02100138 CITY OF CUPERTINO <" ,.
BUILDING DIVISION PERMIT gCONTRACTORINFORMATION:
Bmgp,2,2)gBs10229 WILL CT T D ROOFING PERMITN02100138
Q`A'B+AI.gl? S MARIA N 3540 MARGATE AVE . APPLICATV0sJniU4Tj2002
IONI:: !}0$ 8 92—8 B 7 2 SANITARY NO. CONTROL.NO,
ARCHITECTIENGINEER: FUME E MECII
0
wOp LICENSED CONTRACTOR'S DECLARATION
p I hereby kllirm that I am remised under prnvisinna.f Chapler 9lcommcndrg Job Description
i with Section 7(XX)ofoivision 3 of fee Business and Pmfcuiuns Cada,and myli¢bse is REROOF
F>y mfulllimemuldficet.
License Class Lica
O Z�O Dae Contractor
2=2- ARCIIITEC`S DECLARATION p� �s
�9yQ I undcrsund my Plans shall used as public meds �'LA�i��G®
LLodu YY�.��'11
ou Licensed Prnfcxsiowl
Y i• OarNERexemptifrUIiCeCoubaON NOV 0 5 2002 $8000
Ho S I hereby affirm that I am exempt from rite C.mmanr's License Law for Nc
p 0 following rc a(Sccdon 71131.5,Business and Pndcssinns Gsk:Any city or county
n $ which requires a permit to construct,alter,improve,demolish,or repair any svucwre
tprior to its illation,also requires the applicant for such permit to Zile a sm
igned stateent LDS I V G
?< that he isIccavdpurshomtothe provisions nllhcCnmmcb)rxLin Ww(Chapter 9 39f6@t5El(3dD Valuation
�II--O (commencing with Section 7100)of Division 3 of the B usiness and Pndevslons Cmte)or
y
that be is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 70315 by any applicant for a Permit subjects the applicant to a civil penalty of PNN Occupancy Type
net more than five hundred dollars(SSW). 307 — INSULATION
❑I,as cause f,h.pso,cry,or my employees with wages u their )to cumpenaaunn,
will do the work,and the structure is not intended or offered for Sale(Sec.7Ma.Business Q��.�g D���+�.,({O
and Professions Code:The Council License law does not apply m an owner of 602 — ROOF PL W V V 1VH 1 _ns
Imagery who builds or improves thenen,and who does such work himself or through his
wn employees,provided that such improvements am not intended or offered formle.B. 603 — ROOF BATTENS
however,the building orimprovement ismid within one ea ofcompletion,do,owner- 604 — ROOF IN—PROGRESS
builder will have the burden of proving that be did not Wild or improve for progress of
soma.
I,as owner of the progeny,am culusively contracting with licensed conuacmes to
construct the Project(Sec.7054,Business and Professions Cudey The Convector's Li-
acute law does not apply man owner of progeny who Wilds or improve them..,and.
who contracts for such projects with a convactor(s)licensed pursuant o the Contractor's
License Law.
❑I am cscmpt under Sec. .B&P C for this rowan
Owner Dam
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penally of Perjury one of the following declarations:
I have and will for by
a Cion 37yre of the La or Crude.sure for Worker's Compce of the smirk,r presided for mi Section J71Xi of the Labor Come.for the performance of the
work for which Nis permit is issued,
❑1 bare and will maintain Worker's Compensation Insurance,as required by Section
371X1 of the labor Code,for the performance(i(the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Carrier: Policy N..:
CERTIFICATE OF EXF.M MON FROM WORKERS'
COMPENSATION INSURANCE
(This seeinn aced nut be corepined if the permit is fnronc hundred dolims(510)
,it less.)
I certify that in the Performance of the work for which this Permit is issued.I shall urn
employ any Perim in any manner so as m become subject o the WorkersCompensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:ll:after making this Cir ificae of Exemption,you should
beatme vilifier m the Worker's Compensation pmv ons of the"her Cede,you must
OZ forthwith comply with such provisions or this Permit hall be deemed revnkcJ.
z O CONSTRUCTION LENDING AGENCY
[-.N. I hereby affirm the there is a construction lending agency tor the performance of
a 7 the work for which this prim It is issued(Sec.3107.Civ.C.)
W Q Lender's Name
O. Le &,'a Address
U 0 1 ectroy that I have read this application and sum that the above information is
W P correct.1 agree to comply with all city and county ordinances and state laws relining to
OU holding construction.and hereby suthnri'lienpoescmmiveenf Nis city kr corerupon the I[ �/�t (}/� /�/(/�/t��
r W ahnvcmcmiegmnt%,Ceproperty for inspection expenses
purposes /"_�u/v
6. (We)agree to save,indemnify and keep hamless the City of Cupertino against
U N inconequ consequence
of the Celli and expcnusmit. may in any way a¢mc against sold City
U z A APPLICANT
of thegranting of this Permit.
r. APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL.NON-POINT Issued by: Date
SOURCE REGUhATIONS,
Re-roofs
Signatureof Appl erboo' ammeter Dam
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle has cel material
as
defined by the Cupertino Municipal Code.Chapter,9.12,and the Ilcuth and Safety
Code.Seelier 35532(x)1 All roofs shall be inspected prior to any roofing material being installed.
p Yes C]No
Will the applicant or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
eniit harammi
rdous air comnanis as defined by the Eley Area Air Quality Manrgcome, all new materials for inspection.
District/
p Yes ❑No
I have mad thhem
e rznus materials requirements under Chapter 6.95 of ftCaldre,
niu Ilcalth&Safety Code.Sections 255115.25533 and 25534.1 understand that if the Wilding
Nos not currently base a tenant,that it is my respuwibiliy to nod I the occupant of the
mquimmentswhich mull Wmet Perot Iniwme
uaeoraCecil ficirreoracupamcy. Signature of Applicant Date
Owner of aWmnbed agknl Date All roof coverings to be Class "B" or better
' Building Division
10300 Torre Avenue
Cupertino,CA 950143255
Telephone: (408)777-3228
CUPE��'NO � 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 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.
IMPORTANT:
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: 111 C�'Uct Sin, q
Address: �� o z a-7 i 09 q
Reroofing Company Name: i •D 2 v 0 Vn
Applicants Signature: Date: o a o z
Joe Antonucci
(Chief Building Official)
6/25101