 through
hr of progeny who builds or ovidedet Thereon,mp who doss such wink himself
°rtnroaghltlsowmKeweveectheWiidw_nmsach_improtis%olsamnmmtndwor;-- _. ._ 60.2_ ROOE__PLYWOOD..NAIL
offcscd for sal[:If,howcvca the Wilding-or IIs[oIJ within OM f
g a;imp..=men r=u° 603 - ROOF BATTENS '
olhplction,the owncrbuildcr will have the burden of proving thin h<did not buil)or
improve lar parpme°fail`). 604 — ROOF IN—PROGRESS,mostr _
.pIasowner ofthe O(Sec.7a xcsinesslacomrofeisi withlimrocde Commoners
on .. . l '
Livens m the project fappl to a Business and Professions Cade:)The Como rwar. , [
- License Law does far
m ml owner th property who),builds m improves thereon.
.: . and vector's License
fL such projecu with.°conmanor(s).licenxd pursuant.ru.lhe. ..__.- �'�AL.ED ------ "-- -"'-_-'—'
Contractor's made Law.
_ ❑lam exempt under Sec. � ` ,BffiPCfor this reason „ _i. W
Owner ` Date FEB 0 8 2002
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under,penaltY of perjury one of the following declaralionn
l ❑ 1 have and will mmnmin a Cenificale of Conant to self-insure for Wmrkcf's BUILDING
Compenemion, as provided for by Section 3700 of the Labor Code, for rhe
performance of the work for which This permit is isnucd. „
O I have and will maintain Worker's Compensation Insurance,as required by Section
37M of the Labor'Code,for the Performance of the work for which this permit is
tuucd.My n ersC pe t Inv ce carter and Policy number am r• „ _�,����,�-„.,,,,,,_,�„
wI- ..... ..... .. _. .-..., .. ,. ......._._ .- _
Camer .. ithey No. e - if, :, '.i, L .• t.� it
CERTIFICATION OF EMPfIOM1 ROM WORKERS',
., kits ISs .✓:. a �l trl,�.t s
..... .r COMPENSATIONINSURANCE' "...'.. _._........_. ___._-. ..._..-.._.—..-._..
I (Thisse6lion need not be compined if the permit is for one hundred dollars
(s100)orlcss.) _
1 certify that in the q,whi,
is b Is f r ustr this pc mit Is issued,1 1„_,., :• y , .
hall nm Lmpin persos w 1p M Toe 'Cel m the Workcri '
Coinpcwtio f C. /'
NOT'ICEI API'LI'A "Ia et IixW�ul
'Exemption You should
Z become subject m the Workn provisions of the Labor Code,you mull
p fonhwilh co..Is with swell pe d.
Toss shat bt ecmc reine e
771_7
"CONSTRUCTION LENDING AGENCY .t '
of t 1 rumba,affirm That there is a constructiontion lending agency for the perfoimance
r he work for which this permit is issued(Sec.3097.Civ.C.I
LcnJer's Name'• _ . , _ __ . . . .. 1_.1 _..
;D LendeL[Address”
'V I<enifyth,I have read this application and sure that the above information is
cmmed 1 agree m comply with all city and county ordinances and state laws relating
'Q.V mtrand ngc.n.uri ction,and hereby mthoriu'rcprcsenmlives of this city to enter upon
the above nmmioned pmpeny far in.[peclion pur,ass.
F. 1 Iude)agree m save.indemnify and keep harand.the City bf Cupertino against
Zn liabilities,jadgmenn.costs and expenxa which may qv way accrue again.,said
fJ.z City in cunseq c f the gra g°jJbi pe rd. / r
APPTC11
AN'' RST�yy�`fG I .lit LY 61rHdL,i,.,vo/:ory Issued by: Date
. . soulee x.� , ALLf'��7 •� .
.Signamrc gf AppraantrCnnracmr �— B+t� Re-roofs
HAZARDOUS MAI' IALS DISCLOSURE'
. ,Int,the applicant or tumor Wilding«cupam score or handle bahudbus mdscrud. _Type Of.ROOF.
m de,Section
io the Cupeninn MuniciWl Code.Chapter 9.12.and the Health anO SafnY
. COJe,Scclion 25511(°)?...i '. . 1 .,
❑Ye>. , .,
__. �10-;, „_ __- •.-, .._ All roofs-shall be.inspected.pnoCto any roofing material being installed. ..,_
Will the applicant or future building excursion use equpment or devices which If a roof is installed without first obtaining an inspection, I'agree to'reirove
chmahazard.mitirconsheirem,todefirred thyme Bay Area Air
Q al ty Uanagemem
Dikenw, all new materials for inspection. Applicant understands and will comply with
°Ypx all non-point source re ulations..
�_ - 1 have read the ha'mrdous materials requirements under Chapter 695 of the
CalJorniu Health&Safety Cute,Sections 25505.35533 and25534. undcrhhn1that
if,the building dies vel curtenJy haveammm as'y rylesponsibilnylo notify,the' G/
occupan of require. r!'w 1 It me or, sconce m a nificate of
°”" Signature of Applicant Date _
.e raamprixeaagem All roof coverings to be Class "B" or better
-.. .. .. .. .. OFFICE
Building Division
10300 Torre Avenue
• i �' Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (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 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:
Address: ZZ3 S 5 ,
Reroofing Company Name: c''
Applicants Signature: te:
Joe Antonucci
(Chief Building Official)
6/25/01
Building Division
10300 Torre Avenue
r. '
Cupertino,CA 95014-3255
' J Telephone: (408)777-3228 •-
CITY OF Fax: (408)777-3333
CUPEkT1N0
Building Department
RER®®F TEAR ®FF POLICY
revised 6/25/01
1. You must schedule an inspection for the tear off the day before the date you
wish the inspection to be made. The procedure is to call the Building Division
(777-3228) between the hours of 8:00am and 4:00 p.m. for next day inspection.
2. When the roof is torn off,the nails removed or driven in, and all of the dry- .
rotted wood has been replaced, then you must call the City Building Division.
An inspector will be there within one hour. There are special hours for this
service:between 8:00 a.m. and 11:00 a.m. and between 1:00 and 3:00 p.m.
3. If you call for the tear-off inspection and the job is not ready there will be a
re-inspection fee of$100.00 charged,which must be paid before another
inspection is made.
Joe Antonucci
11
(Chief Building Official)