02100158 CITY OF CUPERTINO •.y
BUILDING DIVISION PERMIT CONiTRACTOR INFORMATION f',+
BIU2-`kc7I214RF1NEDINA LA WOODS ROOFING PERMIT NO 2100158
oWkSR.`HRTEDER EDUARD AND MARGARE 1020 HICKORY CT APPucATTnSJ3152TTj2002
Ask
IONF.: (831) 637-5576 SANITARY NO. CONTROL NO.
ARCHITECfIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
uoi00 LICENSED CONTRACTOR'S DECLARATION O O O O
c t- 1 hereby affirm that l am licensed under provisions of Chapter 9 ucommenting �p qJob
t1 Description
Nzw with Section 7lkNBnf Division 3 of Ne Business and Professions Cale.and my liccnx is REROOF
•oq= f a force and if 4 Lh..a u�Y:
cense clan_ - /
'Zy`a, °ate `"°t`ECI-A NOV 2 7 2002
ARCIIIlTLTS UECLA Al'10
C a a 1 understand my plans Nall W used as public records
OaU
�3uLassoed Notes sinnal BUILDING
a.og OWNh:RBUILUERUECLARATION BUILDING
r $p 1 hereby affirm that I am exempt from the Contractor's License law for the $14567
n a<0o fallowing reason.(Section An I.S.Business and Professions Ctxle:Any city Or county
'•%m� which reo umes A pom,it u,conumn,alter,improve,demolish,or repair any structure
m"^ prior to its issuance,also requires the applicant for such Permit o life a signed statement
that Ise is licensed pursuant wthe pmm
provisions lite Contractor License law(&pler9 3W80002AM Valuation
eX (commencing with Section)IXplof Division 3 of the Business and Professions Cock)or
a 3
that he is exempt Nctefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant to a corn penalty of PN N Occupancy Type
Out morethen five hundred dollars TSSA). 307 - INSULATION
❑ Las owner of the progeny.or my employees with wages As doctor role compensation.
will do Ne work,and Ne structure is not intended or offered for sale(Sec.Zhao,Business p�)��g ��g(�c.,�{O
Add Professions Code:Tom Comh or's License law does not apply m an Waxer of 602 - ROOF PL W V V 1VN 1 L nS
progeny who buildsor improves Hereon,and whodoes such work himself or Nmugh his
sun employees,penvided mm
at such improveente am not intended ornBemd for safe.If. 603 - ROOF BATTENS
however,Ne building or improvement is sold within one year o(compledon,the owner. 604 - ROOF IN-PROGRESS
builder will have the burden of Pmving that he did not build or improve for purpose of
salt.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
consumer Ne pmject(Sec.7144,Business and Professions Code:)The Contractors Li.
cense law docs not apply to an owner of property who Wilds or improves the¢on,and
who contracts for such projects with a contractor(s)licensed pursuant o the Contractor's
License law.
❑1 am exempt under Sec. .B&P C for this reason
Owner Dat
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury one of the following declarations:
I have and will maintain a Certificate of Consent to self-incure for Worker's Compere
moon,as provided for by Section 3700 of the la Wr Cale.for the perfmmanee of the
work for which this pc.if is issued.
1 have and will maintain Worker's Compensation Insurance,as required by Section
3701 of the IehorrCCeode,for Nc pertormance of the work for which this Permit is issued
CC Wurkcr's mol and PI rpmMraml_/1t /
Carrier: WK �fL Pnlic NO.J 915"" Y O
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(Inas section need not W=OmPICled II'the permit is for tune hundred dollars(Stan
lens.)
1 certify that in the performance of the work for which this permit is issued,1 shall not
employ any person in any manner so as In hncnme subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:11,after making this Cenilicam a1 Exemption,you.should
become subject tm the Worker Compensation provisions of the Laror Code,you must
OZ forthwith comply with sue h previsions or Inv Permit shall W deemed revoked.
z O CONSTRUCT ION LEN DING AG17NCY
iZ) I hereby.filum that there is a eomamCfion lending Agency for the Performance of
fl > the work for which this permit is issued(Sec.3197,Civ.C.)
W Q Lender's Name
6. Undeh Address
U C I9 ftdy Nat 1 have read this application and state that the Above information is
W F' comet l agree to comply with all city and county Ordinances and state laws relining m
�U building construction,and hereby authorom represculahes of this city to enter upon the
} W above-mentioned properly for inspection purposes.
(—' (We)agree to save,indemnify and keep harmless the City of Cupertino against
M liabilities,judgments costs and expenses which may in any way accme against said City I//�f
U Z in consequence of the granting of this permit U
;md
PPLICANT UNDERSTANDS AND WILL COMPLY WITH ALI,NPN.PO/IyT Issued by: DateOURCE REGULATIONS /O�Dan,ignature ofAp,luam,Commc.. Dore/_ Re-roofsHAZARDO S MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding occupant store or handle lo.lok rs materil
defined by Ne Cupenino Municipal Code.Chapter 9.13,and the Lcalib and Safety
ade,Section 255321a)'f �� All roofs shall be inspected prior to any roofing material being installed.
❑YesWill thea licant m rmne,Wildin ant use a mem or devices whi=nIf a roof is installed without first obtaining an inspection, I agree to remove
pp d by the 9uig hamrdnus air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yea
Ihave maddoe WsaNnons 2590il25533ad 255yLr1uCnapmrfithat foe Wilding
riasOuHolub
cannot, AvkA tt manrtC15Ht5,myrsnd2553J.1 indcmy,he occupant
Willing
Jtes not currently base a tenant that it is my responsibility m nnuty tW rccupant nl Nc
.'mrsmems w' mus mcI prior i iMnan=enfacenifi=atenrgyca =r O L Signature of Applj ant Date
owticrO auNnri¢d =rat N Date roof coverings to be Class"B" or better
Building Division '
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
• CUPEi�T�NO Fax: (408)777-3333
Building Deparitment
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
Wand 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 V"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:
a
Address: -2-1 LJ
Reroofing Company Name: _�(T�L62 =2=
Applicants Signature: Date:
Joe Antonucci
(Chief Building Official)
6/25/01