02010121CITY OF CUPERTINO
a BUIiAINO DIVISION PERMIT
BUILDING ADDRESS:
604 MILLER AV
OWNER'S NAME:
JAN SEAWAY
PHONE:
00 ARCHITECTIENGINEER:
z
Z y i LICENSED CONTRACTOR'S DECLARATION
O Z - 1 hereby affinn that I am licensed under provisions of Chapter 9 (commencing
Pte{: with Section 7") of Division 3 of the B:2inem and Professions Code, end my license
y is n f orce and r,gl,
SM V Lice la 7 Lic.
KKK �Djlte r
m
CogA
uaS 3 w G"i ARCHITECT'S DECLARATION
t O 1 understand my plans shall ire used as pub[ records
to �
a. i p� p Lensed Professional
viR � OWNER -BUILDER m the CoATION
_ I hereby aRum Nat 11. exempt from d¢ C Professions
os e: Any c Law for the
t ? < following reason. (Sabin ]031.5, Business and vefessiom Code: Any city or county
FO
Which requires npermit reeonswn,almcimprove,demolish. orehapaur my gedstructure
�3$
prior tie issuance, &•.w.lrn..�A,aFGI^cam for such permit wfileesigrtedrteino.
CONTRACTOR
PERMIT NO.
02010121
APPLIC TION S B DAIS
0 7 2002
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
fJ IJ L__' I---1
Job Descr'pption
T/O TAR GRAVEL ROOFVLYURETHANE FOAM &
CASTINGS
❑YetWil' r�BMt
n 'hewont o f t rt bac
imi, M ioN u air it a nwmmams m de
Drsmn 1
t j'I 0Y<r
1 have read the harsdous mo
Occup cL
Owner ocemhc
ZZ
8 occupant use equipment or devices which
d by the Bay Arta Air Qualuy Management
its requirements under Chapter 6.93 of the
a tenant: that it is my responsibilit
yjsl be met priori to 15Shance of,a
Fi
All roofs shall be inspected prior to_any roofing material being installed,. ,
If a roof is installed without first obtaining an''inspection;,I agree to remove
all new materials for inspection. Applicant understand_s_and will comply with
all non=point source regulations;
it
Signature of Appli ant Date
All roof coverings to be Class " B" or, better
-- OFFICE
mf not mote than five, hundred dol?&M). ■ ,
❑I,mowner of Ne propcny,mmy, wegts es Char O e-( compenwsaeion,
will do Ne works and the structure is-act'Intended or offend forsale (Sec.
Business and ProPossions Code: The Contractor's License law does not apply to an
®FdYRor Number
F
e. uccupancy type
--_. ...
3 07 - INSULAT] G*jired Inspections • ' `t
owner of prupcny Who builds or improves thereon, and who does such work himself
601 - ROOF TEAR OFF
or through his own employees. Provided that such improvements are not intended or-_.,+
offered far'.).: IE however, the building or improvement is sold within one year of
'- -- -----'-6 -' `__
02-= ROOF `PLYWOOD—NAIli ..
completion, doe owner -builder will have the human of
p proving Nm he did not build or
improve tar parpox 9r' aalet.
603 - ROOF BATTENS �
_
cl l es owner o(thESS—
am to
e p(Sec. d do:) The
- -
7 Buexcsiness a Commacts
(Sec. ]toa Business and Professions CndeU The
License the projectProle sins C trecmr's
-
License Law divas noir-sue apply toan owner ofproperty who builds improves
_„ l
eaimprovesthereon,
,and who.commctse asuch.projeeb wiN.a commcmr(s).licenxJ Pursuentm.We..
rcentr
._. _-.___._. ._ .... _._._......._._._____.___.__... .._r..___.__. _. _____.._. _ ......C.
-"-
01 am e e License Isw,.
