02100185 T CITY OF CUPEWI'INO 'T r
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION•
BulI7)D(20DR&E FOE DR CAL-PAC ROOFING PERMIT N02100185
Gw&R"&T—P PANDEY 36 RAILWAY AVE APPLICATITnY"TY2002
Ah
DONE: 408 874-0784 SANITARY NO./ / CONTROL NO.
ARCHIIT:C-HENGINIZER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
J.n00 LICENSED CONTRACTOR'S DECLARATION
U F I hereby affirm that 1 am licensed under provisions of chapter 9(commencing Job Description
<i withSection71XXEofDivi.' 3oftheBusia:sandProfessionsCods.andmybee is REROOF
II-- in Tau f-ac na crmf .Qs�a
Z8' " License C,' t�J l Lim.N
OZFin Date/ dZ Co.
M14 ARCHITECTS DECLARATION/
e�rc< I un emund my Plans shall be used as public mentis
al3a Licensed Pmfeasional
Tao OWNER-BUILDER DECLARATION
q Y 1 hereby affirm that 1 am exempt from the Contractor's License Law fart the $7825w S
00 following reason(Section 7031.5.Business and Professions Cade:Any city or county
a K m which requires a Permit to construct,alter,improve,demolish,or repair any Slmetum
w�'r+ prior iso as issuance,alit)requires the applicant lit such Permit o file a,signed statement
�0that he is licensed pursuant m the provisions Of the Contractor's License Law(Chapter 9 33g904I0aa AaG Valuation
yf– (commencing with Section 70(X)of Division 3 of the Business and Professions Cale)or
y $ mat he is exempt therefrom and the basis for the alleged exemption.Any violation of
section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty ofPNN Occupancy
not more man five hundred dollars(5500). 307 - INSULATION P y Type
I,as Owner of ft property,o my employees with wagesM their sole compensation,
will do the work.and the timcmte is not intended or offered for rale(Sm.704A,Business 6 81 –
and Professions Code:The Commemrs License law dors not apply to an owner of 602 - ROOF PL Wtl nCTICGti2ns
m
ppcny who builds or improves lhercon,and who does such work himselfor through his 1`SH 1
own employees,provided that such improvements are not intended or all for sale.If, 603 – ROOF BATTENS
hawevcr.the building or improvement is sold within one year of completion,the owner-
builder will haw the burden of pruving don he did not Wild or improve for purprowee of 604 - ROOF IN-PROGRESS
sale.).
❑1,as owner of the progeny.am exclusively contacting with licntsed contamora 10
construct the project(Sec.70ad.Business and Professions Code:)The ContxtoYs Li-
cense law does not apply to as owner of progeny who Wilds or impmvcs thereon.and
who.Lace for such projects with a C(mtR[mr(s)liamed pursuant m the Contrxmr's
Osmcr law. jis
❑ I am exempt under sec. ,B A,P C for this reaum
Owner Date C
WORKER'S COMPENSATION DECORATION
1 Mmby affirm under Penalty of perjury one of the following declaraduns:
I hew ave will main tin a Certificate of Conant lin self insum for Workers Compen-
77(Wof
ion,as provided for by Section 3701 of the UM,Cade,far the perforsomw of the
rk for which this permit is issued.
1 have and will maintain Warkcr's Compensation Insurance,as mqI by Section
the Labyor Cade.for Ne performnce oftM work for which Nis Permit is issued.
yWnrgRr's ympen ria lnsuntt<c carnicrand Policy numM ,;,rtim I/L� Puliq No.: 7I JO/—Z/ S
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
mos section need not W completed if tW petit is formate hundred dollars(5100)
Ices]
1 certify Nat in the performance of the work for which this permit is issued,l shall nm
employ any person in any manner as ax in become subject to the Workers'Compervalion
Law.,Of Cabronsia.Date
Applicant
NOTICE TO APPLICANT:If,after making Nis Certificate of Exemption.you should
become subject to the Worker's Cam ismiation provisions of the labor Code,you..It
0 ,7, Rrtnwhh comply with such provisions or Nis permit shall W deemed revoked.
z O CONSTRUCTION LENDING AGENCY
F IMrthy af!n tat them is a construction lending agency rmr the Performance Of
Ik 7 the work for which this permit is issued(Si AN7.Civ.C.)
1 Lender's Name
.7 z Lender's Addmxx
U O 1 certify Nat I nave read this application and more Nat IM above information is
1k. Pcorrect.l agree to comply with all city and county ordinances and sNtelaws reining to
QU building conslmction,and hereby allforiM mpxileam Lives Of this city to enter uponf
LQ abovcmc judgments.
udg d property for inspectionxexpenses
purposes.
H CW (We)agree In rove,indemnify and keep harmless the City mf Cupertino against
lin liabilities,csqence fthecosuand eapcmesmit. may in any way accrue against sail City
U Z APPLI consequence UNDERSTAntingND
t)nnia permit Issued by. Date
^� APPLICANT UNDERSTAND WILL CO PLY WITHAL NOPO NT
SOURCE RF,GULATIONS.
_ Re-roofs
/O
Signature ofAPPlica'AUZARDOUS MATERIALS DISCLOSURE tal Date Type of Roof
Will tM applicant or future Wilding Occupant store or handle bevandous motion]
as defined by the Cuper ins,Municipal Code,Chapter 9.13.and the Health and Safety
Cndc.Section 255331x)?
❑Yes pike All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant or furore Wilding oat) nt use If a roof is installed without first obtainingan inspection,1 agree to remove
Pp g pa a AfrQu or devices which P
emit nasaNnus air contaminants as Defined by the Bay Arca Air Quality Managcmcnt all new materials for inspection.
District) l
❑res L�
I have mad the Wvardousmatedals mquimmenty under ChaplcrA 95 of the Califor-
doesnalN�entlyyCwk.SadmsndItis Mynestnadmil,1 Inokrsmndthat uparsuofine /Zy p2'
dors not currently h' a mount.N t it is my resRmfa ce try In m,tify rove occupant nl Nc / r/
require �mPh;m�rWmetpm;"�ixxt)ananracemreatenraea�fancy. Signature ofA/plicant Date
Ownm nr aatnnn,cda crit ��a,e All roof coverings to be Class "B"or better
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
` CUPEkTINO
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 on reroofing and will comply with this policy.
Homeowners Name:
Address: 75 2Q �J _ Oji
Reroofing Company Name: �/� c .
Applicants Signature: �•` -Lr. r, Date: bl� 47
• Joe Antonucci
(Chief Building Official)
6/25/01