02090018 • 1,CITY'OFCUPERTINO
' BUnA1Nc DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERM IT NO..
2289122911 RIDGEWAY DR 02090018
0 APPLTCA ON U DA
91f5 RIDGE OF CUPERTINO HOA 59��4)2,002
PHONE: -.. .. SANITARY NO. CONTROL NO.
00 ARCHffEC17ENGfNEER: . 1 - BUILDING PERMIT INFO
F.m BLDG ELECT PLUMB MECH
.'LICENSED CONTRACTOR'S DECLARATION
5 n= '' I hereby alarm that 1 am licensed ender " Job Description
oi_, pmisinnsofChapmr9(commeneing REROOF
F='='� wi]p Section 7000)ofDividion7af rhe Business and Professions Code,and my license
is in full pmea tem
a�p ',V Licence Class d Conn Y �I����®
3 Darn Convenor
O In ARCHITECI-S DECLAR
1 understand my plans shall be used as public records
as
da.o Licensed!Professional . JUN 13 2003
OWNER BUILDER DECLARATION
X
j I hereby union that 1 pr from me Comranor s License Law for me
I z C toll mg rcaso (Section 7071 S Business and Professions Code Any city or county $35898
wh h requ res perm t ro construct,mtee Improve,demolish,or repair any structure BUILDING..1'
3 m
Priorr d cc.also q the applicant formch permit to rile a signed statement - - UJ r'
tht he is licensed pars nht to me Provisions of the Contractors License Law(Chapter 9 �,. 3 %:iHa n➢I�I,A�a x 7 Valuation
(cmmeung with S«no 7")of Division J of me Business and Professors Code) {. Ly"'`-yt, "5.-131, f']`014 , P 2 _sp,),�7'j.t 1„
or ma he is asempt the«(rote end the basis for he allegN exemption.Any violation
of Senium-]03:5 by any applicadt for a Permit subjects the applirum to a civil Penalty
Occupancy Type
of mare than Five hundred dollars WWI,not 3 0 5AP-N NMA4E 11.w r
01,ate owner of the property,"y employees with wages as their sole compensation, 307 - INSULATION
-will do mc'wark� ad'theawnme is'na'intended nr airmail for sale(Sec.'7Du,' 6 01 - ROOF TEPA � '�'Ins CCt1C1i1$'
'Business and Profession,Code:The Comrann's License Law does not apply m an q }4y
owner ofp.Kny Who Wilds or improves metro.,and who does such work himself 602 - ROOF PLYWOOD NAIL
or Oro. h his own employees.provided that such improvements m not intended or
,... .. _.. . _._.. ......_____._.___ . ...___.
:comps urithea the p year - ROOF-BATTENS"' :.(r :,� -__7
compiled -
g or in,rov<na+m is s Id within'one� �of r,
improv for the owner-builder will have me burden of proving that he did not Wild or
improve for purpose orwle.). � � 604 - ROOF IN-PROGRESS
❑1,as owner of the pmpeny am exclusively comma di w m Idr:)ed ncondaricam - ,. + ;•q ^h +
License
the prolan(Sec. to a,Business and Profession,Cadea The Co theorems _ ly,I,* L'. 11
- - - License Law docs not apply m an owner w of property who builds or improves thereon. '
ind,whn contlans for such projects with a.convacmrts).licm ait pucawm to the.. ___._.... ..._.... .. ........_..
'- exi License Law;
Olum "
am exemPr under Sec.,'" �" - s";B&.PCfor oris,rtason ' I i,i" ;. . �Cf':"i-i❑
'Date r WORKER'S COMPENSATION DECLARATION
I hereby inifirm inelarpenalty of perjury o`ne of the(nllowmg declemoom: -
�t .. , ..
