01120042 LI BUILD NGDIVISION
O PERMIT CONTRACTOR INFORMATION:
BIaL{tlT,ayl}p'%gISTAD CT PERMIT NO, 01120042
:�"fRstift JOHN G AND CAROLYN B T APFIX'.k]IOhsy1LDAT61
`-HONE: SANITARY NO. L V V CONTROL N0.
O C z ARCHITECTE-NGINEER: BUILDING PERMIT INFO
U BLDG ELECT PLUMB MECH
or Z� I-1
`�" LICENSED CON'TRACTOR'S DECLARATION
1 bereby affirm that 1 am licensed under rowi,min,of Chanter 9(commencing
INSTALL 40YR Cd*NU��on
meal with Section 701 mfDI\inion 3 of the Business and Prof c..inns Code and my license
,an lull fortt and effca.' "11 5 4 S`
a ce¢ LicenseClas Lic of
s O ii U Dae t1 s o\ CUntraaor_
t�O✓'-+ s ARCHITECT'S UECLARATIO.
N 1 understand m'plans shall he used as public records �-
:'YY�
ae,p cr Licensed Pn:l'eviewl
_ that I a exempt fr DECLARATION
u�= 1 hereby affmn on 1 mit exempt from the Cessions is Licnyc Law for the $9500 r?< following uimoa(Section)consumer,
Business and oc.de Professions Code:Any pity or county �y 9 5 0 0
j—er which rite issu n permit re comwct,alms improve,h Permit
or repair any structure
e 3 m `-ion t Int q d to ep applicantmr such permlu is signedstatement _ _._.. . . i n
moon licensed p , Sn7000) sn3ofthmmnorsla h (Chapter rvCod9 ,.3Qg''aF6Bl�&PD® Valuation
(commencing :with Section]0001 f U' 3 of the Business li i fAn s Code) r ., I �i r •a
of that he Is 131,5 b fnercfrom and the basic for the alleged pplace on.Any lprodviolationof
of no,
v (citydreddllrscant for aPetmn.nnieatsmenppheantmacislpenalt Occupancy Type
ernes more man five hundred aeuan(sswl. y 3 0 CPN Nt'ii31�t@8E
01.as owner of me PmpcnT.Or my empleryces with.'ages as their ante compemation. 307 - INSULATION
-win do'the'work,and the swcwuis not intended or offered for sale(Sec.76114. 601 - XUU11' TE
Business and Professions Code:Tic Contractor's License Law does not apply to an nBpe(;[lons'
owner of propcny 6 0 2 - ROOF PL Who builds or improves thereon,and who does such work himself NA1 L
or through his own employees.provided that such improvements are not intended or
WEV
-oferedrorsale.If,however.thebuudmgonmprosementis old within one.•us,of . . 603 'ROOF--BATTENS.._ ._.-_. -._....__...--___..__.._. .. .. _ .. .. .
vnpm6`o`he owe ofsacc'r will have me names of proving tont he old net build(it 604 - ROOF IN-PROGRESS a.
improve purposco
. .... .... _... _.___... .. -_ ._.._.. ... ._._.___ --.._....._.. . __.. ._. .. .
❑h trct Orion,the pr the p(Sec.7 I s a t i g li license d Conor ct ra
construct o p j n(S ]to 4.a Business d eProfessions Code)The yes der
o's '
License mx.nm apply t owner of a pen)woo) Ids se improves mere e
d who entices for M1 Protects with o t cmrfs),I licensed pursuant w.he .., . ..... . ... ..... .. ... _ ..
Cinamemi License Law.
Cl1 am exempt under Sec B&P C for this re son
Oxncr Date
;. WORKER'S COMPENSATION DECLARATION
�s I herthY affirm under Penalty of perjury one of the following d«larations:
❑ 1 have and will maintain a Certificate of Coniem to self insum for Wnder's /
Compensation.
Of as provided
dwfor bihisSection 37M of the Labor Cnde; for the
K permit is issued.
