02110120 (2) ' CITY OF CUPF,RTINO
BUILDING DIVISION PERMIT CONTRACTORIINFORMATION.
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,?BUILDING
LA COSMOS ROOFING PERMIT NO 2 110 12 0
owAR13.h1EDEORA 1901 OLD MIDDLEFIELD WY APPLICAT1Yl1'yB1ugry2002
TIF IONIC. 415 493-6373 SANITARY NO. CONTROL NO.
ARCHITELT!ENGINGER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0
°Oo LICENSED CONTRACTOR'S DECLARATION
° Job Description
Iion7SBof ThalIamfitheBuunderndPahmaofCusle. 9(emmenias REROOF P
w with gceenn7qXB of Division lar theemirmv and Professions Code.and my license is
� d "'full lomc'otic t. ED
oyq= LLeen.vctt=����,C
—p Dam 6� ✓ commnor F1—
ARCIImiCTS DECLARATION
0K 1undrrshand my plans snail he umJ as fuMic rccurds AN 20 03
ap,U
.ie a.. Licensed Professinnaf
L'1=° OWNER-BUILDER DECLARATION
I hereby affifm that l am exempt from Inc ConhaeLor's License law far IhC BUILDING $7940
Lie—°o fecaullo va, n.(Section 7031.5.IBusumss and ProfeWors Code:Any city oa
III mnty
%m 6� which requires a Permit In construct.alter,improve.demolish,or repair any structure
prior it)its issuance.also requires the applicant forsuch permit to rile a signed statement
1=5�< that he is licensed pursuant to the provisions of the Contractors License Use PZhapter 9 3S7514.QUdRAtQD Valuation
�Fa (commencing with Section 90)of Division 3 of the Business and Professions Coda of
y 3$ that he is eumpl themfnsm and But basis far the alleged...,tan.Any violation of
Section 003 L5 by any affliction far a permit subjects the applicant to a civil frothy of Prlt NOWE Occupancy Type
not mom than five hundred dnna.(s5nn. 307 - INSULATION
I,as owner of the progeny,or my employees with wages m their sale compenvdon,
will do the wart.end the suunure is not intended or offered for sale(See.7044.Business
and Pmfcaeions Cade:The Contractor's License Law does not apply to an Owner of 660021
02 - R00 F P nMigi fps
pmpeny who builds or improves thereon,and who does such work himselfor thmugh his 1V Hl.1Ls
wetemNoyecs,provided that such improvements are not intended or offered for Safe.If,
603 — ROOF BATTENS
however.the Wilding or improvement is Sold within one year of completion,the owner- 604 — ROOF IN-PROGRESS
builder will have the burden of proving Bad he did not Wild or improve fir purpose of
Sale).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Re.701,1.Business and Professions Craft)The Contrutor's Li.
cense law docs not apply to an owner of property who builds or improvm themon,and,
who contracts for such projects with t amlramor(s)licensed pursuant to the Conmacmrs
License Law.
C] I am exempt under See. .B&PC for Nis reason
OwnerDat
WORKER'S COMPENSATION DECLARATION
I hereby erNm under penalty of perjury one of the fallowing deelarauom:
I haws and will maintain a Certificate ofCameen to self-insum for Worker's Compen-
.firm as provided far by Section 3701 of the Lahr Code.for the ferformance of the
work for which this permit is issued.
1 ban and will maintain Workers Compensation Insurance.as required by Section
71 of Ne Labor Cade,for the performance of the work for which this permit is issued.
y Worker's��m//m/m/••``lin Insurances eranJ Polmynumhecare:
Carrier: W' ��' Policy No.521_W01 7-
CERTIFICATE Olt EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This secomor nee)nm be atmpined if the pemril is Rrune hundred dollars($HX)
,it less.)
1 certify that in the perlormnnce of the work for which this permit is issued,I shall bol
employ any perven In any meaner m as Irl become subject to the WorkersCompensation
Laws of Celifonent.Dale
Applicant
NOTICE TO APPLICANT:11.al lc,making this Cent ficale of preemption,you nhuulJ
become suhjML to the Worker's Compensation provisions of the Labor Crude.you must
O O forthwith comply with such provisions or this permit shall M deemed revoked.
z CON.SFRUCT10N LENDING AGENCY
Pr�- I hcrchy affirm that there is a cinswction lending agency for the Performance of
C4 7 the work for which this permit is issued(See.3117.Ctv.C.)
nd Q Lemle,'a Name
7 z Lender's der's Address
U O 1 ready that 1 ban mad this application and state Ihar the above information is
LL F toren.I agree to comply with all city and county ordinances and sham laws relating it,
Q U building construction,and hereby authentic repremnmlives of this city to came upon the
aft ve-memlinned properly for inspection purposes. ��✓'�
(We)agree m Sara,indemnify and keep hamdess the City of Cupertino against
„Hoo N liabilities.judgments,cores and expenses which may in any way accrue agaimLsaid City m
UZ in comequence of the granting of this Permit
r—' APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALLNO -POINT' Issued by: Date
SOURCE REGULATIONS. n— 1
Re-roofs
Signature of A,IwanUConaum. Date
HAZARDOUSM ERIALSDISCLOSURE Type of Roof
Will the applicant or future building occupant SLUM or handle haraNuus material
as defined by Ibe Cupcninn Municipal code.Chapter 9.12,and the Health and Safety
code,section zss32lay!
❑Yes All roofs shall be inspected prior to any roofing material being installed.
,N
Will thea applicant or future building occupant use t or devices which
If a roof is installed without first obtaining an inspection, I agree to remove
pp gt p Area
n
e'tit hoc<oNuus air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection.
District?
[3 Yet
Ihave%adthchumrdnusmumrialsmgoimmcntsunokr Chapterb.95of Ne Cali(nr-
ata health&Safety Code,Sttdtsns 25505,25533 and 355MI undcrshard that if the landing
does not curemly a ant Nat d is at,reap,msihiiit I mm�ly Inc t'cupam of the
rcyuiremcn hmusth ma Pdor inumccmos"m I ifaann' ', oto
%,9�0�- Signature ofApplicint Date
owrmr see aathoriry 'gaol moi IAll roof coverings to be Class"B"or better
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
&MHO Fan: (408)777-3333
CUPEkTINO
Building Depadment
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: ��-1,'-��typ
Address:
Reroofing Company Name: C
Applicants Signature: Date:
Joe Antonucci
(Chief Building Official)
6/25101