02100120 CITY OF CUPERTINO ' "4 w $
BUILDING DIVISION PERMIT CONTRACTOR°INFORMATION,,,i
x nullZORSAYRhSSARDEN GATE DR ADVANCED ROOFING TECHNIQU g-RMITN021OO120
OwIDUANA NELSON 1179 MYRTLE DR APPLICATIQtQSIdB1D6ff12002
ZONE: (408) 249-4937 SANITARY NO.// TT CONTROL NO.
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MP.CH
0 0 0 0
�00 LICENSED CONTRACTOR'S DECLARATION
�W p I hereby affirm that l am licensed under provisions of Chapter 9(cn renting REROOF Job Description
y� with Secf m]I00pnf Uivisinn3nf the Bushes: nJ Pmfesshr Cude,mod 1,e,nw,,,
int l cc send c-'ct. Q
uh
Fii Lioelass
sc Da e^—
ARCHITECrSD: AR
%06U IundcmenJ my plans shall MusedispucN
bli .. ,
.U e. Licensed Prolessinnul
I.D
y .] QWNER�BUIER DECLARATION
sd S 1 hereby ullirm that I am exempt Irnm the Canlranbr'a License Low lis the .�5 O O
w-p O fallowing reason.(Section 703 L5.Business and Professiores Code:Any city set county''n$� which mquims a permit to construct,mart,improve,demolish,or mpeo any structure
s-Ziprice on its issuance,alit)requires she applicant for such Permit to the a signed statement
that he is licensed pursuant to the provisions of the Comrecmr's License Law Chapter 9 3Si761EIMd4)'dA@D Valuation
s�� (c(mmencing with Section 700)of Division 3 of the Business and Professions Code)(it
y R� lhal he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for if pmmit subjects the applicant m a civil not,,Of Occupancy not more than five hundred dollars($510). 3 0 7 — INSULATION p y Type
❑1,as owner of she property,or my employees with wages as their able compensation.
will do the work,and the structure is not intended or offered for sale(Sec.70,14.Business
and Profession'Cute:The Contractor's License Law does not apply to an owner of 602 - ROOF P "RACIiEns
propcny who huil110,improves Neter,end whodoesauch workhimulfor through his 1�aY
own employees,provided that such improvem,ma are not intended orbffered for sale,I1, 603 — ROOF BATTENS
however,the building or improvement is sold within one year of completion,the owner
builder will have the burden of proving Nat he did not build or improve for purpmc of 604 - ROOF IN-PROGRESS
ole.).
1,v more of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7Uq,Bri in,as and Profession'Code:)The Comracmrs Li-
cense Law ctsa not apply loan owner of property who builds or improves daemon.and
whod.contracts for such projects with a et)ntracmr(s7licensed pursuant m the Cnmracmr's
License Law.
❑1 em exempt under Sec. ,D&P C for his reason
Owner Data
WORKER'S COMPENSATION DECLARATION
1 hereby aRma under Penalty of perjury,one of Ne fallowing dxleretiona:
I have and will maintain a Cer ifcate of Consent to self-insum for Worker's Compcm C�g�
eution,as provided for by Section 3701 of she Labor Code,for the performance of the
work for which this permit is issued.
I have and will maintain Woek,h Compensation Insurance.M required by Section
3701 of the Labor Chale,for fee performance of me work for which his remail is issued.
My WmkerS Com Ansa' sunny currier and PulicynmrWr are:
nier:v�, P1ic .:iS'Y67a')
CERTIPICATEOR EX: PT 10 OM WORKERS'
COMPENSATION INSURANCE
(This section need nm lecompleled if 1M permit is loran,hundred dollars(ghOB
or less.)
I aenify mat in the performance of the work for which this permit is issued,I shall not
employ any person in any manner na as Ie become subject to the Workers'Ct)mrrnsation
Lows of California.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Cenificase of Exemption,you should
become subject m the Worker's Compensation provisions of the Libor Code,you must
OO foMwith comply with such provisions or this permit shall M deemed revoked.
zw3 CONSfRUCrION LENDING AGENCY
(-r mol. I hereby affirm mat mere is a construction lending agency for the performance of
tyi ;> the work for which this permit is issued(Sec.3IN7,Co,C.)
I Lender's Name
] Z Lender's Address
U O 1 cenify mat I have mad this application and stain that the above information is
— emmect.I agree I.comply with all city end county uNinances and state laws relating m
V building construction,and hereby mothorne representatives of this city to enter upon the
W show mentioned property for inspection purposes.
(We)agree ,,eve, m
enifyand keep harmless the City of C.,,tino.,.fast
N liabilities,j0 Is.cos n expenses which may in anyway accrue against said City JC
U Z in cease q roof he, tin ofthispermis. V
^ APPLI NT U DE T ON AND WILL COMPLY WITH ALL NON POINT Issued by: Date
SOUR EREG .AT N .
o-rte . Re-roofs
s pphs omracror Data
BAZARDOUS MATERIALS DISCLOSURE. Type of Roof
Will the applicant or future building occupant stare lir handle Woundcus material
as derined by the Cupertino Municipal Calc,Chapter 9.13,and the Health and Safety
SecCote. Imo 25532(.)'?0Yca 9r- All roofs shall be inspected prior to any roofing material being installed,
Will the applicant or future building Occupant use equipment or devices which If a roof is ' st led t out first obtaining an inspection,I agree to remove
:mil haaardom air conmminama as defined by the Bay Arca Air Quality Managcmenl all new ateria s f i spection.
Dixtrin/
❑Yes n
Iha a oxic. usm Imlilsrt33 and 5534.1 Chapmr6.95ofine Wilding
nim Tical gafct Csvdc, do 55115,354uimm nuun 1u ChapandthmiflM Calling U IQ
does no vnemly s mat it is my responsibilitytu nmif IM t cupmnl 01 me
require crisw ' hmust noel rmissuancrufaCcnifcamo army. g atureofAGolicant Date
f6 O
orantil oned.,ent Dale All roof coverings to be Class"B" or better
Building Division
10300 Torm Avenue
Cupertino,CA 95014.3255
Telephone: (408)777-3228
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.
nWPORTANT:
1. Flat roofs must have a minimum of V"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: J /iA o ,-,4t A 9 dAl
Address:
Reroofing Company No-
Applicants Signature: Date:/ (S- 1 d Z_
Joe Antonucci
(Chief Building Official)
6/25/01