02050179 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
B{JB„DI6( 11)TkL AIRE CT MERCER CUSTOM CONSTRUCTIMMIT NO, 02050179
`bXWAn&. DEBRA BOUR 619 HAWTHORNE AVE UUP AfjY-fbU2
PHONE:
(408) 374-8782 SANITARY N0. CONTROL NO.
WARCHITECr/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MF,CH
a a I'_� U
5 m i m LICENSED CONTRACTOR'S DECLARATION
> Job Description
l hereby firthat l am licensed under pow isione of Chapter 9(commencing REROOF
L aq with Seed,,u7)00)of Division 3 of the Businetiond Professions Code,and my license
�mE7 is in full IV and dcRc l�
O a u .Ly�y`nu C �a Liana
LL O y >' ` J� ��C-ZCT'SU DErec R�
,a-, 1 understand my plans shall be used as public mentis
r
'z p O Licensed Professional
OWNER-BUILDER DECLARATION
1 hereby affirm that 1 um exempt from the Convacsor's License Law for the
z a following reason.(Section 7031.5,Business and Professions Code:Any city or county $10000
I F c which requires a pcm,lt m construe,alter,im,m°s,demolish,or repair any structure
a'°'13 ao prior its I. requires thepplicant for such perm to file asgned statement ..... -
m5t h is Berated ted pu ahno the provisions of the Contractors License law(Chapter 9 v a ,,_3 Q+�6oc 19f@a , r r , Valuation
(rug to Sectio ,70fk1) f Dictum 3 of the Business and Pri tessmm Code) ' t . r .x„ y.
or that he S exempt,herefrom and the bass for she alle6ed evemptlon.Any vi°lau°n - - "
-of Section 7031.5 by anyapplicant for a permis subjects the appllah toe civil penalty
°fnamn°m in..me hundrm dollars($500). APN l$ Occupancy Type
❑haaawiurormeprapenaarmrehpmreeawitnwageaa[mars°leeompensatio¢ 307 - INSULATION
willdoshe work.and the structure'is not intendedor offered for sale'(Sec70i4; _
Busines,and Protest.,Code:The Convacmr's License Law does not apply ,,an 602 - ROOF PL S
no < f property Whobuilds imprents thereon.and who does such k himself
or th gh his ply pxt that such'mpmvem t am no, tended^r
proeme yar°f 60-3- - 'ROOF—BATTENS -' -_.-.. . .__.
oem le fo zthe w er - lh building e m t n sold to - nF G '0�g'2002
id pli p crhuld ill haveihehurdenofprovngthatheddnosbuilJor 604 - ROOF IN-PROGRESS'
mprove for purpose or sale.).
The Cro - .,.
OI fste.,ppcnY I 'v ly t ci o iColl u-0c t trsto �'�®I�y "--'-
conn ct sh p )eet(S< 7044 Ruches, ad P s ns hi d I t two's
License law does not apply to an owner of progeny,who Wilds or improves sherson,
1. -.:: ...
and who,coniracta.for.such.projects.wlth.a commctm(s)Ecoiud pursuant.t°Ne. _..... ._—___..__.___...._. - .__..-...._..__.._-_......_..... __ _....._
„ - contractors License Law.
❑1^mexemptuiider See , „-, ;B&P C for this reason i,; ;)•.,_ _
_ - o.,• - 'Date . . I'.. . .
"-" WORKER'S COMPENSATION DECLARATION
\ I hereby affirm under penalty of perjury one of she following declarations.
O 1 have and'ivill mainsain'a Ceniiease of Consent in self-insure for Worker's
Comperenti°a, as provided far by Section 3700 of In, Labor Code, for m<
performance of the work for which this permit is issued., ,
❑1 have and will maintain Worker's Coinknedion Insurance,as required by Section
;.� 3700 of tne'Labor Coag for the pcif°rmance of the work far which this permiiis
issued.My Worker's Co ,s t do Ins m mer an'd Policy be ore
TIFlC TIONO PTIONFROW
COMPENSATION INSURANRAN CE.' ,M1. ? ` ' '' -
'f, s section tine not be compleretl d th<permit is for one hundred dolhrs '
($100) less.)ssJ '
1 r.,Pl th s ii Person
perfo a of th ort f h ch sh s er t issued I
'shall t employ any person'n any mann r s°es so become sub)m so me Wo kers -� '•'1^
Co.pcnsasion Laws of California:Dam"
App
NOTICE TO APPLICANT the WorkeesC Compmakensation
Cishoms o ofEe pdon'yooumuist become icon comply
she Worker.Compensation permit spoof thelabor iCodenvoked,you must
� � fbnhwitn romply with such provisions or this permit shall be deemed revoked.
f ^ I" f Y o them is
f ENDING AGENCY .
' I he by which di t pi c zd S le d' g agency f she peAorm nc<'
C, ,.J , oftheork for which N.pe is ssucd(S a 1097 Civ.C.)
�.Q -Lende Name. .. . . ...:1....K. ...
�.Z Lend Add .i __.I _....._-.. .
V I c<n Ty re t i l a d thisapplication date that theabove information is
fir+ E.., c,me ( g e t nplY with all city and county ordinances and dead laws Telming
V to Wildi.g oma i n d h mby orhornic represtariallvis ofth s city theater upon
.�.,(s] the above uniibncd pm my far inspection purposes..
r_Mi ( )agrcci . ver indemnify and keep harmless the city of Ctipenino against
.in liabilities mentolls and expenses which may is any way accrue.ogair,d said
V y Citr in'c seq en a the 6mntingofthi<perrim, " '' .. `7
A Nr )( TA SAND WILL COMPLYWITH'ALCNON+PorNT
9 R' -,D Issued by: Date
n, Applied tIC t e - . : -D t Re-roofs
HAZ RDOUS'MATERIALS DISCLOSURE t ^i
Y' w11tn pplicant futurebnldibgoccusim t thane( nazvdw[memnzl ._.Type.of.Roof... ...
as e f w by m c pen MI,coa cn pi 9¢ nd the Health and sarery
cna o<Y zss3zial , 's. 1 , •_ ) ' r, -
., t, t I _ A11.roofs shall be_inspected prior to,any roofing,material being installed,
worn ppli a t J.f t hId gree p tyreeaAt,Qu a Ic< 'ncl, If a roo is inst4 led'without first obtaining an inspection, Iiagree'.to remove
emir h N .air
c t i a, tried b)the nt uA . i rQ Quality Ma.gem t
District? t. ,�( t t
all a
r7 pY - _ for inspection Applicant understands and will comply with
11tl.. ° all non- ' in ce regulations - -
' I h e read she Nous aiials qct re encs and Chapter 6,95'of the -''r i
Calim .Health&Sof yeot .Sections 25505:25533 and 25534-lundemand in.,
if the bud I g n.t that t y apo who b flit run otify the
xto
^ o tit be t poo to sea c f v C nifi,ate of -
0_W 9 ¢whichmu,t ti
mind ie
Signa re of Applicant._.,_ Date
K '^ ° " "°^= D re 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
r
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 Y"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 oh on reroofing and will comply with this policy.
Homeowners Name. �p TiJ/ll r
Address
Reroofing Company Name:
Applicants Signature:
Cie
Joe Antonucci
(Chief Building Official)
6/25/01