02100092 CITY OF CUPERTINO "'
BUILDING DIVISION PERMIT CONTRACTORINFORIGIATIQN'' �
„ata 1 .,TSL
BDEl?l8BkBI51lsLOREE AVE PERMrrN(02100092
s OY'bPOTPR WONG r MAPPLICATIJIUIry 2002
IFHONE: SANITARY N0, // 11 // CONTROL NO.
ARCHTTECTIENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
00 LICENSED CONTRACTOR'S DECLARATION
asGIherebyaffirmthm1amIiOd underddP...omofChapter9(commencing REROOF Job Description
with Sevilla L,.(fil Division 3oftht,Bus sanJPndmsions Code,and mylicense is
F to full to as del cct..� � ��-��"t
'q 3 I.iwnsc C1�Ci TTfc x��'L�I
<F yQaF� 1 to l ARCS IIITIiCTS 1lILLAy IfIN /I/
XI understand my plans 5M1a11 Mused as pul+lic retards /O
co
y U46
wpr Licensed l'rnfossinnal
2a OWNER-BUILDER DECLARATION 2
1 hereby affirm mat I am exempt from the Contractor's License Law for the fir$4 4 0 0
w_Oo following mason.section 7131.5 Business and Professions Code:Any city or county
a. $ which requires a rymot m construct,altof,improve,tied...NO,or repair any structure
poor it)its issuance,also rerfOres the applicant orsuch permit m f Ie a signed summent
that he is limned pursuant it)the provisions of the Contractor's License Lite(Chapter 9 3g5a_T0&2AQM Valuation
F (etmmcna Map cins with Scotian of Division Sof the B usi noes and Professions Code)...
V$E that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 703 L5 by any applicants for a permit subjects me applicant m a civil penalty ofPLV'N OCGO anC e
not mom than fim hundred dollars(SSW). 3 0 7 - INSULATION p y Typ
0 I,u owner m me pmpeny.or my employees with wages u Meir suit,compensation,
will do the work,and me structure is nal intended or offered for sale(Sec.7Wx,Business qp �,j
and Professions Cute:The Contractor's License Law does not apply to an owner of 602 — ROOF P n LV�7.IOnS
property,who builds Or improves therron,and who does such work himselfor through his L
own employees.provided that such impmearmnts sure,not intended or offered for sale.If. 603 — ROOF BATTENS
however.the building or improvement is sold within one year of completion,the owner. 6O4 — ROOF IN-PROGRESS
builder will have the burden of proving mat he did not build or improve fill purpose at
sate.).
El 1,as owner of the property,am exclusively contracting with licensed commeams m
consumer the pmjee(Sec.long Business and Professions Code:)no Contractors Li.
cense law does not apply to an owner of propeny who builds or improves thereon.and
whuc m tIcts fee'of
projects with a contractor(s)licensed pursuant o me Comranor's
c .araw.aaxetryygI and Sec�/ p B h P C for this«eon
Owner a�V—t'" " �a` -ggf(i(UMI'.sxl
WORKER'S COMPENSATION DECLA N
1 hereby affirm under penalty of perjury one of the following declarations:
l have and will maintain a Cool flood of Consent to self-insure for Worker's Compote
Sudan.as provided for by Section 3)11(1 of the talar Code,for the performance of the
.,,it for which this permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
37N)of the Labor Code,for me performance of the wad for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number am:
Cornier. Policy No.:
CERTIFICATE OF EXEMPrION FROM WORKERS'
COMPENSATION INSURANCE
ffhks section need nal M completed if IM permit is free.hundred dollars(SIM)
or less.)
1 certify dim in the performance of the work Iia which this permit is issued,1 shall not
employ anY person�tehY manner se at u�xEgr4F aux:...m the Wmkers'Compensation
Lawsof .CelifnryWs
Applicant
NOT!�CFF//TO APPLICANT:If,after making this Cenillem,of Exemption,you should
Mctbl(Aubjcc,to the Worker's Compensation provisions of the Labor Calc,you most
O O forthwith comply with such provisions or this pefmil shall be deemed revoked.
z CONSTRUCTION LENDING AGENCY
[-. .�. I hereby uBirm mat more is a conswetion lending agency for the performance of
i the work Iia which suis permit is ismad(See.NN7,Ci,C.)
4 Q LeendaName
z 1.cnder's Address
U 0 1 certify that I have read this application and auto thin the above infotmminn is
V, I~ cancel l agree to comply with all city and county ordinances and state taws relating to
O U building eosniclom,and hereby authoria rtpmsentatives ofthis city loaner upon the
D.l abovementioned property for Inspection purposes.
G, (We)agree in save,indemnify and keep harmless the City of Cupertino against
y
liabilities.judgments.costs and expenses which may in any way aceme against mid City
U 7 in consequence of the granting Of this permit.
�i APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOUR E FfiUl.yk,T``f'14
C_ (/' LL I° -it "-'12" Re-roofs
nature of v
Applican iCOnactor Data
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will me applicant or future building occupom sem or handle hmardous material
u defined by the Cupertino Municipal Calc,Chapter 9.12.and the Health and Safety
Ctale.Section 25532(.)? All roofs shall be inspected prior to any roofing material being installed.
❑Yea 0_tNo
Will the applicant or Cut..Wildingoccepam use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
,.it hazardous air contaminants as donned by the Bay Arca Air Quality Mamgcmenl all new materials for inspection.
Thoricty
❑Yes KN.
Ihovt,ma Ytht,huvallousmoteriahmquimmentsunJerChapteroldLiftbe Calding
dies not &SWComedy Cnk,tenant,
it is my rspoSS3s.l it)a understand cap ,ofm�
does not curtcndy have a¢neat,mal it is my msrytuihiliry m n tM oecupant of me S A G
myui cols hichmuuhegnpnnnnissuanccnfaConifcatcof vpanc�. ature of Applicant Date
IVM•
ter to aatnnrlad agent Dare All roof coverings to be Class "B" or better
Building Division
10300 Toren Avenue
4Cuperdno,CA 95014-3255
Telephone: (408)777-3228
C 0 F= (408)777-3333
CUPEPTINO
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 M"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: t�ie \A✓ o+k�
5
Address: . �2� ��,V C1,..
Reroofing Company Name:
Applicants Signature: Date: 10 OZ
Joe Antonucci � .
(Chief Building Official)
'6/25/01