02050135 CI BUILDF C C�ISIONNO
DIIVPERMIT CONTRACTOR INFORMATION:
BIJIIDYpffRE$S:,EKMAN PL DAN ELLIOTT ' S ROOFING CO PERMIT NO. 02050135
OY1 Ifftt5fffE'tOSLWYEUNG 2669 COIT DR nUTFnS?' '?? 2
PHONE' (408) 559-7327 SANITARY NO. CONTROL NO.
33 y
O C AR HITF,CiIENGINEER: BUILDING PERMIT INFO
k u BLDG ELECT PLUMB MECH
day L1 O C_J .1
LICENSED CONTRACTOR'S DECLARATION
S w z 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing REROOF lob Description
!m_u with Sea i700(l)of Division 3n(ihe Eosins,and Prnfcssions Code.andiay license
;xf= is in fall forced �� 40 YRS . COMP/SHINGLES
Od a Liccnu Class`+--�,/-=Z Lic,a j�
is is O y Data S DECLorl
�Rctilrecrs urctn
I I and.ramnd my plans shat)be used as public records
L i C C Licensed Professional
z OWNER-exempt RDECLARATION
't)5 o LL 1 mama,(firm that I um exempt from the Contractor oniono License Law for the
v,
?se
bellowing rcaon.(Semon]031.5.Business and Professions Cade:Any city ar county
x€o which requires a pennh to consumer,alter,improve,demolish,or repair any slrucmm 3 4 0 0
i3=ca Pro , its issuance. Isrequires- theapplicant for suchpc permit file a signcdnytmacm. -__ _ _
in.,he is-Icnedp'na uomep n nnc 1 1 xLicense Law(Chapter 9 074,",
� f Sq.FL,Floor-Area, - ., Valuation
(commencing 'N Secr n]W0)of Division 3 f to Business- and Professions Coder s.074, ( Tit""s
or Nat be Is exempt Nerefrdm and Ne bases for the alleged exemption.Any.,olanon 316 3 011'`0 0'
of Section 7031.5 by any applicant for a permit subjectsthe upplicmm to a civil penally
of no,mora than five hundred dollar,(5100). APN Number 'r,.",' '. Occupancy Type
0 1,As owner ofthe properyt or my employees%ith wagea as their sale compensation. 305 - FRAME
will do the work:and the structure is'no,intended or offered for sale'IScc:7614. -
"Business and Profesvions Cade The Commcmr's License Law does am apply,o an nspectlorl 1
owner of prapcny Who builds or improves thereon,and who does such work himself 6 01 - ROOF TE dW
or through his own employees.provided that such improvements arc not intended or
¢BereafiIf.hosever,the Wilding o;impmaement is sold within one year of .-. _.--` -602 ---ROOF 'PLYWOOD NAIL,-;- --'_... --_.. _. _... . _. ... ..
iadpletion,the owner-builder will have the burden of proving that he aid not build or t. ,
mprove far purpose of sale.). 603 - ROOF BATTENS •
: :. :, "[7i,osawneraGne n - - - ' -' '--604 ROOF IN-PROGRESS.---....
-
-' — ...
props y,am ext Business
y comrocting with licensede Commors m
construct,he project(See. to a,owner o and Professions ills or The Co thereon.
hereo .
Licence Law Jces not apply man owner of apropertycony who builds se improves t to the
h,
and who Ne
Contractor'sco Pracu.for.such projeeu.wilh O pursunmb _.�_..p r�
e commnor s licenud
. 1mexempt
xeLicense Law. �Q�p ®
❑lamcxcm funder Sea ,B&PCfor this reason C�i9
owner ENS MAY 2 9 2002
'WORKER'S COMPENSATION DECLARATION
I hereby from under penally,of ph a,one of the(allowing dedarmioa
O 1 have rind will maintain a Cenificam of Conserv to self-insum for Worker's
V Compensation:asprovided for by Section 3]00 of [be Labor Code, for the (BUILDING
performance mf0ai work for which(his permit is issued.
have and will main&¢ worker's Compensation bramance,as required by Section
37 - f the Cidoor Castle,for he parmrm.Aael of he work For h b his perm t is
isare y or r Cmarpe,(a�l on 1 . ra as rpc ant PoI'y, be ore
Cam Cel- /lnL.TF/� MM
CERTIFICATION OF EXEMON RQ �ORIF�• v 1 h � 1 j :t-� t,1 . Ar nil.;`•1;
...,�) ',.,,...r FEXEPTICOMPENSATION INSURANCE .' ........-_..._.—._._.._.,... .._._._ .._ _.____.
