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02100043 CITY OF CUPERTINO oil BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:Yz .psi ", r/w..,m• F> BUILD@F'.4I4ESEL PRADO WY EMIL KOLEV PERMIT N®2100043 owbR1o411yE:KOLE V APPLICATI?1'�UIYD/i1T/2 0 0 2 ZONE: SANITARY NO. / CONTROL NO. ARCHITEC'UENGINEER: BUILDING PERMIT INFO BLDG ELECT PLUMB MECII 0 0 0 0 w00 LICI3NSEDCONTRACI'OR'S DECLARATION a u u I Herm,dorm that 1 am Gecteed coder onsisloos nr Chapter 9(commencing REROOF Job Description <i with Section?)(BUDivinon3n17 the Brainessand Profesdons Code.and my license is F O y In full force and effect. 90"uf? License Class Lic.of O_Z— Date Contractor F"=5- ARCHHECPS DECLARATION 2 9 K� 1 understand my plans shall M used as public records oats m 3 u Licensed Poilexsional 0< OWNER.BUILDER DECLARATION aI I hereby uffrm that 1 am Cxcmpl loom the Contractor's License Law for the it cI o fallowing reason,(Scaunn 703 L.5,Business and Professions Cook:Any city or county $8000 m which requires a Permit to construct,alter,improve.demolish,or repair any sruclure prior In its issuance,also requires the applicant forsuch permit o Glc a signed statement ys< that he isBecowdpursuant otheProvisions oftheConurnmr''sLicense Law(Chapter9 Valuation co, (commencing with Section 7kd of Division Solthe B.Airessand Professions Code)rr 0.3— that he is exempt thertford and the basis for the alleged esemption.Any violation of Section 7031.5 by any applicant for a permitsubjecu the applicant to a Civil penalty Of IONf-N Occupancy OCCU T hal me.than wFvehundred dollars(s5oo>. 307 - INSULATION p ye p ❑ I,as onerof the properly,tar my employees with wages az their solo eompcnsatinn. will do the work.and the struqure is not intended or ffered for sale(Sec.]BM,Business — p[�Ug �pg�•,k�p and Professions Code:The Conuactor's License Law does not apply to an owner of 602 - ROOF P T YV V n IVH l Lns property who builds or improves thereon,and who docs such work himself or through his Own employees,provided that uch improvements are not intended or offered for sale.If. 603 — ROOF BAT'T'ENS however,the building nr improvement is sold within one year of completion,the owner. builder will nave the burden of proving that rte did not mild or improve for purpose of 604 — ROOF IN—PROGRESS sale.). ❑I,as Owner of the property,am exclusively contracting with licensed contractors to construct the project(See.7 VI.Business and Professions CodeT The Cummenes Li comic Law does not apply to an owner of property who Wilds or improves lumber,ber,and who condos for such pmjecs with a connactor(s)licensed pursuant to the Cnnuactor's License Law. — +"r I am crit funder Sc ��Bq1&PC for Nix¢a no �' `wa o IF cr WORK R'SCOM N ONDECLAR6PION 10-7- 07 mOU 12 9 2002 I hereby affirm under penally of perjury one of the following declarations: 1 have and will maintain a Ceni Ecate of Consent self-i norm for Worker's Condom- of ondom- BUILDING cation,u provided for by Section 3]UI of the Lahr Code,for the performame of the work for which this permit is issued. ❑1 have and will maintain Worker's Compensation Insurance,as"died by Section 3701 of the labor Code,for the performance of the work for which this permit is issued. My Worker's Compensation Insurance carrier and Policy number art: Cartier: Policy Nn.: _ CERTIFICATE.OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This.CLUm need not he completed if de permit is for one hundred dollars($la) or lest) 1 certify to in the effoymance of the work for which this Permit is issued,l shall not employ any pmsrm imp/manner m as to subject become subjeco the WorkersCompensation Laws of Cat,jlYnix. Ic Applicant t still,I t r NOUCErTO APPLICANT:It,after making this Cenificmc of Exemption,you should Mcnm Object m the Worker's Compensation provisions of the Lahr Code.you must O O fon th comply with such provisions rr this permit shall Is,deemed revoked. z to CONSTRUCTION LENDING AGENCY [-+ I hereby affirm that there is a construction lending agency for performance of the work for which this permit is issued(Sec.3B97.Civ.C.) WF Under's Name CL Lender's Address ] z V 0 I certify Out I have read this application and nam thio the alxle l information is ��— Iy F building Constr agree m co.plyand herebyth city and repeciounty nrdiivos ofies and city to entawser relating upothe QV above mentioned prn.and hcrehyauthon purposes. (we) Niscity tocntcfurym the above mentioned to sucy for inspection purposes. f h (Wp agree to save,indemnify es keep harmless the City n Cupertino against N incoabi ises.qunce of ts,the craning Of this pored, may in any waya<cmc against said City C) z in consequence of the graining of this permit. ^ APPLICANT UNDE STA DS A�p WILL COMPLY WITH ALL NON-POINT Issued by: Date 1 SOURC .GULA NS.