02040020 (2) CITYBUILDING DIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
6140 WILLOWGROVE LA COSMOS ROOFING 02040020
OWNER'S NAME: APPLICATION SPB DATE
RUPE MICHAEL W AND ALTIERI JUN 1901 OLD MIDDLEFIELD WY 04/03/2002
• PHONE: (415) 493-6373 SANITARY NO. CONTROL N0.
O O 2ARCHITECf/ENGINEER: BUILDING PERMIT INFO
0
mpy BLDG ELECT PLUMB MECH
m= LICENSED CONTRACTOR'S DECLARATION
I hereby affirm tbar I me licensed under provisions of Chapter,9(commencing Job Description
=!oi with Section 7000)of Division 3 of the Business and Processions Codic and my license REROOF.
y i>mmnrnrcenna= Y ue.« 5 T/0 TAR & GRAVEL, ADD 4 PLY TAR/GRAVEL
:z,n6 Lo innu CPyss
Dam 0 cmdo mr_
S LL O G ARCHITECT'S DECLARATION
S 1 uNer,mod my plans shall he used as public records
Y
3 i p O Licemed Profes.,iowl
s� OWNER BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for,he
C?a following rcaon.(Section 7031.5.Business and Professions Code:Any city or county
F o which requires a permit to conimuct,altar,improve,demolish,or repair any swcmrt
Cct -Prior to it.isuaresn,atm requires Neapplicam for suchpermit m file a signed mucancer - - -- - r A ---- - --- -
a.3°-°
up[he is licensed pursuant to the proviumis of the Currencies License Law(Chapter 9 S F[ Floor•Area- -
(=bn;m,rk,n$wiin sndgnr7(I(10)nr Dndainm3or me ere:res.dna liar ssimrseae) ``:)j'k?'j"y.;,;,`q' Yer s.:•Oi ,-rtZ:�+tA PO,% Valuation
or that be is czempt theiefmm rand,he basis for the alleged eaemptioh.Any violation
d Section 7031:5 by any i p,heme far n permit mhjeas the applicant m is civil pemdty-
'of not mole than five hundred dollars(S50% APN Number t r-'q r Occupancy Type
°I,as owner ofthe propery,n my employees with wages as their sole compensation,
w;u-d.the week:dad the's,mcturnfnet intended or-offered-for'sale fS=c.7044' 3 07 - INSULATII2�2}Lired Inspections" f
Brainiest,and Pmfcaions Code:The Commcmr i Licenu Law does not apply to an
r of progeny Who builds or improves thereon,and she doer such work himulf 6 01 - ROOF TEAR OFF
owner --
or through his own employees. building
,hot such improvemems arc not intended or
:comaaro::ale:lcnowevd.mit]hav the 602 ROOF PLYWOOD NAIL.1 : 'a� . . •..rr7..'.,.
completion,the owner-builder xnll have roti Women or proving that he dict amt build m
imprv=rnr namna=er aria). 603 - ROOF BATTENS '
-- '— d comments, — .._ _._ . .
°1,as owm ti
owner of me property.aexclusively contracting with licensecommmto 604 - ROOF IN=PR RE -"-- :,-:,:'7:T;n';
construct the project(Sec.704V.Business and Professions Code:)The Contrea,b is
License Law does no,apply,o an owner of pe,peny who builds or improves,hcaon,
. ._and who conuacts.forsuch projects with a cornmctor(O licenud.pursuan,to me
C0.
ontractors e Ip
1 pt d
BPCTmisrt n& FINALE® Il
Oweei I,'Dau r
WORKER'S COMPENSATION DECLARATION APR
'r 1
I" Ihereby aRrm under Penalty of perjury one.of the following dm
ccladA
ons. PR 6 2002
° 1 hove and will rommiin a Cenificam of Cnnsem to self-insum for Worker's
. Compensation, as provided for by Section 37W of the Labor Code. for the BUILDING
performance of me work(or which this permit is issued.
J have and will numain Workers Compensation Insurance,is required by Section
- _ -37W of the Wlwr Code,for the performance of The work for which this .it is
sued My Worker s Comprnsauon Insurance carter and Policy number an:
- _
T ..... ... .�. _ ..e �... .. .. ._.. .._ _..r._.. ..
