02100197 CITY OF CUPERTINO ;-�
BUILDING DIVISION PERMIT - CONTRACTOR INFORMATION
• Bu14&q,@4RiSRANDY LA COSMOS ROOFING PERMlYN02100197
OW114RIMAN RICHARD M AND BARBARA 1901 OLD MIDDLEFIELD WY APPLIcA1POSPfl3I13TY2002
HONIi: (415) 493-6373 SANITARY NO. CONTROLNO.
ARCHITECrIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MF.CH
0 0 0 0
WOO LICENSHI)CONTRACfOR'S DECLARATION
4 w O 1 hereby firm that I am licensed under f Chapter 9(commencing
Job Description
�p Proviaiona,, Per REROOF p
w with Section 7lgkp of Division 3 of NU Business and Prnfessilanx Code.and my license is
a
In lull ngeand e cV.. a �f y�/ FINALE®
ozHct= Lkcn. CI gl"i-i"II•p�, Lic.M_!
N� Dam Cnnvucmr
A'sludlIT:CTS DEC blicre NOV 1 8 2002
y a 1 undcrsanJ my Plans shall be ueJ as puNic rcurzds
XOyu
rLLOG Licensed Professional
OWNER-BUILDER DECLARATION
<y I hereby affirm Nal 1 am exempt from the Contractor's License Law for the BUILDING $7250
m6po following reason.(Section 913 I.S.lousiness and Professions Cade Any city or county
e ae$ which requires a Permit to construct.alter,improve,denmlish,or repair any structure
"^
prior o its issuance.also requires the applicant for such Permit n file a signed statement
L"Za that heislicensedPursuanttothePmvisiomnfthcConwaurtsLicenelawWhipter9 3*6913I0oUA@0 Valuation
(commcncing with Section 71MR8 at Division3ol the Business and Pmfesxions Concent
i that he is exempt therefrom and the basis far nm alleged exemption.Any violation of
Section 703 LS by any applicant for a permit subjects the applicant N a civil literally of PNN Occupancy Type
wt mew than five hundred dollars($504)). 307 - INSULATION
01,as owni property,or my emplo,ra with wagesas their.wdecompenaaion,
will do the work,and the structure is not intended or offered for sale(Sm.70,1A.Business
and Prolesdons Code:The Contractor's License law dors not apply a an owner of 602 - ROOF P n cltii2ns
property who M1uilds or improves Ncrc„n,ant who dres such work himself,,,through his
wnemployms,provided that such improvements anchor intended oroBemd lar.sale.If. 603 — ROOF BATTENS
browser,the building or improvement is said within one year of completion,due owner- 604 — ROOF IN—PROGRESS
bonder wiR have the burden or proving Nat he did owl build is,improve I parpose of
sale.).
1,as owner of the property,am exclusively cuntraeting with licenud conracto(s to
construct the Names,(Sec.7W,Business and Professions Code)The Contractor's Li-
cense law does bol apply u,an owner of property who builds or improves thereon,and
who connotes for such Projects with a contractor(s)been e d pursuant to the Contactors
License law.
❑ 1 am exempt under Sec. .B&P C for his reason
41 Owner Dat
WORKER'S COMP17NSATION DECLARATION
I hereby al firm under penalty of perjury one of the following declarations:
O I have and will maintain a Certifcate of Conxcnuo self-insure rnr Workeds ComNn.
sution,m provided for by Section 3703 of the Labor title,for Ne perfurmancc of the
work for which Nis permit is issued.
I hate and will maintain Workers Compensation Insurance,u required by Section
9117 of the Labor Code.for Ne performance of the work for which this perntit is issued.
My WorO Imear/� emrm,T and Policy number arc: ' Z
Cartier: L Policy Nei a 1�Q 2-
W1
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Trhis seelilan need nm be comPICled if tbe permit i5 ha one hundred dollars(SI110)
err Ices.)
1 cerdfy that in the Performance of the work for which This Permit is issued,1 shall not
employ any perssn in any manner su as m become subject o IM WorkersCompemation
Laws of Califomla.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Cenilicae of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
O O forthwith comply with such provisions or this perm;tshall be deemed awok d.
Z CONSTRUCTION LENDING AGENCY
(-1 4 I hereby affirm Nan there is a conslmelion lending agency lot the performance of
a, > the work for which this permit is issued(Sm.3139.Cis.C.)
111 A Lender'sNamc
Il Lender's Address
U 0 1 eenify Nat 1 have read this application and slate that the shove inflammation is
D. P correct.1 agree to comply with all city and county ordinances and stale laws relating to
� U building construction,and hereby auNmire ritumscmutives of this city to enter upon the
rshnvrmin inned property for inspection purposes.
f•' P. (We)agree to save,indemnify and keep hamdem rbe City of Cupertino against a9�
N liabilities,judgmcnul,atsts and e a penes which may in any way accmc aguma said City
U in conscqucam of the granting of this permit. (w
.. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL IN INT Issued by: Date
SOURCE REGULATIONS. �O L
Re-roofs
Signmum,,f Appl....U(Commilor Date
HAZARDOUS MA 'RIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hu,ardous material
as defined by the CupcNna Municipal Cone,Chapter 9.12,and the Health and Safety
140 Code.Section 255321x)% All roofs shall be inspected prior to any roofing material being installed.
❑Yes t -
will the itReantor future buaNh l sew chs or devices which If a roof is installed without first obtaining an inspection, I agree to remove
pp built., then a Air ,
emirict? nus air contaminants as dclincd by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes GZtia/
1 have read the himadous materials requirements under Chapmrd.95of Ne Califnr.
bin Health&Safny Cotlo:,swarm 25515.25533 and 25534,1 understand Nat ifte building
docs nnl<urmnd have a¢nam.Nal n o my rcspomsihillly In nnufy the In'cu a I of the
reqsrcqa;=me, ia, arbemelpd tuiGsum,cenracerdfeamor��P Signature of Applicant Date
o Z
owntn or authon,. agent Dare All roof coverings to be Class"B”or better
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CUPE�TiNO � � Fax: (408)777-3333
Building Department
Subject Reroofing policy for the City of Cupertino.
1. Prior to permit issuance,you must agree to comply with 1997 LBC 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'/,"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: r>z—t-� n�rv�
Address:
Reroofing Company Name:
,�QQ o
Applicants Signature: �✓-�i Date: /0/50/0 i
Joe Antonucci
(Chief Building Official)
6/25/01