03010029 I
CITY OF CUPERTINO a fug
BUILDING DIVISION PERMIT CONTIl2ACTb120INF#1RMATION�
BUILDING ADDRESS: CONRAD ROOFING SERVICE PERMIT NO.
866 BETLIN AV 03010029
OWNER'S NAME: 332 PHELAN AVE APPLICATION SUB DATE
CHOU TERRY M 01/07/2003
ONE: 4 O S 2 94—7 615 SANITARY NO. CONTROL NO,
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
Op LICENSED CONTRACTOR'SDECLARATIONCON
1 hereby affirm that I nm licensed under provisions Cns of Chapter 9(en ening Job Description
with Section 711(I(1)nf Divisi 3nf me Business and PrmfcSsin sC de, license is
o. infullforccandefful. 2 REROOF
oil�on4 Uun Claa Lle.N T/0 2 LAYERS OF COMP. INSTALL 30LB, FELT &
Dale Contracmr
ARCHITECTS DELLA�o� me its u lunticrstand my plans shell Mused as public records 30 YR. CERTAINTEED
to u Licensed Professional
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
ya00 following reason.(Section 7031.5.Business and Professions Code:Any city or county
x g( which requires a Permit to carear cl,alter,improve,demolish or repair any structure
Prior to its issuance,also requires the applicant for such permit to file a signed statement
tx?x< that he is licensed pursuant to the provisions of the Contractor's License Uw(Chapter 9 Sq.Ft. Floor Area Valuation
Fm (commencing with Section 7000)of Division 3 of the Business and Professions Cmde)or
y that he is exempt therefrom and be basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of APN Number Q&DWAcy Type
not more than five hundred dollars o5o0j.
❑ L o the w.,of the Pmpertg or my empltraes wim wwdfor alei(So.compena imeas
will do fework.andthe structureisnots License
it for saleepply to an B me,
and Professions Cade:The Contmchrs License Law doe:nal apply m an owner ter Required Inspections
property who Wilds iImproves thereon,and who doesouch work himselfedthrough his
man however,thees,ping or Improveat suchment
Itis vements,aw sold
witinnot eyearndedoroRered for cower, 305 — FRAME
builder ,me buildingorimprovementissoldwithinone year of completion,heowner-
beilder will neve the human of proving that he did not build or improve far purpose of 307 — INSULATION
sale')' 601 — ROOF TEAR OFF
El 1,as owner of the properly,am exclusively contracting with licensed ronuoclors to 602 — ROOF PLYWOOD NAILF'NALI=
constrict the pmjecl(Sec.7044,Business and Professions Code:)The Contractor's Li-
cense Law docs not apply to an owner of property who builds or improves hereon,and 603 — ROOF BATTENS
Lcense Law.mrsuch projects with aconuanorts)licensed pursuant the Contmaor'e 604 - ROOF IN—PROGRESS FEB 1'0 2003
❑ Iron exempt under Sec. ,B&PCfartbismason
Ownef Date BUILDING
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of he fallowing declarations:
1 have and will maintain a Certificate of Com mon to self-insure for Workch Compel.
sstion,as provided for by Section 37W of me Labor Code,for the Performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
370 of the Lahnr tle.fn�ypyvformance of he work for which this Permit is issued.
My Worker' neat nlnaumnce cam and Policy n mbgr arm ✓ 2 6 I -1
Cartier. Policy No.: l f
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not Wcompleted if the Permit is formic hundred dollars(5110)
or less.)
I certify that in the Performance of the work for which this Permit is issued.I shall and
employ any Person in any mannerso as to become subject to the WorkersCompensation
Laws of Celifemia.Dote
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Ichor Code,you must
OO forthwith comply with such provisions or this Permit shall be deemed wicked.
CONSTRUCTION LENDING AGENCY
[r 4 I hereby infirm met here is a canstrumion lending agency for the Performance of
ai > the work for which this permit is issued(Sec.30q7,Co.C.)
aQ Lender's N.
z Lender's Address
U I certify that 1 have read this application and scam that the above information is
fi F correct.I agree to comply with all city and county ordinances and state laws relating to
0U building construction.and hereby authorise representatives of this city to enter upon the
Da shove-mentioned property for inspection purposes.
a (We)agree to save,indemnify and keep harmless the City of Cupertino against
IA liabilities,judgments,costs and expenses which may in any way accme against said City
U 7 in consequence of he granting of this Permit.
F7 APPLICANT UN �RSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR EBU flyyNS.
/lam 1-7-0 )— Re-roofs
Signal rc of Applamin/Contracmr Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle harallous material
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code.Section as532fayr All roofs shall be inspected prior to an roofing material beim Installed.
❑Yon [I No P P Y 8 g
Will he applicant m mom beading eeapant a equipment or deviceswhic `If a roof'is installed without first obtaining an inspection,I agree to remove
mit haxandous air c mtarrommis as defined by he Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes r]No
I have rend the havardnus materials requirements under Chapter 6.95 of the Callum
nor Health&Safety Gavle,Sections 255115,25533 and 25534.I anderamnd that if the building
does not currently have a tenant that it is my msponsibillty m ratify the occupant of the 1 !!!
requireplot to I.... is ceml2atenfacuprray. Signa ure of Applicant Date
M�`n
/-2-03
Owner or authamed agent Dote All roof coverings to be Class"B"or better
Building Division '
10300 Toren Avenue
Ctitpertino,CA 95014-3255
Telephone: (408)777-3228
CUPERTIND Pax: (408)777-3333
Building Depa ent
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 W'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: Icy Ll�o,�
Address: �(�6 � fij�i. /}v.
ljeroofing Company Name: _. �--A /,ECO-1
Applicants Signature --7Z,1/L--.Date:./ -
Joe Antonucci
(Chief Building Official)
60/01