Ciiriei'�7./ �4r• -poLcy 00 / 2.5
'sY,,,_CERT IFICATION OF EXEMPTION FROM WORKERS - -, l•e�. ' >• n , f.dT'I, l.e
COMPENSATION INSURANCE - ys '( _ -- ------___
'r�'• (TTn unrmn need not be comPl'.17 —if the garret,is for one hundred dollars - - -----s 0,.1131 -- - -- - _- -_V:,'-- --i\r --
(51Old or less.) -
pp. t.c;uy ma,io WciufrmLcn ohh k'far wMch h, permit .- ._.=.., .a .-.,. .•. _ ,.:.- - . ._ry r`. ,. ; ��.... ..,. . _ .
s iss ed'1 .1 ,
ono,employ any person n any mann i become bjec,t the Workers' "
CmComps , n Lav"of Cal forme Dole " ' '
become subject to the Worker's C ps pr s ons oft -
Appl t u should
- -
'NOTICE TO APPLICANT If.after Making,h s Certificate of Exemption.y
he Labor Code you st
forthwith ply-lfi h provisions or m permit shall be decimal invoked,
z 0
tib ..! -' IICONSTRUCr1011ENDINGAGENCY1 '' t -
I h by iiff1iiii th,them Dost t -r dreg it for the pn foinienceH
�.r ofth w k far whmh,h pe t 'ssued(S 3097;Civ.C) " .. ._. ._. _...... _.. ...--._-__ _. .
Lendef Name, '• t� ""
..., "n. .�
ZLenders Address
I cractify that l have mad this pplicaton and „ that the move informmion is
�'[r comes I agree to comply with all city nd county,ordinances and state laws ala,ng
Q.V
to buildingc , ilo and hereby sonnetize mposentri orthis cityt mer upon
,he M e d p pends .gnu rap muse ,
(WN agree in,.coca
indemnify knife hreir may
s.in an City of c cft .inx,xnard
IF-r W City in conudgme a cosec and expenses w eorit: y i- any way accme against said
- V Z City neo sequence of,h gram gof,hTI Perms `; /rte
APPLICANT.UNDERSTANDS WILL COMPj,PWITHALL N 'yf�I`T ” Issued b r Date (/
SOURCE REGULATIONS Q p s T y Y•
e Signature ofpppIiiacJC.rroamr .' r c1. Re-roofs
i HAZARDOUS MATER1AL561SCLOS6R2 - -
wn me pprcant m,taea'la g« pant at(xe nal naLaamaterial Type of Roof. .. - , .. .
u dedicate byre Cu,.ia.M p l Cmdr,Charter 9.12,..d,hn Health and Safety
Codes t 25532W1 't' , t s .. - t r ,`s -s r, It".,1 /t,)�d•
11 ye, y '97T t., ., , 5 D _ All roofs shall 5be Ins ectad nor_to-an roofin material vein
P P Y g. g installed.
t pp. If a roof is installed without first obtaining an inspection';I'agree:to remove
Td• Will the applicant ft nodding occupant AmaA t ly Macmwnieh
man et? -o s air coni m wn¢as defined by,he Bay Arca Air Qualny Mmegem<m
Dim ma all new materials for inspection. Applicant understands and will comply_with
T , , . all non-point-source regulations.
s�c-s I
have red the h z Noua nhaccnalszacapdr;nnel under Chapmr 6.95 of me
Cil f a H ohh&Safery Cod 5 coon 25505 25533 rad 25534 1 ural rstund that 1
rime bmltl gdxsnmtc remlyhave a tenure mu„ yresponsibility to notify the
ra'upam of roti requir be t poor m issu tic ora Canificme of
rats 'h ch mux,
openy . . - Signature of Appl' ant Date
_. .
Ov aamnd,,dd rc a, ;m All roof coverings to be Class "B"or better
OFFICE --
�i
Building Division
1 10300 Torre Avenue
{"Jy� Cupertino,CA 95014-3255
f Telephone: (408)777-3228
ItCITY OF Fax: (408)777-3333
-UPEkTINO
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.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: x_
Address: Z{p /t2c��
Reroofing Company Name,:/
Applicants Signature: yD .
• Joe Antonucci
(Chief Building Official)
6/13/00