02100123 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:,,-,,
BU Da WAY CAL-PAC ROOFING PERMITNO2100123
owN'bifls &E:& LINDA TAN 36 RAILWAY AVE APPLICATIIMSYR1D61'Y 2002
NE. 874-0784 SANITARY NO. CONTROL NO.
ARCHFITICf/ENGINEER: BUILDING PERMIT INFO
Petmz /7
BLDG ELECT PLUMB MECH
�00 LICENSED CONTRACTOR'S DECLARATION tK
P nRERO I
�t1 with Section 70M)of Oivisinn3uf dte Business and Professions Code,mid m/y license is l
<
"ain't
n full lnrec and
If L �� Z 10
Z p Lice .I 3 Lic.M _
OZ— Date Contractor ED,
Tlirroti 1 unJcraund my plans shall M vud as public mcnNsaG Licensed Pmfc.siunal
OWNER-BUILDER DECLARATION
I hereby affirm that 11. exempt from she Contractors Co License law for nc $11900
sdv_p0 which
following reason.pearnt 7113 LS, t,Altossand professions Code:Any city structure
$� which requires a gamut re construct,eC alien improve,demolish,o repair any statement
r
that
slits cenedpursuauance.also rtyuiree Nof for wchpe Contractor's
Eles Low sntemem
5< that me cing wit pursuant 7it 00 provisionsDvsion 3.hc Cnnaanur's Liccnu LionsCharter 9.)., 3�0F'Jt.•7F0do3Al@D Valuation
(commencing with Section 7(Ml07 of Division)of she Business and Pmfcuions Calc)nr
$ Nal he Is exempt therefrom and the basis for the alleged exempuon.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant a civil penalty of PNN Occupancy Type
not more than five hundred dollars(5500), 307 — INSULATION
❑I,as owner of the property.or my employees win wages As their sole compensation,
will do Be work,and Ne structure is not inrendW orofftrtd for safe(SecJ0a4,Business g�S�ks� X55
and Professions Code:The Conuacwrs License Law does not apply to an owner of 602 — ROOF P ZVYIJ n1QJ�Clipns
property who builds or improves thereon,end whodws such work himselfor through his
own employees,provided that such improvements are not intended oroaered for sale.If, 603 — ROOF BATTENS
however,the building or improvement is sold within one year of completion,the owner. 604 — ROOF IN—PROGRESS
builder will base the burden of proving that he did not build or improve for purpose of
sale.).
1,as owner of the property,am exclusively contracting with licensed conaumn to
construct the project(Sec.7W,Business and Profession&Code:)The Comractars Li. _
Genu Law does not apply to an owner of progeny who builds or improves thereon,and
who contrawo for such projects with a von wro)licensed pursuant he the Contractor'a
License Law. t
❑lam exempt under Sec. .B&P C for thin reason ,
l s
Owner Date ( o
7C11WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
have and will maintain a Cerufica,ofComem toulFinsure for Workers Camper.
n,as provided for by Saturn 37M of the Labor Code,for the performamc of the
k for which this permit is issued.
have and will maintain Worker's Compensation Insurance,as required by Section
0 of the Inbar Cnde,for Nc performance of the work for which this permit is issued.
Wark C peas.. Insix—ecearnerand Pulicynumbcr art:
ier:_--_I Policy FROM
-U3 OR 0/'�0 27
CERTIFICATE P SAI[ON'II NFROM WORKERS'
COMPENSATION INSURANCE
(This section need not he completed if she permit is routine hundred dollars(SIM)
or less.)
I certify Nu in the performance of one work for which this permit is issued.1 shall not
employ any person in any manner sn As in hecomc subject to the WorkcrS Compensation
Laws or California.Date
Applicant
NOTICE TO APPLICANT:If,afwr making this Cenificaw of Exemption,you Nould
become subject to the Worker's Compenuiion provisions of the labor Cole,you mast
7OO forthwith comply with such provisions or this permit shall he deemed revoked.
q tiCONSTRUCTION LENDING AGENCY
[—i I hereby affirm that there is a construction lending agency for the performanee of
the work far which this permit is issued(Sec.3097,Civ.C.)
aQ Undeis Name
z Lenders Addresszm)
V 0 1 certify Nat 1 have read this city
and coon and statea that the s wvc information printing is /
U correct.1 agree a comply with all city end county ordinances and nam laws relining m
OO alwn-meding ntimmiion,and hereby auNon purposes. uvea of this city menwrupon Ne
shove (Wa)agree ao ateity for emnify an keep es.
LL (We)agree w cast,indemnify and kith harmless the City it Cupertino against
U VJ inconseq Judgmentse gratsing expenses this
crit. may in anyway accrue against said City /
A APPLICANT
of the RSTA granting or this permll.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL N N-POINT Issued by: Date
SOURCP.REGULATIONS ��
/los �� DmE Re-roofs
Signature of ApplicaHAZARDO Dam
HAZARDOUS ATERIALSDISCLOSURE Type of Roof
Will the Applicant
m,fMuni building tecupamsorenrand O ha�ousmaterial
As deMeJ by the Cupertino Municipal Code,Chapter 9.13.and Ne Health and Safety
Cute,Section 25532o)7 / All roofs shall be inspected prior to any roofing material being installed.
❑Yc&
Will Ne applicant tit future building occupant esu equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
Iran harm ous air conwminants as defined by she Bay Arca Air Quality Management all new materials for inspection.
District?
❑Yea (yk`�
I have real the w Mous materials requirements under Chapter 6.95 of the Califo-
meHealth&Safety Code,Sections 25505,25533 and 25514.1undennndOat ifthe huiliing
does not current y have a¢nam,that it is my responsibility w notify Na occupant of Ne
nyuircmen hic s nwtpdo niaaaanteonctniBtawara<apan SignatureofA licant Date
�� of All roof coverings to be Class "B" or better
ovom rsmloin. gent Taw
f''
Building Division
10300 Tom Avenue
4 CWMIino,CA 95014-3255
Telephone: (408)777-3228
Pax: (408)777-3333
CUPEPTINO
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.
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 1/4"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 fll
comply with this policy.
Homeowners Name: 5L i a X Va qp� /A-' .
Address: 7//C1 ,. �. r.,-,�Q Loa-..,
U —
—T—
Reroofing Company Name:
Applicants Signature: Date: i0 /G O 2-
• ' Joe Antonucci
(Chief Building Official)
6/25/01