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02120035 (2) CITY OF COP6RTINO BUILDING DIVISION PERMIT CONTRAC_TORfINFORMATION: Om A Es LOS GATOS ROOFING PERMITN02120035 IOWI{didLTERS CHARLES AND CONNIE 1771 SMITH AVE . APPLICA1TI23ypI)7Y2002 [ONE: (408) 298-9399 SANITARY NO./ 7 CONTROL NO. ARCIEW..0 tENGINHER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECH 0 0 0 0 I^d00 LICF.NSEDCONTRACTOR'S DECLARATION I hereby aflirm That I am licensed under provisions of Chapter 9(commencing REMOVE EXISTI b 6ff� tion wBbSamioaTkrotDivisnm3nthBXhelp.ofcssiunsCalc.andmyliemeis INSTALL ASPHALT SHINGLE S oin= Lie.0 29t,g comm ?tFA 1AJ6 dARCUITECTS DF A ATION I understand my plans shall he used as public records dOyU 3 w Licensed Profcesinnal OWNER BUILDER DECLARATION Contractor's y<P I hereby aflirm mat 1 1. cacmpe from me Cosiones Count: License law for the w a O C folluwing rcaum.(Section t 11omm Business and ne.de ioli Cowie:Any city or county which requires a permit m Comment,the,aitch i applicant for su demolish,or repair any soucmm 1(]B Q Q W that hor ni6ce aced pursuant it.also )the lhovisisof for suchpermiuoicensle asigned(Chapter Chaps cm Fra that cingwidpursuatntnthepffisinnsnfineCamsinssan ProbaswlCode)Or Sq. Ft. Floor Area Valuation y F$ feat he is(commencing therefromon and Me hi isinn r of me Busaged exempt on.An inns Code)of 35911030 . 00 that be is exempt therefrom and me hair for Ne allege)exemption.Any violation of section 7031.5 by any applicant for a permit subjects the applicant to a civil Penalty of APN Number Occupancy Type not more man Bas hundred dollars($W). 3 05 — FRAME P Y YP O 1,as owner of the property,or my employees with wages a their sole compensation, will do me work,and me sneture is not intended or offered for sale(Sm.704,1.Business and Peterecons Code:The Contractor's License Law does not apply to an owner of 601 - ROOF T Ir Spections properly who buims or improves thereon,and who does such work himself or through his own employees,provided that such improvements am not intended or offered for sale.If, 602 — ROOF PLYWOOD NAIL however,the building or improvement is sold within one year of completion,me owner- 603 — ROOF BATTENS builder will have the burden of proving that he did not wild or improve for purpose of .It.). 604 - ROOF IN-PROGRESS 0 1,as owner of the pmpmy,am exclusively contracting with licensed contractors to construct the project(Sec.744.Business and Professions Code:)The Contractor's Li- eenxe Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(a)licensed pursuant o the Cmmmmiore License Law. NAL ❑ 1 am exempt under Sec. ,B h P C for this reason �I L wner Dare �AN 15 2003 WORKER'S COMPENSATION DECLARATION 1 hereby alarm under penalty of perjury one of the following declarations: I have and will maintain a Certificate of Consent to set f-insure for Worker's Compere N siumn,a provided for by Section 3710 of me Lahr Cele,for the pedmmance of the �1L��NG work for which this permit is issued. 0 1 have and will maintain Worker's Compensation Insurance,as required by Section 3100 of me La, Code,for the performance of the work for which this permit is isued. My Worker's Compensation Insurance carrier and Pol icy number am: q Carrie' J/N/� C&-6 P. TihJz2—r//—OJi CERTIFICATE OF EXEMPTI OM WORKERS' COMPENSATION INSURANCE rllua section need not be completed Rinse permit is for one hundred dollars($100) r less.) I certify that in the performance of the work for which this permit is issued,I shall but employ any person in any manner so as to become subject to the Workers'Comp ssation Laws of California.Dam Applicant NOTICE TO APPI.ICANT:if,after making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the labor Code,you must Oz forthwith comply with such provisions or this