02110116 CITY OF CUPERTINO
BBH.DING DIVISION PERMIT CONTRACTOR INFORMATION:->
BUu *1:SRANDY LANE R E ROOFING & CONSTRUCTIO PE3*M02110116
owr@AsR,h1rORR 108 OAKLAND PL APPLICATIIllsYBl'91y2002
HONE: 408 925-9995 SANITARY NO. 7 CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
w00 LICENSED CONT'RACTOR'S DECLARA'1lON p O O O O
po u I hemby ri Pon the 1 am Iicensed ander prammorie of Chapter 9(mmmenciag REROOF (EXI STI �b
0 , with Section 7X0)of Divisin 3of me Buboes mad Pnde�siom Code and my license is
in full fcmumd clfccl. '�q /��
=o�= Lieen�GlG. tlLie.N� L b�� �N�LE®
oy—o Dam_ �m _
I--� ARCIII :CI'S UECL !
�'�� w ermine n,y plana mnau clod as pan 'recn> NOV 2 s 2002
oats
u'ci ie I. Licensed Professional
0 OWNER-BUILDER DECLARATION
S ui I hereby affirm that 1 am exempt from the Contractor's License Law for the
$1900
�aoo following mason,(Seetion 7031.5.Business and Professions Code:Any unyorcounty BUILDING
6I m which requires a permit w construct,alter.improve.Jemuhah,or repair any structure
� prior u,its issuance,also mrryires the applicant ler such Permit it)file asigecd.matemcn.
r-?s< that he is licensed punuam eo me prnv sof the Contractors Lecnsc taw Whapter9 3SW61UM&8AQ@ Valuation
a (commencing with Scctiun 7kXpaf Division 3 of the Business and Professions Codi or
WNat he is exempt therefmm and the hasis for the alleged exemption.Any violation of
Section 7131.5 by any applicant for a permit subjects the applicant to a civil penalty of PN NONWE Occupancy Type
not mom than five hundred dollars(SM 307 - INSULATION
❑ I.as owner of the property,or my employers with wages as their sole compensation,
will Jo she work,and the structure is not intended or offered for sale(Sec.liked,Business
and Preferences Code:The Commucror's license law does not apply to an owner of6 02 — ROOF P nRAcliitris
property who builds or improves pros thereon,and who docamol,work himself or through his
own employees,provided that such improvements arc not intended orolTereJ for sale.If. 603 — ROOF BATTENS
however.he building or improvement is mild within one year of completion,the owner 604 — ROOF IN-PROGRESS
builder will have the burden of proving that he did not Wild or improve for purpose of
salt.).
D 1,as owner of the property,am exclusively contracting with licensed contractors to
consumer the project(Sec.7Ha,Business and Professions Code:)The Convector's Li-
se law does not apply in an owner of propertY who milds or improves mcmi and
who contract for such projects wit a enmranm(s)licensed pursfanuu the Contractors
Lice.Low,
1 am exempt under Sec. .B&P C for this reason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 humpy affirm under penalty of perjury one of the following declarations:
ED 1 have and will maintain a Certificate of Consent to self-insure for Worker's Compete
.tine,ss provided for by Section 3700 of the labor Code,for the performance of IW
work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as required by Suction
of me Labor Code.for the performance of Jm work for which this permit is issued.
My nrkcr�s sCooanaNns`mu Insurance carrier and Policy other v
Cartier: ✓12t 1�' PolicY Nc.: E_
CERTIFICATE OFAXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This rection need not W completed if the permit is forone hundred dollars I$Bad
or less.)
I certify that in the perforronce of the work for which this permit is issued.I shall not
employ any person in any manner so m rat Wcome subject to the Writers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:H.after making this Ccnircale of Exemption,you should
hceomc subject to the Worker's Compensation provisions of the labor Code,you most
OO forthwith comply with such provisions or this permit shall W deemed revoked.
z CONSTRUCTION LENDING AGENCY
[-. I hereby affirm that thew is a construction lending agency fns the"luminance of
IY7 the work for which this permit is issued(Sec.YNT Civ.C.)
tit Q Lender's Name
O. corrects Address
greet
V 0 1 certify that 1 have read this application and mita that the above information is
building constitution,
comply herebyth lndichid represounty entatives
of and stem laws enter
gm 1/V'/a9J'J.rY
�U .1iovengemithactiomand hereby rc news. rises of this city,cnmr upon the
abovcmentiorce property for inspection purposes.
>" (We)agave w save,indemnify and keep harmless the City of Cupertino id ity
UN incoufesjudgmenhe Poing estimates Which may mmyway aeeme.gamst said City _ OL
C.7 z in ttmreyuNT NDERSming of this Permit.
NT UNDERSTA WILL COMPLY WITII A L NO POINT Issued by: Date
SO :ATIO
<< �y Re-roofs
m ApplmanVConljJabur Dam
HAT,'ARDOUS MATERIALS DISCLOSURE Type of Roof
WiLLNoapphcam or future building sareupam stem or handle haraNulu material
as defined by the CuNrI no Municipal Code.Chapter 9.12,and the Health and Safay
Code,Section 25532(a)? ! All roofs shall be inspected prior to any roofing material being installed.
❑Yes Nn
Will mea ream lir future building occf al free f or devices whip If a roof is installed without first obtaining an inspection, I agree to remove
pn 1: Pa ympmen
tell AaeaNuus air contaminants;as J ncJ by the Bay Arca Air Qualify Management taw materials for inspection.
Dismal
❑Yes No I
�_ I
Ihave ad the huvardoes materials mgaimmems under Chapmrfi 95nf me ihor- \� ��
nig Ilcalm&Safety Cons.Sccdons 255115,25533 and �5
2551s.lundcrstand that if Jr Wil l
o tenan I re.,molo ify In nobly the occupant of the
mspi sou tp'o r ancon Ccnificalcof Oicup 'y.
oh Signature of•Applican Date
aft All roof coverings to be Class "B" or better
Owego iwJa,
OCIOF
Building Division
10300 Torre Avenue
Cupertino,CA 950143255
Telephone: (408)777-3228
CUPERTINO Fax: (408)777-3333
Building rtment
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 VV 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
eejppoliccyy on reroofing and will comply with this policy.
Homeowners Name: 1 1 CA-?, t_ UR
R
Address: 2� �lYIi0Y L. p�
Reroofing Company Name: 'T' �� �y GF i (� Co'j 5TZL�-C.-TI•du\ .
Applicants Signature: Date: l I p 2
• Joe Antonucci
(Chief Building Official)
6/25/01