❑lam exempt under see.':B&PCfor this ..on
.: l�"•: :'11C•P'1
-
Ownsr•t ."`Dote'
" -' "' WORKER'S COMPENSATION DECLARATION
'
I hereby alarm under penelty_of perjury one, of the following cadarstiom:
❑ I have and will maintain a'Catifmam of Consent to aelf-insum for Worker's
l
Compensation; as provided for by Section 3700 of the Labor Code, for -the
p ofurmance of the work for which this permit is issued.,
have and'will mainmlit Worker's Compensation Insurance, as rcquircd by Section
7M of the Labor Code, for the pefformance of the work for which this permit is
i.. aced M Worker's Ccimpe tion 1. uiunca tamer anal Policy nump6er a.rcA
c No i✓C 7.2V
[icy
y.l^
sy :e!- `i T•"}A,'•
' CERTIFICATION OP. EXEMPTION FROM WORKERS'!
s,t.%�1 ! 1.121,4 e1
COMPENSATION INSURANCEt 1
._...._..,, _...._...,,,, ...__ .-._ _ ...
''(This lection need not be tomplercd if the permit is for one hundred dollars
SI 00) or ICSs.)
I certify than m f the wortT ch ubj perm tis issue) I
pt in
shall not employ any person any a
m any manner so as m became subject m the Workers'
co
f Call
Comicant' on Laws of Calil'omla. DateAppls'
:NOTICE TO APP LICA :1.=Rcr making this Cenificme of Exemption: yogshould
Q Q66hime
subject to the Worker's Compensition provisions of the Labor Code: you must
fdnhwim'comply with
such provisions or this permit shall be deemed .yoked.
'e`I''! •• (CONSTRUCTION LENDING'AGENCY'
1 h re6y allium that d - W lending agency forthe
"
coet n performance
n
bf the irk fo Which this is issued (Sec 3097 Civ C
y.Q
pemm )
L oderl Nam
Lender's Add es
0Q
U,
V-
s
m ahordinances thandcatmal mig
c5th tact Imgreyesnac apsly, 411 scity c❑ countyn rid sm
ndstate
t t laws
b dtl ns o d hereby nth enttives ofthr ty mener upon
gmen
owa
bntopony f pu n p -
dgrectove,idemnify orok cip harnita the y peni,am,,
liabilities.judgments.costs and expenses which mayinany wayaccrme against said
City n co equence f h gmming of dp mi
I
/Z(5
NI
STRCANT UNDERSY 5Ate'rtCi�I. CO>f WITH ALL NO POLI
Issued by: Date
SOJIRCE REGULAT S.I / / ��s Q OZ
„Signature
of ApphdandC.m.,to 'DataRe-roofs
.
HAZAADO MATERIALS DISCLOSURE
t Will theapplicant or, future b Ild ng occupaw store or handl haiurdaus material
m,lefned by one r iv,nir, M n =. ml r•,de Chapter 912 and the Health and Safety.
�I
,... `J pe Of. ROOF .... .. _. __ .. _ . .. _ .. _... ... .. ........ . .-,...... ,.._ ..., ., _..
❑YetWil' r�BMt
n 'hewont o f t rt bac
imi, M ioN u air it a nwmmams m de
Drsmn 1
t j'I 0Y<r
1 have read the harsdous mo
Occup cL
Owner ocemhc
ZZ
8 occupant use equipment or devices which
d by the Bay Arta Air Qualuy Management
its requirements under Chapter 6.93 of the
a tenant: that it is my responsibilit
yjsl be met priori to 15Shance of,a
Fi
All roofs shall be inspected prior to_any roofing material being installed,. ,
If a roof is installed without first obtaining an''inspection;,I agree to remove
all new materials for inspection. Applicant understand_s_and will comply with
all non=point source regulations;
it
Signature of Appli ant Date
All roof coverings to be Class " B" or, better
-- OFFICE
CITY OF
CUPERTINO
Building Division
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: (408) 777-3228
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.
A
IMPORTANT:
1. Flat roofs must have a minimum of 1/s" 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:
Address: 60 Y -)IAUSI. �01-
Reroofing Company Name: �. �9 e'
Applicants Signature: Date: /Z41
o ti
Joe Antonucci
(Chief Building Official)
6/25/01