Permit shall he deemed revoked. CONSTRUCTION LENDING AGENCY 'r+ rNs I hereby alarm mat there is a construction lending agency for the performencs of the work for which this permit is issued(Sec.3891,Co,C.) W Q Lender's Name .0.7. z lender's Address U 0 1 certify that 1 have read this application and suite that the above information is F^ come[.I agree to comply with all city and county ordinances and state laws relating to QU building construction,and hereby amhnriic representatives of this city to enter upon the W above-mentioned property for inspection purposes. 4 (We)agree to save,indemnify and keep harmless the City of Cupertino against F fq liabilities,judgments,costs and expenses which may in any way worse against said City / U inconsequence of the granting of this permit APPLICANT UNDERSTAND W COMPLY WITH ALL NON-POINT Issued by: Date SOURCF.REGUI. S. Re-roofs nature of Applicam/Contranor Date I IA].ARDOUS MATERIALS DISCLOSURE Type of Roof Will me applicant or future building oecapam store or handle hamous mammal no defined by he Cupertino Municipal Code.Chapter 9.12,and me Health and Safety rmde,semea zss3xa>? All roofs shall be inspected prior to an roofing material beim Installed. ❑Yea y�o P P Y g g Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove emit haeardous air conuminarms as defined by me Bay Arca Air Quality Management all new materials for inspection. District? ❑Yes �ou I have read me haynrdnus materials requirements under Chapter 6.95ofthc Califor, as Health&Safety Crowle,Sections 255(15,25533 and 25534.1 understand mat it Me building does not curtcn11 how a Round th 't iris m aibiliry w notify do rcFDd f me \ mqulrcments whit bene rt ear mtiam or 0.eupI nature of Applicant Date wner orauthorindagent / All roofcoverings 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 Y4"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: ,n a r Ile �� /l O`l 19 Address: 8077/ s() e- Reroofing Company Name: 6 0�'J N Applicants Signature: G//-9 7Z Date: 2— Joe Joe Antonucci (Chief Building Official) 6/25/01 Cul l CITY OF CUPERTINO CIiPEI�F PERMIT APPLICATION FORM uanti Fee ID Fee Description Fee Group BMITIGATR Res. Housing Mit Fee BUILDING BMNEWMULTI New Multi-Family Res MECHANICAL BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL BNEWMULTI Multifamily Res ELECTRICAL BNUCOMME New Comm Electric ELECTRICAL BNUCOMMM New Comm Mechanical MECHANICAL BNUCOMMP New Comm Plumb PLUMBING BNUMULTI New Multifamily Res PLUMBING BOVERTME Inspection Overtime BUILDING BPBACKFLOW Atmospheric Vacuum PLUMBING BPCESSPOOL Cesspool PLUMBING BPERMFEE Bldg Permit Fees BUILDING BPFIXTURE Pblg Fixture PLUMBING BPGAS Gas Piping System Fee PLUMBING BPINTERCEP Ind Waste Interceptor PLUMBING BPLANCHK Plan Check Fee BUILDING BPLANCKADD Plan Check Add Multi BUILDING BPLANCKREP Plan Check Repeat Fee BUILDING BPREPIPE Repipe Of Fixtures PLUMBING BPSEWAGE Sewage Disposal PLUMBING BPSEWER Sewers PLUMBING BPSPRINK Lawn S rinkler/Backflo PLUMBING BPSTORM Storm/Rain Water PLUMBING BPTRAP Kitchen Trap PLUMBING BPVENT Alt of Drain &Vent PLUMBING BPWATER Install/Alter Water Pie PLUMBING BPWHEATER Water HeaterNent PLUMBING BPWSVCS Main Water Service PLUMBING BREINSPECT Reinspection Fee BUILDING BREMACOVER A/C Unit> 10,000 clip MECHANICAL BREMAIRHAN A/C Units <= 10,000 cfm MECHANICAL BREMAPPLI Appliance Install MECHANICAL BREMBUSWAY Remodel Busways ELECTRICAL BREMFIXT Lighting Fixtures ELECTRICAL BREMFURN Relocation of Furnace MECHANICAL BREMFURNOV Relo Furnace > l OK btu MECHANICAL BREMHEAT Heater Installation MECHANICAL BREMINHOOD Installation of Hood MECHANICAL BREMMISC Misc Apparatus ELECTRICAL BREMNRAPP Rem Non-Res Appliance ELECTRICAL BREMPOLE Pole/Platform Fixture ELECTRICAL BREMPOWER Power Devi ce/A aratus ELECTRICAL 2of3