02070011 CITY OF CUPERTINO -
' BUILDING DIVISION PERMITCONTRACTORJNI'ORMATION::
1`�Ln11jtg1RP6`ARDENA DR R A^CONSTRUCTION PERMIT T2070011
O (r"TED L AND FLORA C 559 CAMPBELL TECH PARKWAY APPLICAT017sPUTT/2 0 0 2
PHONE: (408) 369-9921 SANITARY NO./ CONTROL NO.
t
M9 ZOF ARCHITECTIE.NGINEER: - BUILDING PERMIT INFO
z u U BLDG _ ELECT PLUMB MECH
Nzu
v= LICENSED CONTRACTOR'S DECLARATION Ib Description
i z_❑ 1 hereby afanm mu 1 am licensed under prnvnien,of Chapter 9 rcnmmencing RE-ROOF OesCFI p
:you, with Section 70001 Of Division 3 Ofthc Business and Professions Cod m$tTy license
in fall force and eft . 33
O U Ourcn.xr Cla LIc.X �8�� +
i 3 LL y Ome� I_Dti Comrncmr Y5�e'gY
Ir—ARCHI ftiCT'S DECLARA' ON
:ion i I understood my plans shall be axed as pm1a records
l lo
i ¢
Idoo 1.ien,edProfexxinmal JUL 0 8 2002
m OWNER-BUILDER DECLARATION
a
m 1 hereby)amen um exempt from the Connaclor's License Law for the
w=
C z Q toll l y o
.(Section
1 7031.5.B I d predestine,Code A y aunty $8000
wh h ts i p al o .t t he top d I.1 n p ....a mature BUILDING
i 3= poo t uissuance.al requires theapplicant f h PL vn fl g d mmmem
thath f e Cdp n tl mgpn ons fth C I I rsL' L lCM1ap¢r9 -, v Valuation
OcAnnumentraig all Settle.7000)ofD 's 3 ofth Bull. .and P f s Code)
or that he is exempt therefrom a rd the bass for the alleged asourph.m.Any violation
-of Section 7031.5 by any applicant for a Parton subjects the applicant to a civil facility
of not more man five hundred dollars(5500). PN R9WE Occupancy Type
❑1,as Owner of the and
they,ru my employes with wages offered their sola compensation,
307 - INSULATION
Businss an Prk,"andlhe ode, ie is not udo,ella's Li or enseLaw for salt(Secy to 14:an -
Business and Professions Code:The Contrncmr's License Law does not apply m anI Ions' '
owner of property Who builds or improves thereon,and who does such work himself 6 02 - ROOF PL4Rf� ,
orr through his own emyeyes,proximad mm such improvements are not intended or - 603 - ROOF -BATTENS - -
offcrcd for sale.IL however,the builditi� - "' -
g or improvement n sold within one year of
improve for theowner-Builder will have the human of proeing lhm he did not bald or 604 - ROOF IN-PROGRESS
improve far purpose of vale.).
°IaSowneruftheProperty, nBusinss ad ntracfngwmfe,)The Camnurstuachume - -License
the project(Sar.7In a Business and Profess ons Corills or The Contractor',
License Law does notapplysuch
In an owner of lmdearty who builds se improves thereon,
:.: ]' and who commas far such Projens.wilh contortionist licensed purmmm to the
. .. .. ...... .. . . _. .. _ _ .. . _ __
Commmofs License Law.
°I am exempt under Sec.' ,,8&,P C for this reason (;
ova, Date'
WORKER'S COMPENSATION DECLARATION
}} Ihereby affirm under penalty of perjury one of the following declamliono
_G.�11 I have and will comidain n Cert&ntu of Concent to sclhinsure for Worker's
Compensation, as providedfor by Section 3700 of the Labor Cable, for the
performance of the work for which this permit is issued.
01 have and will maiddr.Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the perfornance of the work for which this permit is
Its had.My Wo�:efs C n s t 1 rsumnce tamer end Policy lumber are.
Car r r I _Policy No ��J e
GERTIPICAC NONE TION INSURANCE WORKF, 5"i' - - l .xv n_: l ', l- .'�
..,. v- '.. '..
COMPENSATION INSURANCG. •....._ .-. _j.. . .._.._..__.... _._.,._. _- _.'._._ ....: ___ ...,_._ .____.....
t• " permit is for one hundred dollars y ^' •' - - _ -
(Thi vection need not bc'cam Iced f the
ISI00)orlcssJ -
.. _ of
_. ._ .. ..^. ...._
Icer lY yrrynp in an necofth ora f- tichil spc n nsscker, L ,,
Cam fit a wn Laos
s ill person In any mann r so a5 io become suhlect to the Workers' -
Comicant icon laws of California.— ate
A�PPlioant ... ._- : s'
r .. .... _. ... .. .. ...... . .. _,.
to,mmeNOTICTOAPPLICWliff r,aflnr making this CeniOca¢of Exnnplion,you should r
z hey me uhjeenotheN L rsC mpensat fvisions'of the Labor Code,you hour
C forthwith comply with such p ns'r Ipe it Shull be deemed revoke)
CONSTRUCTIONIENDINGAGENCY -
I h reby affirtn'lh uM1 a maw handle,agency for the perform nee
i.yfwalk for heti his ppermitsis,.'
s ud(S 31)97 C'v.C)
W Leen de m
shae ...,: ... . .. ...:
6a Q Lender.Address " . . _. . . .. ... -. ... -
0. ) ri fy mat l h .read this applicationN
d are ash aboveformation is
curio t.1 agree to comply with it city and county ordinances and state laws relating
nt inn;
(, t0 building c,huend hereby awhonae representatives of this city 10 enter upon
the dimle-mannitened pr p rty far inspectionImp e s.
(W)agrcu Cosa Idemnfy dk pha l6l siheCty fCpmn 4gainst
Fr lip
liabilities,judgments.c t and expenses h h may'n any y m against said ^
City cmegence oftb ling of this pmnt " " -
APPLICANTU NO WILLCOMPLY WITH ALL NON-POINT I1
SOURCEfiii !-41? Issued by: Date l
Signature( Y a vpplHA f OUure hding Date'. Re-roofs
HAZARDOUS MATERIALS DISCLOSURE'
C
od Sen on he Catarina
e,p t r re r bundle Health amaterial. Type Of ROOF, -
as definedb the Cu en oMunicipal Cod Chapter 912 and the Health and Safety
Will the applicant orfuturebudding by
use equipment dev ce n t t
ta Y
y All roofs.shall be inspected prior to any roofing material being installed... .._
°Y ❑Ne
Management min If a roof,is installed without first obtainingan inspection;P agree to remove
emit haaardnus eu conmmmants as definedb the Bay Area Ail Quality Management P g
District? . all new materials for inspection. Applicant understands and will comply with
1 °Ye °N all non--point source raga tions.
i
1 M1a a reod'the'haaa d0 pulled, qu t made,Ch pt r 69S of me .. C
C ifi mm H alth&Safety C d Sections 25505 25533 and 25534 1 understand that /f
(Itieb Id gdoes aha t haveat ant m t11 is my responsibility to oufy me
hpant f ere Which sl be t Herto issuance of h CcniEcam of
O upd Y
7 I G' gnature of Applicant _ Date
ower. ,anmoerraaga,t -Data All roof coverings to be Class "B" or better
OFFICE. _,.. ..... .
Building Division
T 10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
400F 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 1/a'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 Narde:
Address:-,V--
Reroofing
ddress:
Reroofing Company NanV. —
�— —
Applicants Signature.. - ate:ate:
• Joe Antonucci y^_
(Chief Building Official)
6/25/01