03010024 (2) 4 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION
r7
BUILDING ADDRESS: PERMIT NO.
20274 VISTA CT 03010024
OWNER'S NAME: APPLICATION SUB DATE
PETER WOODMANSEE 01/07/2003
HONE: SANITARY NO. CONTROL NO.
ARCHITECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
�00 LICENSED CONTRACTOR'S DECLARATION
% Job Description
�a F I hereby affirm that I am licensed under provisions oo
f Chapter 9(commencing¢ with Section 71M)ofDivision 3mf the Business amTProfessinns Code,and my license is _.--
<� In fallfoacande e C S 00 REROOF
o°z q_b Data CC.ter`*�t C. - REPLACE 40 Y CDX PLYWOOD
2M�Q� ARCIIITI:CTSD RATION & 1 3
cloud y I as public rcmNs
ce 0.
su LL C Liccnud Prafc cel
Oat I am exempt
from
DECLARATION
1 hereby.(Section
1 1. cxcmpr from the fesmras Co License taw for the
00
following re requires
(Section 7onstr Business andProfessions
sae,de i demolish,
Code:Any city nr oounry
K which its iss s a permit re ores the aheq impose,demolish.or repair any xtrucmre
pooF�Il^ that holo ceased aauant to the thprovisions
visiosoffecant r such Cobmarmit mfiense I ncd stetcmcm
c haromisnoenrig wit pursuant 700[ym vism cries BrmnssiLiecnac lmma Coptery q. Fl. FIOOr Area Valuation
8 (nttheis exempt Serafrnnland dee
3 oftheeged exeandon.An vi Cmle)of
Nal he is exempt Therefrom and the baso for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number OdAoAcyr Type
not more Nan Ove hundred dollars(S500L
I,As owner of the property,or my employees with wages es their sole compensation.
will do Ne work.and the structure is not intended or offered for sale(Sm.7046,Business Required Inspections
and Professions Code:The Contronar's License Law does not apply to an owner of q p
pmperty who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If, 305 — FRAME
however,Ne building or improvement is sold within one year of completion.Ne owner. 307 — INSULATION
builder yah, will have Be burden of proving that he did not Wild or improve for purpose of
1. 601 - ROOF TEAR OFF
I,as owner of the property,am exclusively contracting with licensed contractors m 602 - ROOF PLYWOOD NAIL
construct Ne protect(Sea 7044,Business and Professtmu Code:)The Coloratura Li-
renne Law drics not apply to an Owner of property who Wilds or Improves memon,and 603 - ROOF BATTENS
who connects for such projects with a comracmr(s)licensed pursuant o the Contractor's'
License Law. 604 — ROOF IN-PROGRESS
❑Iamexemptunder Sec. ,B&PC for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
I hereby affum under penalty,of perjury one of the following declarations:
❑1 ban and will maintain aCeniOwteof Conant mself-iname for Workers Compcm
sation,u provided for by Section 3700 of the labor Code,for the performance of the
work for which this permit is issued.
❑1 baro and will maintain Worker's Compensation Insurance,u required by Section
37(m of the Labor Code,for the performance of the work for which this permit to its ad.
My Workers Compensation Insurance carrier and Policy number am:
Cartr. }rOW POhcy N LCS{'aS0002']
CERTIFICATE OFUEMP'o OM WORK RAE S'
COMPENSATION I RANCE
(Thu section head not bccompleted Bthe permit is forms,hundred dollars(51(101
or tem.)
I unify Nat in the performance mf Ne work for which this permit is issued.I shall not
employ any person in any manner so as to become subject m the Workeri Compensation
Laws of California.Date
Applicator
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation pmvistuns of the Labor Code,you must
OO forthwith comply with such provisions or this Permit shall be deemed revoked.
H CONSTRUCTION LENDING AGENCY
[-+ I hereby affirm that dare is a conxuunion lending agency for Use performance of
fix 7 the work for which Nis permit is issued(See.3097.Civ.C.)
GM Lender's Name
z lender's Address
(� (21 unify Nal l have read this application and state that the shove information is
F rnrtcct.1 agree to comply with all city and county ordinances and state laws relining m
QU building construction,and hereby summim repration.ivesof this city m enter upm the
Da ahnve me e)agree
propertysaw,for inspection purposes.
,I (We)agree m save,indemnify and kith harmless the City accrue
Cupertino against
N in
of
grassing of hisexpenses whtch may in any way eecmc against said City
C.)Z maansequlTU UNDERSTANDS
of his permit.
'—' APPLICANT UNDERSTANDS AND WILL COMPLY WITII ALL NON-POINT Issued by: Date
;4REG*N'
ULATIO .
Re-roofs
re moracm, a¢WHE lheepPlicandfutuebulUngwupa ALS D`SCcO handle hsrardous materialType of Roof
ined by the Cupenim,Municipal Cale,Chapter 9.12,and the health and Safety
Section 25532fe)7s[ All roofs shall be inspected prior to any roofing material being installed.
❑Yea NnWitt the applicant ter are buildingouupam usccquipmcm rrdevices whish If a roof is installed without first obtaining an inspection, I agree to remove
aaardoux air ematamimnu as defined by Ne Bay Area Air Quality Management all new materials for inspection.
t7
❑Yes Nu
6.95
Ihave mad the haraNnsmnion ismy res,somxum,to runty me
meCantor. ,�------f�
nice Hcallb A Safety Code,Sections 25505,25533 and 25534,1 understood thm if me binning
does nm curtently have element,union is my msponxihil'ny,m notify the oecupant of the
revi nkx wIt It sI b,met pdnnm issu...faCertlOd of Wcuanc. SI na re Of Ilea ate
f All roof coverings to be Class B or better
norm uthori $Col al
Building Division
f : 10300 Topa Avenue,
Cupertino,CA 95014-3255
Telephone: (408)777-3228
&C,CUPERTIN� Fax (408)777-3333
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 VV 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 an reroofing and will comply withyas policy.
Homeowners Name: &7
Address: I
Reroofing Company Name: Nbxtj MmQ ,
Applicants Signature ✓ � Date:
Joe Antonucci
(Chief Building Official)
6/25101