02100121 CITY OF CUPERTINo ^••�. *s'x�i •�,a,r�
BUILDING DIVISION PERMIT CONTRACT(gR INFORMATION
3uIrhTu&90ESEDWARD WY ADVANCED ROOFING TECHNIQU !'-'RMfrN02100121
D 001VEN RICHARD P AND LINDA L 1179 MYRTLE DR APPLICATT"Ti/1Fd1D0TF72002
ONE: (408) 249-4937 SANITARY NO. 7 CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
w 00 LICENSED CONTRACTORS
under provisions DECLARATION
U U1 ionhereby7A affirm Ihm 1 am licensed under Pole of Codd 9(commencing REROOF ]fib Description
with Section 8XM17 nl Division 3nf the Ouslncss an Plol'cssinns CuJc.nnJ mylians is
in lull lora antyeffen
zoo= Liccnu ClasK/ Lk.x ��
C_F W Dam —O Cnnva
< ARCHITECTS DE TION
K Q ndeestand my plane shall be used as public records
OyU
u�31+t, Licensed Professional OWNER-BUILDER DE CLARATION
My I hereby affirm that I am exempt from the Contractor's License Law for the
O following reason.(Section 7031.5.Business and Professions Code:Any city or county $10000
a%$� which Inquires a pctmil to COn51rnf1,alter,improve,demolish,or repair any structure
ad
ZN Prior o its ivmaded.also requires the applicant for such permit to life a signed statement
< that he is licensed parmamtothe previsions ofthe ConewoisLia seLaw(Chni9 3YIg60ffldaAIa0 Valuation
AsFO (commencing with Section 71"B(if Division 3 of the B usiness and Professions Code)or
a 3$ that he u exempt themfrum and Jm basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally ofpN N Occupancy Type
not more than five hundred dollars($500). 307 — INSULATION
❑1.as owrmr of the property,or my employees with wages az their u1e compenvtion,
Will do Jm work,and the structure is not intended or offered for We see.7064,Business (�q�Sr gqg
and Professions Code:The Contractor's License law does not apply to an owner of 602 — ROOF P T W V nt'q[-cf fns
propcny,who builds or improves thereon,and who does such work himself or through his l�
own employees,provided that such improvements are not intended oroRered for sale.If. 603 — ROOF BATTENS
however.the building or improvement is sold within one year of completion,the owner-
budder will have the burden of proving that he did not nand or improve for purpose of 604 — ROOF IN—PROGRESS
sale).
1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7(4 ,Business and Professions Code:)The Contractor's Li.
cense law Jens not apply to an owner of property who builds or improves thereon,and,
who commands for such projects with a contraclnr(s)licensed pursuant m the Contractor's
License law.
❑ I am cxcmpt under Sec. ,B&P C for this mason �/
Owner Damp rk r�
WORKER'S COM PENSATION DELLA RATION 's 8
I Nearby M.under penalty or perjury am ofthc following declarations: O�/
I have and will maintain a Ci nirmam uo of Consent wif insum for Workers Cumpen-
sation,as provided for by Section 3700 of the IaMr Code,for Ne performance of the a 90 p
work for which this Permit is issued. �� G 7
❑ 1 have and will maintain Workcr'x Compensation Insurance,az acquired by section 'Z®
3700 of the Labor Code.for Nperformance
Ne of the work for which Nis permit is issued. ��
My Worker'sGlnliens�tio sumnce carrier and Policy number am
Carrier
Cartier: P n; /�Yn� 73 J"o
CERTIF71CATEOFE%E PI' OMWORKERS'
COMPENSATION INSURANCE
(TTis uniom need Bol be eomplc¢d iftbe perrnil is linonc hundred dollars(S IIXB
,it less)
1 certify that in the performance of the work for which this Permit is Issued,I shall not
employ any parson in any manner u az to become subject it)the Workers Compensation
Lewis of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Cenilicam of Exemption,you should
become subject tu the Worker's Compensation provisions of the labor Cotte,you must
OO forthwith comply with such provisions or this permit shall be deemed worked.
2 M CONSTRUCTION LENDING AGENCY
h I hereby a0irm that there is a construction lending agency on the perlormared of
aithe work for which this permit is issued(Sec.3197,Ci¢C.)
111 Q Lender's Name
z Lender's Ackland;
U O 1 certify that 1 have read this application and slate that the above information is
w Hcorrect.1 agree to comply with all city and county ordinances and xme laws relating to
Q U building construction,and hereby authoried repreuntativcx of this city to cher upon the
above
libut .mentioned property for inspectionacs purpowhich m.
F gy, (We)agree to save indemnify and keep harmless the City of Cupertino against
y incoitics.judgip rcos inand nscswbich may in any way accmc against said City
U z inconu cof , n Nis permit.
ERST /
w^ APP ANT ON QRST DS AND WILL COMPLY WITH ALL NON POINT sued by: Date
50 CE REG ATIO � v
Re-roofs
S a re oi7q,iffieramiCiatmenn Dat,
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hamfdoos material
ex defined by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
,MLCom.Section 25533(.)!
❑r a �.In All rpteriA
aspect rior to any roofing material being installed.
Will thea scant or future building occupant use e If a wit u first obtaining an inspection, I agree to remove
Pp b p equipment devices which g p
moil haiaNuux air contamiwms as delined by the Bay Arca Air Quality Management all nrI sp tion.
Distri[ty❑YesIh' aal the has. us materials noummen6 under Chapmf(.95oftheCalifr-
nialicn o cty Coxlc, tion.525505,25533 and 25.53i.l undcrsmnJ that ifthc buildingd�as Ien 11,have nail.Nm it is my rspnohill y to nouly th t cupan1of diereq men hichm betun poortoissuana ofa Certificate of0.nua cySignant Date
'it
apthorindagcnt Date All roof coverings to be Class "B"or better
Building Division '
10300 Torre Avenue
Cupertino,CA 95014-3255
` Telephone: (408)777-3228
CITY 0 Fax: (408)-M-3333
CUPERTINO
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.
MWORTANT:
1. Flat roofs must have a minimum of YA"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 Ii on r oofing and will comply with this policy.
Homeowners Name <
Address: i LA
. Reroofing Company N e: -L�C/" r
Applicants Signature: _ —
Date:
Joe Antonucci
(Chief Building Official)
6/25101