(Thus union maid Dol be cote lard of the r - -
(SltAgcrless.) _ p perms ns for one hundred dollars ,
shall I 1 fy th r n er pe f (the' rk fine come u ct -
Cr ply any Person y manner o m become s b)ect m the Workeri
Comicant on Laws of CBI. m. DereAppl "
becomeNOTICTOAPPLICANT If. Emakingp Cenificaleprovisions of
of Exemption you Moult - '
Z ncna subl 1 y it Wok Compensation p 'onsll e d Labor Code,you must
0 fonhwiN comply with such provisnns or this perms shall be dttmed rcrok<a.
_ ... . . __...._ I. . ._ ..
_
rU!)r - '' CONSTRUCnON LENDING AGENCY-
1=
GENCY -
a ' I h rcby firm that pert a issued
lending agency forN performance
W r of the work(or which Ns permit is issueQ(Sec.3097,Ov.C.) '-
a (� Led Na .. .. .. _ _ . .. _. _ ..._. _ _ ._ _ _ ......__ _.. .. ...
VZ LiuxlaAddress
0 1 esti fy that 1 h e rtad rh pplicai and sur N t N bo ( auon n
E.rI nacl Agree to comply with 11 ty ands only ordinances ad state law,relaxing 1
V to building contraction,and thereby carbonize represenleuves of Niscity to enter upon
.W ,he above-memioned property for inspection purposes.
. Ci (We)agree io save,indemnify and keep harmless the Ciiv of Cupertino against
W liabilities,judgments.cost and expenses which may in any way accma egainsl said t
U rZ+ Cia'in con sequence o ST line0DNis pnmlt. - •' - ^ Q
til' CA "" 'VD STAN(S' ND WILL COMPLY WITHAL NON-POINT C_Tl./z
<C 10• :.•i X22 Issued by: Date
SiBnamrc ofAyp!canom tar.'. •.,: - - ,Da!e'; Re-roofs /
HAZARDOUS MATERIALS DISCLOSURE'
wt)N pplicant Pomrt bu Id g occupn 1tart o-.handle hazartlou mai -m T f Roof
As def ed by the C pen num M pal Cad Ch Pt 9 12 Ad Ns Health and Safety
-Type ooo
Code Section 255321.1 !, , z Z
: * ,; `•"1 ,Y . _
�n ''- All roofs shall be inspected prior to any To material being installed.
W 1 _
1"he fowmbuilann8«cupm
ausesgmp entorae i¢sy'meh If a roof is installed without first obtaining an inspection;I-agree to:reirlove
Ali.h r„n air contaminantsa claimed by the Bay Arca A Quality Management
District' all new materials fginctiorL, Applicant understands and will comply with
all non p int` 1irctlons,,1 h d'Ne'hazallo mm 'alrtq mea nde Ch p, 695 f rheCalifiaccon HI, cr Safely Cod S ions 255052551) nd 25534 d land Thalfnc�b ldned snot currentlyh ea renal thtit is yresp 'blty to nmifyNe
pceopa r f Ihy,rcquirunen , brth sl be e'p i It issuance of Cenificate of ✓
c Signature of Applicant Date _
trot_ ¢sen! Dive All roof coverings to be Class "B”or better -
_ ..OFFICE -
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 1/4"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 Namd:"�p
Addr;9: 19 c1�6 ,e e k VVIA 21<
Reroofing Company e:
Applicants Sign 0S„
Joe Antonucci
(Chief Building Official)
6/25/01