❑"1 have and'wiil'maimart'-Ceniticku"rf C.mcm so sH6inmm for Worker's
Compensation;.ssprovided for by Section 3]00 of rbe Labor Code. far he
....fir' "performbnce brine work for which]his permit is ismad. .
have and Will runmaid
work 's Compensotion'Invumnce,as rcquirt,f by S«lion
3 r t. k for which m pamm,]s
issued.MY WCERTIFlCATIONOFE%EMPTION FROM oIy robe e:'
3]00 aLme I�Iwr Code l m performance rr he taut , -
e; un enmdon�u c soarer ao P
cN w Z
2-
CERTIFICATION =6
IO t + Pol cy No. 4 s
"a WORKERS{ ' '. t- 1. ] ♦.:. ., 1 it i g
.ucrtlon]reed
COMPENSATION INSURANCE r
'P' ](Thtsnot he cbmpined if the permit is for one hundred dollars
1$1W)or lna.)
1 comfy mai in the port tee r e (the work fo wh ch m] Perron is issued 1 ...
shall not employ any Personto any manner soils m become suFlen io the Workers -• + 1 s.. . It
Coinpematam Laws of California.Data
''APPl sant: .. .t .'.?. -_. .__: ... .. __ ... .. .,... .,.... .. . ...
If,
er
Ncame subject
APPLICANT,Workers
rs Compo Compeng nsation
sprovisions o of Exemption,you should
to
becameeh romlp totheWorkers Comms or thin rwoushall he d erredabor Code,you mus
Q C) (nnhwiiti...... with such provisions or this permit shall be deemed revoked.
�yJ _ ._._...___-.. _ ... .... ..._
}CONSTRUCnmNLFNmING AGENCY
1 h rcor glTrm rho m ocommit on lending agency for the performance
hch ihl.pen tis'siued($ 7047 Cw.Cl
of work for
'-Lender Name.. _ . . ._ . ._ ..�. ..... .: .... ..... . _ ._...__..... . ._... . . _._, "...•'.i't_- _ ..._ .__. __..
Cordes s Aadrcss;
1 sonify that 1 have read is applicotion and slam that the above information is
FT+=[r cuncml agreeto<omPly,wn all riry and county,ordinances and state laws relating
no building connrtirsion;andhemhyaumodm'represene6es of this city m enter upon
'rte the bbuve-meminned P, pen for inspersion^ purposes.,,,,I Wej agree mauve.Indemnify and keep harmless the Ciry of Cupertino vgoina
Vd liab]Ifl,s judgments,costs rd expenses hbh yin any way accrve agains]said
U Z, Ciry m consequence of rhe g ra mail.
:AP7LICAM1"I'UNDERST - nD WILL COMP[., VI HALL'ALL OI T /
souRGe REduEArlDNs ,' (f Issued by; Date 714
Signor rcaf ApplicbnUCommaor„ t _,'�Dte Re-roofs
n
' HAZARDOUS ERIALS DISCLOSURE ' ,
Wll me applicant or forum Wlding pate rare rhandle haiardous matenel Type OfR00f, .- _. .r-.. rte.- - - -.
i def red by tha pcnioo Municip Cade Chapter912 ml me Health and Safety ,
Code $❑ecYeon 2553J(n) l i'.(:'l. ,. .. ., t �,r ')'T] s,;' 14 Yl« .1'j }a .r l. . _ .. ..-.- 7•..,._.
_.All roofs.shall be inspected prior.to.any roofing matenal.being installed .._,.-
wdllh, planar futurebudoi goccupant useequipment d ces which If a roof is installed without first obtatmn an ins ecnon"4 a ree to'remove
emit narmdou air Co.[. in as as defined by the Bay Area Air Quality Management g P g
Dt v t _ all new materials for inspection.,Appl>_cant understands and will comply.wlth.
1 °Y" ° all non-point source r illations.,,.- "
- Californiat tie ]a ,rent the h zard us m renal req ircm ntu d Ch pt x695 oLme
I have tea
&Safety Cede Seed ons 2550.5 25533 and 25514 i understand that
building same currently have annual, ltar I.myresponsibility annuity be
- - -
p is h h 6sr he con pit r] sso f n Cenif rc of
Octu
4/SOL - Signature of Ap [cant Date
Owner or a m It Data All roof coverings to be Class B"or better
'OFFICE -
1
Building Division
1 10300 Torte Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CI 0 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 1A"per foot slope and demonstrate that
there is no ponding. I .
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: Z , 1-2
14roofmg Company Name' C-
Applicants Signature: Date: f a a Z-
Joe Antonucci
(Chief Building Official)
6/25101