02100036 (2) CITY.OF CUPERTINO ` ' ,
BUD.DINC DIVISION PERMIT 1,CONTRACTOWINFORMATION'.
�,� � d
14TI.1l fI1551ESTONITA WY CAL-PAC ROOFING PERMITN(02100026
owFBMRA,Y GLUMAC 36 RAILWAY AVE APPLICATI(1r."6'5/2002
{ONE: 408 874-0784 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
r00 LICENSED CONTRACTOR'S DECLARATION
rc-P Ihereby affirmmallamfia<n.sedunder provisions ofChapter 9(commencing REROOF Job Description
<i with Seelion�]IMMq of Divis 3nf Ne Businall and l'ndessions Cnde.and mylicens in
inlulllon'c nnyl J
ilenx 3 1. _(t_? Z lFdOQ� �2�. ®
OZ—� Uam_ Comroclnr_
ARC III3T:CrS UECLAR TION
� �a I understand my plans shall M used as public recur.
'u33 Lmmsdon
cnua rroal
OCT 2 2 2002
��•aa OWNER-BUILDER DECLARATION
ce6 I hereby affirm that I am exempt GuConnector's m IM1e Conctor's License Law cut nhe
w E a O following reason.(Section]131.5.Business and Professions Calc:Any city or eountY BUILDING 21260
d x m�+ which requires a rermit to consumer,alter,improve,demolish,or repair any structure
priom r its issmatee..1111 requires the applicant Inr such renmil m file s signed memm
uiac
I"�a mm he isprovisions
liccnsaJ pursuant to the of the Contracnm's Litt .¢
nLsw(Chzpum 9 3S�SR.4kfl8Ar&0 Valuation
ver$ (commencing with Sceion'!0(kl)of Division 3 of the B usioess and Professions Come)or
y that he is exempt lfemfmm and the basis for the alleged exemption.Any violation of
Section 7831.5 by any applicant for a permit subjects the applicant to a civil penalty of N-N Occupancy Type
ant mom ban Ever hundred dollars(S500). 307 - INSULAT.ION
I,as owner of the property,or my employees with wages as their sole compensation,
will do the work.and dmimucture is not intended or offered for sale(Sec.]BMI,Business p��gg n 19�n9�; p
and Professions Cade:The Comracroh License Law dues not apply to an owner of 602 - ROOF PM YY V ,�Lns
property who builds or Improves thereon.and who does such work himself or through his
own employees,provided that such improwmcros arc not intended or offered for sale E. 603 — ROOF BATTENS
however,the building or improvement is sold within one year of completion,the mvnc- 604 — ROOF IN—PROGRESS
lattice,will have the burden of mvin,Nat he did nm Wild or improve for pm,mu or
sal.).
❑1,as owner of dire progeny.am exclusively contracting wit licensed contractors m
Construct the project(Sec.7(Wq,Business and Professions Cale:)The Contractor's Li-
cerise Taw does not apply t,an owner of progeny who Wilds or improves theteon.and
who contracts for such projects with a contractions)licensed pursuant to the Commanoi s
Laen t,Law.
[:]I am exempt under Sec. ,B&P C for this reason
Owner Dat
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury one of the following declarations:
1 have and will maintain a Certificate of Consent to sclfinsum for Worker'sCompen-
smion,as provided for by Section 37011 of me Later Code,for Bac performance of the
work Inr which this"or it is i.ssucd.
1 have and will maintain Worker's Compensation Insurance,as required by Section
.700 of the Labor Code,for the performance of the work for which this permit is issued.
My Wmkcr' tin a)merrcc carrier and Policy number ea:
CartPolicy No.:J�72 5
CERTIFICA'IE0 EKEMPr10N FROMWORKERS'
COMPENSATION INSURANCE
Alissection need not lecompletedifthe crap is formic hundred dollars D]00)
,it less.)
I cenify that in the performance of the work for which this Permit is issued.I shall not
employ any person in any manner m as to Mcnmc subject o the Workers Compensation
Laws of California.Dmc
AppOc.nt
NOTICE TO APPLICANT:I(.after making This Ccniflatc of Exemption,You should
hccmme is comply
l y the Worker's Compo nation provlssms of the meed r Cole.you must
Oz hanhwith comply with such provisions or this permit(hall MJccmcJ evoked.
zCONSTRUCTION LENDING AGENCY
[� I hereby affirm that there is a a'onslroction lending agency for the performance of
�i 7 the work for which this Permit is issued(Sec.NAG.Co,C.)
Tal Lender's Namc
z Unite xAddress
U O 1 cenify that l have read this application and state that the arrow information is
UJ curtcm.lagocm comply wiBanspeall ct rs and county ordinances and sort laws rclaningw
O U building construction.and hereby aehone,representatives mf mix city to enter upon the
r 0.r' about-(We)nedare to ertysave IDI inspection keep hs.
f" 0. (We)agree to ave,indemnify es keep may
in an the City of CUPcnsts against
y Iiahililics.juJgmcnts,costs and expenses which may in any way aarvc against said Ory
U in consequence of the granting of this Permit
r APPLICANT UNDERSTAN ND WILL OMPLY Willi ALL NON O NT Issued by: Date
SOURCEREGULA'1'ION
3 > Re-roofs
Slgnmureof A,plicamicTocon
n Date
Ii AZAR U S MATERIALS DISCLOSU RE Type of Roof
Will Be applicant m f uture building rwcupanl store or handle haerdi ns material
as JefineJ by the Cuin
perto Municipal Code.Chapter 9.12,and te hHealth and Safety
Gare.Section 25531(.)1 All roofs shall be inspected prior to any roofing material being installed.
❑Ycs
Will thea licant of future buildin ant usee of ent or device.wbien If a roof is installed without first obtaining an inspection, I agree to remove
fin gonur
tins(navaNuus air contaminants as defined by the Bay Arcaa nitv Quality Managcmcm all new materials for inspection.
Diurin'!
❑Yes RW _
I have read the M1mnodousmaterials requimmenL under Chaptur(i.95ofthe CaliGrt-
nit Health&SafelyCoae.Sections 25515.25533 am12553d,l understand that it the,Wilding
Jtcs not curtcnnl hn I,Wm it is my res mss hillty m notify the rce n f the
requimmc ch teabc ,pnt,tnislu, oracemEcatemr r cr SignatureofApplican Date
Ow ora aulhnrivcJ age 1 Date/ All roof coverings to be Class "B"or better
Building Division
*C0
10300 Torre AvenueCupertino,CA 95014-3255
Telephone: (408)777-3228
CUEkTINO Fax: (408)777-3333
Building Depa ent
Subject: Reroofing policy for the City of Cupertino.
I. 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/"per foot slope and demonstrate that
there is no ponding.
I 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: c u�
Address: /O 5l//
Reroofing Company Name: /Y/g �C�
Applicants Signature: C-'<z e� 6P �z k
Date:
.9 yT
Joe Antonucci
(Chief Building Official) °
6/25/01