03030006 CITYOFCUPERTINO ' +-��' '+°'� »_ ��
BUILDING DIVISION PERMIT - CUNTRACTUI2INFORMATION .
BUILDING ADDRESS: SHELTON ROOFING PERMIT NO.
20075 FOREST AV 03030006
NE
OWR'S NAME: 1988 LEGHORN ST PERMIT ISSUE DATE
DLASK FRANK AND JARMILA 03/03/2003
NE: 7— (65U) 961-7699 SANITARY NO. CONTROL NO,
ARCHITECGENGINEER: BUILDING PERMITINFO
BLDG ELECT PLUMB MECH
opCZ
tl00 LICENSEDCONTRdunderSDEConsofCON JobDescri tion
UF 1 Mroby arRrm Nat I em liaved under provtsions of Cluprer 9(commencing p
RjW With Section 70M)or Division 3 of the Business are o'fes�sions Code,find my he...Gis
j12y Lloll ue.foaendcffe P foo REROOF �Eiil�tnE®
V{? Licen las LIc.M 1"�-�"�
nF DdLL' Contractor
qq Z mi ARCHECSDECLARATiOd MAR 2 12003
1 ucnMmanJ my plans shallTfW used as public records
Oyu
G LkcnxO Pmlcssinnel
3 Oat I a.exempt
DECLARATION
no
I .. .(firm Nat11- exempt from the Contractors Ca :An,c Lew fm tW BUILDING
p O following mason.(Sauan 7M 1-5.Guiness and are.dum ns Code:Any city or muory
$ which mquirs a permit to lsi construct.alma nt fmve,demolish,or repair any swam l
H o Prior m its i licensed
P alw mqo the lW appvision o for soh pewiuo Reesla e axe(Chrement
�� that ing wit Purse.ntfe she provisions the Contractor's ud Praflaw(Chapter Sq.Ft.Floor Area Ion
$ (commcneing with Satien]000)ofDivision3 of d¢eusineu and Pmfessians Cede)or
y Nor
n be s exempt ummfrom and the bull for the alleged clumption.Any violation of �I
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of p y '7 N
not mote Nan Ove hundred dollars(M). XM r EOccas anc .7
❑L u ownerk.and
progeny,a my.timanes with wage u Nc(Sec.cW,Business
will do the work.end the Structure B nolimentled.aRend(.nate(Sec.706/,Business
and Pmfessmem Code:The CanmctoYs Liam,law deal not apply 0 an Owner of 307 - INSULbI;�PT�Rd Inspections
racially who buildsor improve thereon,and whodassuchwork himselfor through his
Own employes,provided that such Improvements rte not intended aro@red forsale.If. v -601 — ROOF TEAR OFF
however.the building or improvement is told within one year Ofeompledon,the owner- 6O2 — ROOF PLYWOOD NAIL
Wilder will have the burden of proving that Incdid not build or Improve for purpose of
aim.). 603 - ROOF BATTENS
❑I.as own.of tW propeny,are exclusively contracting with licensed commeon to 604 - ROOF IN-PROGRESS
covwct Ne pmjea(Sec.7044,Business and Professions Code:)TW Conmctv's c-
ave law docs not apply to an ownm of propenY who Wilds or improves NeMon,and
who contracts for such rmjects with acomnmor(s)licensed pursuant to the Conmumes
License Law.
❑I am exempt under Ser ,B k PC for this Masan
yr Data
WORKER'S COMPENSATION DECLARATION
1 hemby afOrm under Penalty of perjury one of the following declarations:
have and will mednuin aCoarare arcenwnt to elf b.a.fm WotkcM1Compen-
17W
n,u Provided for by Section 3700 of the labor Code,for me performance of the
k for which Nis permit is issued.
I have and will maintain Worker's Compensation Insurance,u numbed by Section
of the labor Ce4,for dm performance of Ne work for which is permit is issued.
WorkeM1Compensat�io�n�lnwn artier and Polity nu rer. "�T+Se'h Polity No.:
^gI SCI CERT�C�OFEXF1rfPnON FROM WO t1. a
l( iQ C MPENSATION INSURANCE 'fe'"„1
or IMS.)(This Sexual need not be compkred if the Permit is far Mm hundred dollar(SIM)
1 unify that in the performance of the work for which this Permit is issued.I shall not
employ any Person in any manner M.1.become Subject o the Worked Compensation
Laws of California.Data
Applicant
NOTICE TO APPLICANT:IL after making this Ceniricam or Exemption.you should
become subject W the Worker's Compensation provuions of the lahm Code.you mut
� z foMwithcomply wish such PrnvisiovorOil limit shallWdoomed!revoked.
Z O CONSTRUCTION LENDING AGENCY
I hereby efnrm Net them is•construction lending agency far the Performance of
1i r7 Ne work for which Nu permit I.island(See.3097,Ci,C.)
L0 Lcndefs Name
0 z Lender's Addmu
J C) I sundry that 1 have read this application end sure On,the SWve infona.dim I,
L F armn.l qxe to comply with all city and county ONinum and sure laws relating he
U Wilding conswclion.and hereby embMire MPrexnutivu of this city to enter upon de
in cOnmenuaneProPcny for inspectiotPnse
n a
W (We)agree to eve,indemnity and keep Islamics,the City of Cupertino against
to Iiabilitis,judgments,coats mdespensu which may in try way oma against lid City
J7 in eonxof of Nc granting of this Permit.
r'77 APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
�JrT
7 � Issued by:SOU � Date
alga
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future bulWing tecuput store or handle henrdev material '
u deRnnd by the Cupertino Municiral Cade,Chapter 9.12,and the Health and Safety
c,Schon 25532(x)1
Son..
All roofs shall be inspected prior to any roofing material being installed.
Wm me applicant er future Wilding Occupant use equipment or dcviva which If a roof is installed without first obtaining an inspection,I agree to remove
t Wnrdnv air amemin.nts u dcfned by the Bay Arca Air Quality Management all new materials for Inspection.
tri07
❑Yes N
1 have Mad the hesaadnus mamiielsrryuimmenuunder Chapter A95 of the Califon say
nia HoSIO&SxcIYCOM,SMIMm 25505,25533 and25534.1 undcnut ithat ifthe Wilding
dos not cuwmlmutant.ve.mut .that it u my rapomihaay to unify me occupant or On
requiramca ich ustbemci ricrutismance Ofa CCNOcautof Oc p e>cy.
Signatu of Applicant Date
U.Mrmstanxisimequ, Data All roof coverings to be Class"B"or better
Building Division
• 10300 Torre Avenue
Cupertino,CA 95014-3255
CITY 0 Telephone: (408)777-3228
CUPEkTINO 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) Preinspeclion 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 that the
proper City inspection can be performed. so
IMPORTANT:
I. Flat roofs must have a minimum of�"per foot slope and demonstrate that
there is no ponding.
2. An I.C.B.0.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: L
Address: ado 75 -�gQ��p a.L..
Reroofing Company Name:
Applicants Signature:
Date: 3 3 v3
Joe Antonucci
(Chief Building Official)
6/25101 �'