�/ x �c�_ Re-roofs S gra' me A,firem rrlmcunDole HAZARDOUS MATERIALS DISCLOSURE. Type of Roof Will me applicant or furore,building occupant store or handle•hvallous material az JcrZd by the CuPcnino Municipal Calc.Chapter 9.12,and the Health and Safely .rJc.Scninn 255321a)? E]Yes )�LNr, All roofs shall be inspected prior to any roofing material being installed. Will the applicant Or future building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove emit moments air contaminants as defined by the Bay Arca Air Quality Management all new materials for inspection. Duthidy ❑Yes PO I have read the hazardous materials rcquiremcos under Chapter 6.95 of Ne Califon ria Health A Safety Cook.Secuom 255)5,25533 and 255331 undersnM that if the building q does not currently have a mount.Na it is y resrymsihiI y to notify IM occupant Of the regairemen�Avmenmosnemel'dormi•,anaoracemGeate Ibenpancr. Signature ofApplican male rUataorocdagent Dale All roof coverings to be Class"B" or better 0 OWNER-BUILDER VERIFICATION 1. (Check one) I or my immediate family (parent, spouse or child) will perform: A. All the work authorized by this permit B. _ A portion of the work C. _ None of the work If B or-Cis checked,com Tete 2 or 3 below. �F� OCT 0 7 2002 2. A state licensed contractor will be hired to do: BY: A. _ All of the work _ B. _ A portion of the work(complete section below) Contractor Address/City Phone # State License # Type of work to be performed • 3. _ I will utilize unlicensed person(s) other than my immediate family to perform all or portions of the authorized work. I understand that I may be an employer (see reverse side). A, Certificate of Insurance covering workers' compensation must be on file at the City of Cupertino Building Department office. Person/Firm Address/City Phone Number Type of work to be performed ..................................................................................................................................................................................... I declare under penalty of perjury that the above is true and correct. I have read and understand the Owner-Builder Information (reverse side). Property Owners Signaturl de: 10- I__0 Z ©al DamJob Adds ��`2�4 �� F�-A-170 kA;&c{ Permit# Any changes to the information provided on this form shall be submitted to the City of Cupertino Build Department. fy( CITY OF City of Cupertino Building Departnnee 10300 Torre Avon CUPS TINO Phone: (408)777-3228 Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as owner-builder you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract,you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family,and the work (including materials and other costs) is$200 or more for the entire project, and such persons are not licensed as contractors or subcontractors,then you may be an employer. if you are an employer,you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes,workers' compensation insurance,disability insurance costs, and unemployment compensatiole contributions. There may be financial risks for you if you do not carry out these obligations,and these risks are especially serious with respect to workers' compensation insurance. For more specific information about your obligations under federal law,contact the Internal Revenue Service (and,if you wish,the U.S. Small Business Administration). For more specific information about your obligations under state law,contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale,property owners who are not licensed contractors are allowed to perform their work personally or through their own employees,without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an owner-builder building permit, erroneously implying that the property owner is providing his.or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N Street,Sacramento, California 95814. Please complete and return the enclosed owner-builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, Building Department, City of Cupertino Printed on Recycled Paper Budding Division ' 10300 Torre Avenue ' Cupertino,CA 95014-3255 Telephone: (408)777-3228 Fax: (408)777-3333 CUPERTINO 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) pproval3) 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: C'F i c Vo Lel Address: _ 744 l;i. pp- 00 WA-Y CPx ` er��w CA- Reroofing Company Name: F)y •[\-M e W L- Applicants Signature: , Date: l O - 7-D'Z i Joe Antonucci (Chief Building Official) 6/25101