02120021 CITY OF CUPERTINOqtr _..,
BUILDING DIVISION PERMIT CONTRACTORIINT+ORMATION:
BUl1D04/GPgaesAMISTAD CT WESTSHORE ROOFING CO PERMITNO2120021
owSTO E ELMER 5869 WINFIELD BLV APPLICATTTSY11"TY2002
Akk
ONE: 408 629-2100 SANITARY NO./ CONTROL NO.
7ARCHCTCT([iNGIN1UR: BUILDING PERMIT INFO
BLDG ELECT PLUMB MUCH
� LICENSED CONTRACTOR'S DECLARATIONJob Descn [Io �®
a1 hereby air,.that 1 em licensed under pmvisions of Chapter 9(commencing REROOFpsh Section7hG)of Division 3 of Ne Business and Professions Code.and my license isall Tome an Heet rJqN 169=A ILic.N 7 ofralZ�LL s07i Camnmr ��2141pT ARCI3TIEC1'S DECLARATIOp � /�
9 C< I understand my plans shall M used as public meatus
aoaD D//Vo
LLO G Licensed Professional
s OWNER-BUILDER IDN
u<Z I hereby N
by affirm 1 am exempt fromm the the CCmu umnnnr's License to the $1 a 191
w—A0 following mason,(Sauon 713 L5.Business and Professions Coda:Any city or county
�S ff which requires a permit In cooatmct,alter,improve,demolish,or repair any structure
prior to its issuance,also acquires she applicant for such Permian file a signed statement
that M is licensed pursuant to aw provisions;of the ConuacmrS License Law(Chapter 9 3%l2FA5[ &1A&0 Valuation
ce (commencing wish Section 701)0)of Divisinn 3 of the Business and Profeasions Qvk)or
5 that M is exempt therefrom and the baro for rhe alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects Ne applicant to a civil penalty of PN NEWWE Occupancy Type
not mom than fin hundred dollars(3500). 307 - INSULATION
I,ss owner of the Interparty,or my employees with wages as their sole compensation,
will do Ne work,and the nructum is nal intended or offered for sale(Sec.1044,Buainesr — ROOF T
pWr
end Prossio
fens Code:The Contractors License Law does not apply w an owner of 602 — ROOF P yyLJ nCDeCllons
property who wildsor improv thereon,and whoduc
ocar h work hmselfor ithrough his 1tlAlLt
own employees.provided Natsuch improvements are not intended or offered for sale.If. 603 — ROOF BATTENS
however.the building or improvement is sold within one year of completion,the owner,
builder will have the burden of proving that he did not Mild of improve for purpose of 604 - ROOF IN-PROGRESS
sale.).
❑ I,as owner of the property,am exclusively contracting with licensed conlractnn to
construct the project(Sec.7044,Business and Professions Code:)The Contractor's Li.
cense Law does not apply to an owner of property who Milds or improves Nemon,and
who contracts for such projects with a confractorho licensed pursuant w the Contractors
License Law.
❑I on exempt under Sec. .B&P C for this reason
Owner Dam
WORKER'S COMPENSATION DECLARATION
1 hereby affum under penahy of perjury one of the following declarations:
I have and will maintain a Certificate of Comonuo self-insam for Workers Compem
73700
ften,as provided for by Suction 3100 of the Labor Code,for the perfnrmence of the
ork for which this permit is issued.
1 have and will maintain Workers Compensation Insurance,as required by Section
of Ne Labor Code,for Ne performance of the work for which this permit is issued.
y Woher C mpensafinn lnsumnce ca^tierint Policy numMram:rrier, w�� Policy No.: ty���UZ
CER'IFICATE 0 EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not M complemd if the retmit is for one hundred dollars(31(X0
or lasts.)
I terrify,that in the Performance of the work for which this permit is issued,l shall not
employ any person in any manner an a to Mcome subject o the Workert Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If.after making this Certificate of Exemption,you should
become subject ro the Workers Compensation provisions of the labor Code,you must
OO forthwith comply with such provisions or this Motor shall he deemed revoked.
z .~ CONSTRUCTION LENDING AGENCY
y.
[-+ I herebyalfrm shat there is a construction lending agency for the perfmmance of
{Y,> Ne work for which this permit is issued(Sec.3091,Civ.C.)
GQ Lcnders Name
z Le der's Address
U 0 1 certify But 1 have mW this application and sure that the own information is
Is,0 (✓ wildingIagreemcomply with all city and countyordinancesof and cute laws relating e
D V ithowngc timuedfpro and hereby authonp rposes. rix of this city memcr upon the
W shave-(We)a or property saw firidem ify an keep to
(We)egret to save,indemnify and keep harmless IM City nc Cupertino regains
y liabilities.judgments,cosu and espcnses which may in any way acme against mid City
Uz in consequence of the granting of in. parmir. y.
ra APPLICANT UNDERSTANDS D WILL COMPLY WITH ALL NON-POINT Issued b Date i- 7
\ SP CE REGULATIONS. �
Re-roofs
SignatureofA can favDam
li ARGOorUS MATERIALS DISCLOSURE Type of Roof
Will are applicant or future building occupant store or handle bandanas material
as de0ned by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 35532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes s
Will the applicant(it future building Occupant use equipment tit devices which If a roof is installed without first obtaining an inspection, I agree to remove
chair haza dous air contaminants as defined by the Day Area Air Quality Management all new materials for Inspection.
District?
❑Yes Nu
I have mad the Section,
25505,
55 pts 5533 me 5534,1 r Cbapwr695 of Nc Caldi
rain llcalIhave mad he humuasions materials
oui tin er capter 95 if he building
docs not currently have a warm,On,if is my remmusibilhy m noNy the occupant of the
` requirements which must he prinnnisaanpc of a CaNficrm of 0.u'pancy. Signature 0 App cant Date
\mak —tom O4_*"L
owner,,auto ,cd a t Data All roof coverings to be Class"B" or better
a Building Division
10300 Torre Avenue
�. Cupertino,CA 95014-3255
Telephone: (408)777-3228
F= (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 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: ,.5 tg VG Pm e'(-
Address:
Reroofing Company Name: Le S 5- 4ixZ6 oor vv c)
Applicants Signature: Date: Z—6-f—a L--
Joe
_Joe Antonucci
(Chief Building Official)
6/25101