02100179 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACT RANFORMAT,ION:
BU111y SKP2fENCANYON VISTA DR ROOFCO OF SILICON VALLEY PERMIT NO 2100179
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lOwRM@IqO DEEP CLIFF HOA 844B EARLE AVE APPLICATTtOS//13,M"2002
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ZONE: 408 795-3335 SANITARY NO. CONTROL NO.
ARCHITCCTIF.NGINEF.R: BUILDING PERMIT INFO
BLDG ELECT PLUMB MICH
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,Op LICENSED CONTRACTOR'S DECLARA'T'ION
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r I hereby affirm al I am licensee under previsions Of Chapter 9(commencing Job Description
Glu wdhseerl� rlkxpnfuivixion3nnheBazmv and Promssion.[Code,and mylieenwta REROOF
in lull Tt�tyanJ tllctl. '5 �� rrAO afgs aA ®
O n K LiccnsxCiax —�� I.ic x �9`�Y+1r lr'I"q Gt
oN— �m /0 Cnmumbo
I--�1° ARCHIItiCr'ST
atIunderstandmyplansshall used uhlic ,rda NOV 1 5 2002
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9130y Liccnwd I'nrlcssinnal
rLLOa OWNER-BUILDER DECLARATION
<S I Wrchy alfirm That I am camp)from the Contractor's License Law for the Bu'WING
1"1�p NgG^ r M 12 0 0
a 1n a Oe O following reason.(Section 7L5,Business and Professions Code:Any city or county L.66//
x m which requires a permit m construct.eller,improve,demolish nr repair any structure
'o—'^ prior to its issuance.also"fires the applicant for such permit to rile asigned sumntent
FZa Iher he is licensed pursuant ,,the proviAmrofrhe Contractor's license La.(Chapter 9 3,*61Et2IE&9A&@ Valuation
(com menti ng with Section 7kiOf Division 3 of the Business and Professions Code)or
e, — that he is exempt therefrom end IM basis for the alleged exemption.Any violation of
Sertion 703 L5 by any applicant for a permit subjects the applicant o a civil penalty of pN+NWJWWE Occupancy Type
not mom than Bae hundred dollars($500). 307 - INSULATION p y YP
I,as owner of Inc property,or my cmployces wise wages as Noir sole compensation,
will do the work.and the structure is not intended or offered for sale(See706q Bulinus pmt ung
1�
and Professions Cade:The Contractor's License Law does not apply to an owner of 602 - ROOF P WlJ nyy HcIlFlns
property who builds or improves Hereon,and who does such work himself or Omagh his
own employes,provided that such improvements are am intended or offered for sale.If. 603 — ROOF BATTENS
however.the building or improvement is sold within one year of completion.me ve owner- 604 — ROOF IN-PROGRESS
builder will hathe burden of proving that he did not build or improve for purpose of
sale.).
0 1,as owner of the property,am exclusively contracting with licensed contractors to
convict the project(Sec.70,14,Business and Professions Code:)The Contractor's Li-
se Law does not apply to an owner of property who Wilds or improves formed.and.
who contracts for such projects with a contractor(s)licensed pursuant o the Contractor's
License Law.
0 1 am exempt..our Sec. B A,P C for this mason
Owner Dale
WORKER'S COMPENSATION DECLARATION
1 hereby alarm under penalty of perjury one of the following declarations:
I have and will maintain a Certo czm mcomentto self-insure for Workei sCompcn-
sation,az or
provided for by Section 3700 of the Later Code,for the Terfmance of the
work for which mil permit is issued.
0 1 have and will maintain Worker's Compensation Insurance,az required by Section
39ro of the Labor Chile,for d e performance of the work for which this permit is issued,
My,
y
Worker Compensation Insurance c ier anJ Pol'y number amp
'eo iP;W1 Poli o.MWO ty��_
RTIFI,AT OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
Fibis section reed notbecomplemd iflW permit is Gnone hundred dollars(S IIx)
or Icsa.)
I ccnRy 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 became subject to the Workers'Compensation
Laws of California.Dam
Applicant
NOTICE TO APPLICANT:e,after making this Cenifcnte of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
O O limnwi o comPly wise such provisions or Nry m
perit shall he retired revoked.
z h CONSTRUCTION LENDING AGENCY
F I hereby affirm Out there is a Construction lending agency for the performance of
4Yi me work lit which this permit is issued(Sec.3897,Co,C.)
1S] Q Lender's Name
U
z) Z Lender's Address
V Q 1 unity that I have mad thisapplication
and ciun and sum Nat and
above information is
ly F^ building 1 agree elcomply with all city and county madw,or and Cute laws relating e
V building conswninn,and hereby auNorim reprcsenutivcs of his city mercer.,,,a the
shove-mentioncr property for insIx ction purposes
(We)agree to gran,indemnify and it. harmless Inc City of Cupertino against �� 4
rn liabilities,judgments.cos;and expenses which may in any way accme against said City
U ,'� A consequence NDER granting(If this permit.
APPLICANT UNDERS DS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
S RCE UL
rt of ApplicanVCnmmnnr Dm Re-roofs
1 IAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant or future building mcupanl Crete or handle havarrnus material
az defined by IW Cupeninn Municipal Code.Chapter 9.12,and the 11ca1N and Safety
Code.Section 15533(a)7
❑Yea All roofs shall be inspected prior to any roofing material being installed.
Will mea applicant m mmrt Woum If a roof is installed without firs[obtaining an inspection,I agree to remove
pp g Occupant use equipment or devices which g I
emit hazardous air comaminams as defined by the Bay Area Air Quality Management all new materials for inspection.
DISVICri
❑Yes
1 have mad the harardoux materials requirements undor Chapmr 6.95ofthe Califor-
doesnahh&SalbtyCtW,have-error. 355115,35533and7551ity,,, rsunJ NmifIW IMthg /
doessrm eurrcndr hint a mnant,Nal itis myme ulnsibilridm Tf IW rccry. of me
rtggiremerLs when mnstn r mmisspance nfa ctnifieam of 'bun err. 4ignure of Applican Date
summixed agcnl Dalt All roof coverings to be Class "B" or better
Building Division
pDepaitm, 10300Tone Avenue
Cupertino;CA 95014-3255
Telephone: (408)777-3228
Cl of Fax. (408)777-3333
CUPERTINO �uildint
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. L .
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:
Address 21—
Reroofing Company Name-
Applicants Signature: Date:
Joe Antonucci
(Chief Building Official)
625101