02010015 (2) CITY OF CUPERTINO
.".WILDING DIVISIONPERMIT CONTRACTOR INFORMATION:
' BUILDIN.ADDRESS: PERMIT NO,
22474 STARLING CT A L RESIDENTIAL COMMERCI L 02010015
OWNER'S NAME: APPLICATION SUB DATE
MUENCH DORIS O TRUSTEE 14893 E HILLS DRIVE 01/03/2002
HONE: SANITARY NO. CONTROL NO.
\, .. (408) 729-6100
8 O O ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
to
E J r
<11
z z LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that 1 an licensed under provisions of Chapmr 9l commencing
„ �W wimSection 70001of Division 3of01BminessandPro lI'dimsCode.and m1Bc=n.e RE-ROOF T/0 RE-SHEET
p f7 rs in(ull forte and eRcc � �,�,� �
S e,i u License Claes Lic,ro i?
Doc Contia<mr,
uyS 3 a y ARCHI ECT'S DECLARATION
p.,u O g 1 undcrsmnd my plans shall be used a puhlic mcoNs
n
80 Licensed Professional
OWNER BUILDER DECLARATION
u� 1 hereby affirm m,hat I aexempt from the Contractor's License Law for me
F z a following reason.(Section 7031.5,Business and Pmfe.ssions Cade:Any city or county $4000
I x n which requ;ms a permit m construct.alter,improve.demolish.or repair any almctur=
d3 ..prior to its issuance,also mqu'aes the applicant for such permit to file a signed statement
that he ij licensed p,dsyam to the pmns,ons of the Comrucwrn License Law(Chapter 9t '❑�-�1QOr.s�[e a.r¢ 11 (( Valuation
(2ommcnc;ngµilh Seytiaa YQ7()af Division 3ofine Bromat,and Professions Cade) �. �)'. 13'zs�l tiGj YV U7%5.11.reel '. ' '
or that he is cicmpt therefrom and me basis for the alleged cxemphon.'Any violation
- of Section 7036.5 by any applicant for o pants,subjects the appl;cant,o a civil pcmilry
rof not mom than five hundred do] ($500). 3 05 APN �( v Occupancy Type
❑I,as..net offm propeny,or my employees with wages as their sole compcnsatian, 3 07
will do the work:and the'smanum is nor intended or offered for sale(Sec.7011; - -
Business and Prefessimre Code:The Cnmmctor's License Low does not apply to an 601 - ROOF TEA1kg6jp 'Inspections'
owner of property Who builds or improves thereon,and who does such work himself
.1 through his own employees.provided that such improvements are not intended or 602_...-- -ROOF PLYWOOD_NAIL,._.
-offered for sale.If.however.the buiidin8 or improvement is sold within one year of -
completion,the owner-builder will have the burden of proving that he did not build or 603 - ROOF BATTENS
improve for purpose ofaalea. 604 - ROOF IN-PROGRESS
_ _.__. .. exclusively
contracting with licensed contractors _ ._... ... ..... . ....__. ._ _ ..- ._... -_
❑1:m owner of Ne props.,am Business a d Profession,
- "
_
consumer the does
($s. lore Business and cay ,hola Cad=:)The Convenor's
License Lew does no,apply loan owner th property who builds m d mos
a,M1so rhe
...ond.wctor's oac¢for.such Drojecu with.a commnor(s).licenud pursuant m me
Contractor's License Law. .,. .
❑I am exampr under Sec :B&PC Tonnes reason rBp ®
' wner '
bum
P� OOVX
WORKER'S COMPENSATION DECLARATION JUL
't
I hereby affirm ander ivewlty of perjury ane of the following declarations: J 5 2002
1 have and will brnini6in a Ceni,icam of' U` 1Consent m sclf-insum for Workers,
Comp=nsa;on, res provided for by Section 3700 of ,he Labor Code, for ,he ��'
performance
of the work for,which this penitis svurd., . LpIIVCrI
❑1 have and will maintain Workers Compensation Insurance,as required by Section
3700 of the Labor Code.for,he performance of Ne work for which,his permit is
sued.My W k 's C mpe i Ins - c c me^-and'Policy number
Cart a ICYN ITJ
EXEMPTION 1 ROM WORKERS-
I
SATION I\SURANCE' _.- _ ... _.,. _.. _ _—__. __._. .
i L TIFICAT NOF
C NPEN.
u c ..... _ v 'I ti I1
'
This section need not he completed if the permit is for one hundred dollars '
IS 100)or less,l,
-.: - -
,.-.' Ic ifY tM1t m Prf bfm kfy
shall t1employ y p= m y ro
Co' p s f n La -s tit C D
NOTICETO APPL1CANl of r k gt nfcam of Exempt y sh Id s
beco bj n .,he"or
k s C.
t ons of m Wb Cod 'y u 1
c Q fonhw th coyly with h p icons or thishail b d cmcJ revoked.
z CONSTRUCTION LENDING AGENCY 'I
l hereby uffiim that them is aconswniun lending agency for perlommnce
.09
of'he work for which this permit is issued 1See.3097,C;v.C.I
,7 'Lenders Nome." .s ._ . . .-... .. _ .-.- ...
Lender's Address' '
'U I many that l have mad this application and state that the above information is
fa. E., .contest.I agree to comply with,all city and county urdmunces and state laws relating
O C) ,o building construction,and hereby vu,horis'roprcsentaives of this city to enter upon
,he.",e no minm d Pnrpany for inspection purposes.,•,
F 0. (W )g e,osae de ly and keep harmless the City ofCup=n cogaina
k0 Imb'l tims.)augments.costs and,expenses w hich may,to any way, a agamu,said
U.z C r q cc of e t of,h Trott is
Ll
SAP LI( V U t0 HIAL\RDOUS DA RIALS ID SCLOSH E I M1 J aO1NT Issued by./ ! - - '. „' •• y,
Sig t of App c nV t n Re-roofs
W a mane prgfuwrt but dm ecu ant stem or handle nevootid material
-.Type. . Date
dI m= ppl g pof Roof
as defn dbY the Cupen Mymnpal Cod
Chapter R.and,he Health Y „� ••, _�, ., I-„ .'t. .. '
S❑cY`2ss32i) ❑No ' A_ t.i'.; _ All roofslshall.be inspected prior-to.any.roofing,material being.installed.-,__
Will the applicant or f, ren-las ocuti,runt use a,cipmem or device,which If a roof is insialled without first obtaining an inspection,-Iiagree to remove
emir h dose air contaminants .df dby the Hay Am..A Qr1IuyM ag ent
D;, all new maC97
r ' pec C n. Applicant understands and will Comply with ..
oY ID NO all non-poilau
I have read the r.nodous nmenals reyu ncmcnis under Chapter 6.95 of the
Califamia Health&Safety Code., moms 25505,35533 and 25534.1 understand that _. I
-if me ing does no oncmly h c a mnvnt,that h L my responsibility,o notify the '
occu t ,he mqui tents whi muse k met prior to issuance of a Cenificam of
° 3 Signature of Applicant Date
„tier mor;.= regent Dat= All roof verings to be Class `B" or better
Building Division
10300 Torre Avenue
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 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 will comply with this policy.
Homeowners Name: Cl�//LG _
Address: 2 Z y7 4z
Reroofing Company N C— �6
Applicants Signature: Date:
Joe Antonucci
(Chief Building Official) .
6/25/01