02110153 1' CITY OF CUPERTINO
a BUILDING DIVISION PERMIT CONTRAC-TOWINFORMATION
IUlr�,pc r3HSGARDEN GATE RESPONSIBLE ROOFING INC PERMIT N92110153
OWIDONAhgI:ESTIND 2882 SPRING ST APPLICAT1911i15I 6TY 2002
IONS: (650) 969-6151 SANITARY NO./ ` / CONTROL.NO.
ARCHITECT/ENGINIHiR: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
foo LICENSED CONTRACTOR'S DECLARATIONply 9p
0�t5!p I hereby affirm that I am licensed under pmvisiom of Chapter 9(commencing &TAR GRAVEL li& CScripfiOn
with Section 71XXq.f Division 3uf NC Busimmod Profamium CMc,and my license is
in ton rorec sone tot.
F' Z Licen��i Z
Lie
,b AL
E®
OZ-4 Da¢ Contactor fp[a C L
ARCIIITECTS D[CLARATIDN S I` FIN
9 I understand my plans shall be used as public recoNs '1 Q
FaG LicensedPmhodoml DEC 1 0 2002
OWNER-BUILDER DECLARATION
pe .e f 1 hereby affirm that 1 am exempt Cram the Contractors License low for the
mF00 billowing moon.(Section 7031.5,Business and Pndessiom $5040
Cade: BUILDING
n'M 2(L which requires a permit m m
consumer,altar,improve,demolish, ru
,or repair any mcmre
Fzy prion,,am ismarme.alsnrcyuires tMapplicant for such Permit I.file.signeamiumem
FFmm< 'hat he islicensed pursuant In am pmvisionsofthe Contractor's License law(Chapler9 3SiIGl3a9e832AQ0 Valuation
y+FS (nlmmencingwith Sectian71XX0of Division3uflhc Bourro nd Pmff.mos Code)nr
toy that W is exempt lhemfrom and the basis for the alleged exemption.Any violation of
Section 703L:5 by any applicant for a permit subjects the applicant to a civil Penalty ofpN N Occupancy Type
not mom than five hundred dollars(1500). 307 — INSULATION
❑ 1..owmrofthe Property,.,my employees with wages.Ne'u sole compensation,
will do the work,and the mructom is not intended or offered fmadc(Sec.7014,Business
sena Promad is Code:The Caauacmrs License Law da. m napply m..owner of 602 - ROO F P n �cfi�ns
pmpeny who builds or improws thereon,and whodnes such work himself or dough his
Own employees,provided that such improvements am not intended orartered lbr.le.If, 603 - ROOF BATTENS
howeve9 the building or improvement is sold within one year of completion,the owner.
builder will have the burden of proving that be,did nut build or improve for purpose of 604 - ROOF IN-PROGRESS
sale.).
I,as owner of the property,am exclusively contracting with licensed con mines to
convect the partner(Sec.7044,Business and Im e.ium Code:)The Commerce,Li
cense law docs not apply to an owner of property who builds or improves aremon,and
who common,for such projects wit a contractor(s)licenced pursuant to the Conlrumrs
License Law.
❑I am exempt under Sea ,B&P C for this noon
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby eRrmunder penalty of perjury one of the following declarations:
I haw and will maintain a Certificate of Convent to self-insure frrWorkehCompcn-
.tion,as
pmvi ted for by Section 3700 of Ne Labe,Code.for the pedormanm of the
work for which this Permit is issued.
❑I have and will maintain Workers Compensation Insurance,.required by Section
3700.1'On lain,Cade.far the performance of Ne work for which this permit i,issued.
My Worker's Compensation Insurance carrier and Policy number are:
Carriers fA T, Ja— xZ Policy No.:7�3 J�C '0 V
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMP17NSATION INSURANCE
(ITusccuon meal nm be complete)if dm Permit is form¢hunNcaldnllm(111X1)
or less.)
I candy that in the Performance of the work for which this Permit is issued,I shall not
employ any person in any manner so as in become subject1.the Workers'Compensation
Laws of califomia.Date
Appliem,
NOTICE TO APPLICANT:If.after making this Cenilicate of Exemption.you should
bee-ome subject to the Worker's Compensation provisions of the Labor Coale,you mull
OZ forthwith comply with wan previsions or this Profit shall W deemed invoked.
z O CONSTRUCTION LENDING AGENCY
(~ ti I Meshy aOirm that Nerd is a construction lending agency for the Performance of
the work fur which Nis Permit is issued(Sec.300,Co.C.)
W40 Lmderh Name
Z Lender's Address
(J P I Cenee Nat I have tad Nl4ty and allua y o SLM than and
suite l information mmboa Ii l /
D. U bonding 1 agree ct comply with all city and reunty mativ aces aW atom laws relining a
V mirvengcanreculprnand bemhyamhon purposes. of this city menmr upon the
G aMve-(We)are I.ertysave for impecdan t kee
(s ju agree to save,indemnify and kap harmless the City of Cupertino against
Hy incoiti.,judgmentse gormand oaperv.whicb may in any way acerae against said City
(„)7 A APPLICANT
of DERSF NDS this Permit
�7 APPLICANT UNDERSTANDS AND WIL1.COMPLY WITH ALL NON-POINT Issued by: Dale
SOURCE REGULATIONS.
-ea -LG a-roofs
Signawrc of Applicanl/Cantsannr Dam '
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the,applicant or future Wilding occupant mom or handle h.allom material
.defimd by dre Cupertino Municipal Cale.Chapter 9.12.and IM Health and Safety
Code,seam,zss3zlo7 All roofs shall be inspected prior to an roofing material bei,
❑Yes ON. P P Y g g installed.
Will the applicant nr future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
emit hmaNeus air bom minunm as delincd by the Bay Arca Air Quality Management all new materials for Inspection.
Diurict7
❑Yes 0 N
1 have mad the he.ardousmwrials rcquimmcnu undo CMpmr6.95 of the Cm or-
nialleath&Satiny Cude,Smio.25N15.25533 and 255M.l understand that iflbe huilif g
does not currently have a tenant.that it B my responsibility,to notify the occupant of Z/-LG -e7 z_
requirements which mum be met prior toiss..or.CcnlOcam of(Bcopancy. Signature Of Applicant Date
-4 ���� //-LC^D
Owner or authorized agent Dam All roof coverings to be Class °Ba or better
i
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Fax: (408)777-3333
�UPEI�TINO
Building Department C� � 8
2 6 ?00
Subject: Reroofing policy for the City of Cupertino. By
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.
We understand the above policy on reroofing and will comply with this policy.
Homeowners Name: Don k es-Ui r d
Address: Mqn?) Gar CAP n &CA7P—
Reroofing Company Name: /yRgspartSiV) -P Fon-t'1rYn -1-r-IC
Applicants,Signature:
• Joe Antonucci
(Chief Building Official)
6/13/00