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02120010 (2) CITY OF CUPERTINo rhe `. .' ` BUILDING DIVISION PERMIT 'CONTRACTOR'INFORMATION: BUIg)G(1eDIVEPTEMBER DR PRASAD ADEM PERMIT NO 2120010 OwIFIZA&AD ADEM APPLICAI'IPIPTSy'nT/�t2002 AL INFIONE: SANITARY NO./ CONTROL NO. ARCHITECT/ENGINFER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH pm� 0 0 0 0 LICIthinI CONIItd underp DECLARATION <° Iion7aa1Brm madam Reenaed ender provision:e.rcharmTv(eo.menemg Job Description <iu, wimScemmngkBnfDivision3ofaMBusinessandPromesionsGde.andmylicenseis REROOF <p. in full limaand effect, FllilALED LicenseClara I.m.x OZ—� Dam Comrac'un DZ;- Date ARCIIITI'.CI'S DECLARATION DEC 2 3 2002 y< 1 undersand ll M my plans send as pehlm records a: i 0 w3u. Licensed Pmfcaiooal =p OWNER-BUILDER DECLARATION �lI 1 �k�/'. s a f 1 hereby affirm Inas I am exempt fru.fire,Contractor's License Law for the BILDI400 to z p 0 following notion.(Section 7031.5.Business and Pronasions Code:Any city or county which requires a permit m construct,alter,improve,demolish,or repair any structure rZi pd.,to it,ismeoree.also bottoms the applicant for such permiuo Glc a signed statement th ���5 i < io he is licensed pursuant Contractors the provisions of the Contors Licenvc 3Ss12 law(chapter9 115M("A@0 Valuation yHm lcummeucing with Section 7000gnf Division Sof the trustees,and Profession Code)OI y that he is exempt damfmm and IM buil for the alleged caemption.Any violation of Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of 3()APrkfNFaW Occupancy Type not mom lush five hundred dollars($500). 307 - INSULATION ❑Laoweerofthepmpenyormyemployce wimwagesmtheirsolecomp.tsation. will do the work,and the slrucmm is not intended or offered for sale(Sec.7M1W,Business �p��y and Professions Code:The Contractor's License taw does not apply m an owner or 602 - ROOF P "Wit" property who milds or improve tlamon.and who doessuch work himself or through his Own employees,provided that such improvements are not intended or offered mraale.If. 603 — ROOF BATTENS h.vever,me building or improvement is sold within one year of completion,the owaer- Wildcr will have me burden of mostng mal he did oat build or improve for purpose of 604 - ROOF IN-PROGRESS salcJ. 1,as owner of me progeny,am exclusively contracting with licensed contractors lir construct the project(Sec.7044,Business and Professions Code:)The Contractor's Lh cense law diva not apply to an owner of properly who builds or improves ramon,and who contacts for such projects with a contractors)licensed pursuanuo the Contramo's Ln , Law. 1 am eirintt�under Sca/y��� •f�`.`��'� .B 6 P C for this reason 0 net t W SRS MPEN AT0 ECLnRAT10� 1 hemhy aRam under penalty of perjury one of the followi dedaraunns: 1 have anJ will mainmin a Cenifeme of Cnnsenl la sdGinxurc for WnrkcYs COmpcm station.as provided for by Section TIDO of the labor Cede.for the partom ance of the work for which mix permit is issued. I have and will maintain Workers Compensation Insurance,a required by Section Alt)of be labor a d,.for he performance Or the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number am: Carrier: Policy No.: CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not he completed if the permit is for one hundred dollars IS BOB Or lava.) I cenify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner sox mMcta coxa jttun thWW nrkers'Compensation Laws of Califudg c -0 Appli blTO :lr.ul�cr akin this Cent a of Esemptien,you should Neorm subject to the Worker's Compensation provisi me labor Code,you must O ,x forthwith comply with such provisions dr this ivrmit shall M deemed revoked. z O CONSTRUCTION LENDING AGENCY [.. .N-. I Mteby affirm mat there is a construction lending agency for the performance of gY. 7 the work for which this permit is issued(Sec.3097.Civ.C.) G] Q Unders Name Z Under's Address V p 1 certify mal 1 have read this application and slate that the above information is n.P correct.I agree to comply with all city and county ordinances and state laws relating to �U building construction.and hereby sultana,repmmnatiws of this city to enter open the 0 [+l aluwameotion'd propeny for inspection purposes. 42 (We)agree to save,indemnify and keep handless the City of Cupertino against 1 5 F' y liabilities,judgments,costs and expanses which may in any way accrue against said Cay U Z in convequenec of the granting of this permit, r. APPLICANT NDERSTANDS AND WILL C MPLY WITH ALL NON-POINT Issued by: Date SOURC RE ATIONn ov)s e-roofs Si A,dieam/Contaetor V V Dace HAZARDOUS MATERIALS ISCLOSURE � / Type of Roof Will the applicant or future building occupant store or ban yLSMrzWork material defined"'yo y the CuTenin r Municipal Code,Chapter 9.12.and th Hadh and Safety code.,union zs532tar! �' All roofs shall be inspected prior to any roofing material being installed. ❑Ycs If a roof is installed without first obtaining an inspection, 1 agree to remove Will the applicant or future building occupant use equipment or devices which tion hasamon,air aooamtdanes as dcrned by the Bay Area Air Quality Management all new materials for inspection. District? 1/ E]Ye., I have mad de haourbusm.erials requirements under Chapierfi.95 ofine Caliror- W JO ^T nialleuA SafetyCade.Seedons25N15,25533 and2553J.l undersand lhatiflM building tena ✓ Jl does one currently have a nt m.is is msth. y rexpamlhy minty the Occupant of the t mquim nts anmamMmetpdt mist ce nneato moraeuparmy' ignatureofApplicant ., Date b" All roo nngs to be Class "B" or better Owner Wr aati o sed agent bit, Building Division 10300 Torre Avenue 4 Cupertino,CA 950143255 Telephone: (408)777-3228 OCOF Fax: (408)777-3333 CUPERTINO 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: P K flS Ik0 PM 1'V1 Address: 0 QWt, LuPeK—I 1n30 Reroofing Company Name: Applicants Signature: Date: i ZI a r)�-- • �Joe Antonucci (Chief Building Official) 6/25/01 OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family(parent,spouse or child) will perform: A. All the work authorized by this permit B. _ A portion of the work C. _ None of the work ]Rri C F7VFD If B or C is checked,complete 2 or 3 below. DEC 3 2002 2. A state licensed contractor will be hired to do: BI'' 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 will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be 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). n Property Owner's Signature: co � O� 1 Date, 12 3 l�0 nom, job Address ICI .S� P— Permit# C) v V Any chances to the information provided on this form shall be submitted to the City of Cupertino Build • Department.