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02100173 (2) CITY OF CUPERTINO •i'A 'J BUILDING DIVISION PERMIT CONTRACTOR INFxORMATION: 1lngDk6i8)DKSSS:STELLING RD KEVIN SULLIVAN ROOFING PER1,1I'1'N©2100173 OWNAK4PyAIMASAKO AND MASAO TRUSTEE 1696 VALLEY OAKS DR. APPLICAIID3SPf21*1�2002 Ah orHONE: (408) 842-1057 SANITARY NO. CONTROL NO. ARCHITEC(ENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 oLICENSED CONTRACTOR'S DECLARA'[ON �r00 Job Description F L hemnr affirm mm I,m ueen.we Omer provisions or Chapter 9 aomr„emdms p azo withScetionmXXO.nrvkhan,3oflrll ra nndP.nreeannsctwu namrucenwix REROOF �ORIALEI� w m full n,rce A�ypIhxII�,wwdaxPLhIrrwcmds Je' �o Lice. Gras Lie.. 3715 oN— ale c.m acro ✓ CTS RATION OCT3 7 r/002 � ¢s Iunacrlax 1 L apew0 w 3 u% Licensed Professional OWNER-BUILDER DECLARATION BUILDING h a E I herehy uffum that 1 am exempt from the Contractors License Law fur the Y 9000 w—ofo O llowre ing..on.sbeir n 71111.5.Business and Professions Gwe:Any city or county %m2 which requires a Permit m construct,alter,improve,demolish,nr repair any s,ructure w—" poor to its issuance,also requires he applicant for such Permit o file asignedmatcmem t-Z6 that he is limned pursuant it)lbe provisions of the Contractor s License Law(Chapter 9 3S�61311[70&AAaL@ Valuation 'FC (commencing with Section 70XXpof Division 3 of the Business and Professions Curb)or Wthat he is exempt hcmrrom and doe basis for the alleged exemption.Any violation of Section 7031.5 by any applicant cora permit subjects the applicant to a civil penalty or U APNN Occupancy Type not more than five hundred dollars($503). 307 — INSULATION O 1.as owner of ore property.or my employees with wages as their ode compensation, will do the work,and the structure is not intended or offered for sale(Sec.7040.Business and Pmfcssiom Code:The Contractor's Licen.¢law saes mm apply to.n owner or 6 0 2 — ROOF PL nfN,i Vns property who builds or improves thereon,and who does such work himselfor through his widemploy«s.pm.iaedmatsumimprovements am,notiatandedoroneredmraide.If. 603 - ROOF BATTENS however.the building or improvement is sold within one year ofcompletion,the owner- 604 - ROOF IN-PROGRESS builder will have the burden of proving that he did not build or improve for purpose of sale.). 0 I,as owner of the property,am exclusively contracting with licensed contractors 10 construct the project(Sec.704,Business and Professions Codc:)The Convacum's Li verse Law does not apply mo an owner of property who Wilds or improves thacon,and who commits for such projects with a conte mm(,)licensed pursuant to the Contractor's License law. O l am exempt under Sec. ,B&P C for this reason Owner Dam WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 1 have and will maintain aCer ifcate of Consent m self insure for Worker's Compen- sation,a provided for by Section 371X1 of the Labor Code,for the performance of the work for which this permit is issued. 0 I have and will maintain Worker's Compensation Insurance,a required by Section 371.)of the Lahor Code.for the Performance of the work Be which this permit is issued. My Wnnrr�kcr*s Compensation Insurance carrier and Policy number are: Ca icy/'5'22L Policy o.: S� �Z C17RTIFICATE OI'E%EM OM WORKERS' COMPENSATIONI SURANCE (Tbis.welion need col toe compleled if Ibe Permit is hmonc hundred dollars(311X1) or Icss.) I ecrefy that in the performance of the work for which this Permit is issued,10.11 nm employ any person in any manner m as m become subject to the Workers'Compnsation Laws of California Dale Applicant NOTICE TO APPLICANT:If,after making this Cenificate of Exemption,you should become subject uo the Workers Compensation provisions of the LaMu Code,you must 0 Z forthwith comply with such provisions or Nix permit shall be deemed revoked. zO CONSTRUCTION LENDING AGENCY [-. 1 hereby affirm bat Ne¢is a construction lending agency lot he enormance Of 7 the work for which this permit is issued(Sec.31997,Civ.C.) W In Lender's Name at. Lender's Address U 0 1 certify that I have mad this application and stale that the abuse Imfmmmiun is P cartei l agree to comply with at l city and county ordinances andstale laws relati ng to �U building construction,and hereby authonm repmsnmtiws of this city to enter upon the aWn-mentioned property for inspection purposes. a (We')agree to save,indemnify and keep harmless the City(if Cupertino against i F' N liabil tires,judgments,casts and expenses which may in any way accrue against said City U Z inconsequence of the granting of this Perm it. ,.a APPLICANT UNDERSTAPI ' NU Will,COMPLY WITH ALI.NON-POINT Issued by: Date SOURCI' GULATl 2- / /� Re-roofs nawrco ApplicanuCommeLor Date HAZARDOUS MATERIALS DISCLOSURE Type of Roof Will the applicant or future building occupant store nr handle hvardous material as defined by the Capsicin.Mugicipal Code.Chapter 9.L2.and the Health and Safety Qwe.Section 2553apf! t� All roofs shall be inspected prior to any roofing material being installed. Yes Will the applicant nr future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove emit na..amous air eonlaminant as ncd by the Bay Area Air Quality Managcmcm all new materials for inspection. Disaricl7 ^M`,/ D Yes I have mail thc herallous muLLriaLsmquimincnLmnderChapmr 6,95 of thc Callfnr ria IIeurb&Surety Coyle,Sections 255(15.25533 and 25534.1 understand that if the la ilding arcs not currently ban a moral, t is my msWotsi1dity to notify fire ac Pant of the rl c hichm 'umicuanccnf.Cenihcare ,I nPcy Signature of Applicant Date' ' m�'--� . Q� All roof coverings to be Class "B" or better Owner Or aturniecd agent Dam Building Division 10300 Torre Avenue Cupertino,CA 95014-3255 ` Telephone: (408)777-3228 Fax: (408)777-3333 CUPERTiNO 'Building Deparitment 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 musthave a minimum i*T+um of VV per foot slope and demonstrate that there is no ponding. 2. An LC.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: /Lf/'L , 9HA9LZ QA*f Address: 138 Z 5, S�EwIW6- ✓� . reroofing Company Name: u✓•9 51-q� SE4,11eO Applicants Signature: �e: !o Joe Antonucci (Chief Building Official) 6/25/01