❑1 have and will nammoin Worker's Compensation Insurance,as required by Sced on
34X1 Of the Labor Code,for the performance of the work for whmh his permit is
Issued.My Workers Compensation Imu a nce camer'and Poliev'nummer arc 'w
S4F9i. Gun+r Ewsa o..t�
•Cam SNSJrt AN�£.FJp SPUIicy No.: 28.C' 1 " � -
- \ CERTIFICATION OF EXEMPTION FOM WORKERS
COMPENSATION INSURANCE`
or
t cad nm he co nplemd if the perntafor one hundred dollars -t
(SI00)or less)
1 cenpl hat m er min rte f the work for co mh this e perms seed I -
shall notcm employ any 1' . m any manner so as m become subject m the Workers < "t:,t '• ''
CUmpcnsation Laws or Celilnrnia.Due
..Applicant
NOTICE TO APPLICANT:If,res after eakmg this CeniGrote of Exemption,you should -"--'
z 0 become subject to he Workers par nnr Compensation provisions of he lamer Coda you muit
forthwith comply with such provisions or this permit shall he deemed revoked
E+ � 't '
CONSTRUCTION
' COr10NLENDINGAGENC.Y
thereby affirm metLeeis I dmg agency forthe perom's
ance
the Irk for which h p,u n is issued(Se 097 CivC
Lena -- t
-.
Name -.. .,... .. _ .. . . _.. . ........-..._.. . .. .. ..... ..._.. .. ._ .
;D,Z Under,Address -
�TU•s O -1 ccnily ma 1 have read alis application nntl some ha me above information is
F coli eat.1 agree m comply with all city and coumy ordinances and state laws relating
Q U to building corstrvetion.and hereby authorize representatives of this city to enter upon
ry he above-mentioned property for inspcnim pwpuse,
f, 0. 01 agree 1.sole,indcmnify and keep harmless the City'of Cupertino against
(0) liabilities,judgments.costs and expenses which may in any way accrue against said
U Z City in consequence of the granting of this penton. fes
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
u1.AnoNs. Issued by: Date
Signal re nt AppbcunVCnmmn ��'or a,e
HAZARDOUS MATERIALS DISCLOSURE'" Re-rOOf$
a
Will Ne applicant or future building occupant store be handle hrfardom'material ...Type of Roof...
as defined by me Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code Sordicar 25532faIa o -
W'�• __Al] roofs shall be mspected_prior_to any roofing,material being installed.
'niontri'Will the ' ot rte b ' g p equipment deliver,
_
it h adocommandants
itcnm a t d<rinca b) h B y Are A Quality Management a roof Is nstlledwithout first obtaining an inspection;Itagree'toremove
all n-ew materials for inspection. Appcant un
lide.rstands and will comply with
- ❑Yet No .. .
all non-point source regulations. ,.
�.y - Ina c'reea the h onus mi q 25533a under Ch pmrxodarrf he
r, '
Califo it H elm&Safety Cod Sections 25505 25533 and 25534 I d rsmnd that
if'heb Id' gJ s frocarrently have atenat that it is myebpro 'b'I'ty to unity the
Occupant fthe requirements ti muare I st t be ed P t issue a f a Cenificme of �,�_ G� .l�/t t
Slgn�era applicant Date _
Uttar, eaagent. q,m All roof coverings to be Class "B"or better
-OFFICE ..
Building Division
a-)040
10300 Torre Avenue
Cupertino,CA 95014-3255
• Telephone: (408)777-3228
CITY OF 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.
IMPORTANT:
1. Flat roofs must have a minimum of 1/4"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: :5'0+4N C', L-A u n L4Z
Address: /O 3 -:2 .4M L 5'7.4/)
Reroofing Company Na cs1/11 m fl 2 �LZA/6
Applicants Signature. 4 L Date:
•
Joe Antonucci
(Chief Building Official)
6/25/01