02110069 CITY OF CIJPEwrINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
pdd1PM4D9RLVOSS AV LINDY ROOFING CO INC PERMI"EL02110069
230 !
OWDO ,: THURMAN AND MILDRED 5554 HARVARD DR APPLICATION.]-4°d•Tf2002
ONS: 408 269-2025 SANITARY NO. CONTROL NO.
ARCIIM-CF/ENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MP,CH
wpm LICENSED CONIRACfOR'S DECLARATION
z�F Ihemby affirm that l am licensed under provisions of chapter 9(commencing REROOF Job Description
<7w wbh Scetion TOO of Division 3of the Busin and Professions Code.and my license is
�j N ;n full fnree s car
ZO"v(Z Liccna toss Licp /�v 13ll IJ
oy—o
Date 2,:�Cn_1.A��W�/
ARCIIITECrS LARATI N
¢a 1 underslanJ my plans shall be use s Puhlie rc<ordx g'
Oyu 11
30 to LicensedI'mfeainnal rs�
06 , OWNER"BUILDER DECLARATION
<i 1 hereby affirm that 1 am exempt from the Cnnraauh 1.ian.m Ww n,r roc
$11090
w—o O following reason.(Section 7031.5,Business and Professions Gare;Any city or county
which mquircs a permit to eansther.alte,improve,demolish,or repair any atruc om
w�'r+ poor to its issuance,also requires the applicant for such Permit to file a signed statement
that he is licensed pursuant to the provisions of the Contractors Lice ase,law(Chapter 9 39:P5t00dd4A&a Valuation
e�tu (commencing with Section 711!1111 of Division 3 of the B mumass and Professions Code)Or
y Nat he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 703 L5 by any applicant for a Permit subjects the applicant to a civil penalty of PNRb� Occupancy Type
no,more than five hundred dollars($500)' 307 — INSULATION
I,as owner of the propeorty.or my employees with wages as their sole compensation, 681 RE16
will do the work,and the structure is not intended proffered for sale(Sec.7001.Business �1 k��({O
and Professions Cute:The Contraclnrs License law dues set apply to an owner of 602 - ROOF PL � LVH 7-L n5
property who builds or improves thereon,and who docssuch work himself or through his
nemployers,pmvite!that such improvements am normm�ded or offered for mle.If. 603 — ROOF BATTENS
however.the Molding or improvement is sold within one year of completion,the owner- 604 — ROOF IN—PROGRESS
but]&,will have the burden of proving Nal he did not Wild or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7014,Business and Professions Code:)The Contractor's Li-
crow Law docs not apply In an owmcr of property who builds or improves thereon,and
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
Liecose Law.
❑l am exempt under Sec. B&P C fur this ration
OwnerDow
WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury one of de following declarations:
1 have and will maintain a Certlficare of Consent n sal f-acture for Worker'sCumpco-
cation,as provided for by Section That of the labor Code,for the perfnemance of the
work for which this Permit is issued.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
3781 of the Labor GNc,for the Performance of the work for which this Permit is issued.
M Wke(r''sCu//mp�c n�sa�tin/rylntumncc carter and Pnit /umberam.
�atricr:"IL 4 I� Pnlic ire � �
CE T gCATF.OFEXEMPTIONFROMWORKERS'
COMPENSATION INSURANCE
Orris section need not he completed if IM permit is foronc hundred dollars(S Rat)
,it less.)
1 verify that in the performance of the work for which this Permit is issued.1 shall nor
employ any ps,outin in any manter.snse,it)become subject on the Workers''Con,ansaion
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Eacmption,you should
become subject to the Worker s Compensation provisions of the Ian Code,you must
07, forthwith comply with such provisions or this Permit shall List deemed revoked.
zO CONSTRUCFION LENDING AGENCY
[r rNi I hereby alllrm Nut there is a construction lending agency l or the Performance of
Ik 7 the work for which this Permit is issued(Sec.3097,Co,C.)
{S1 0 Under,Name
7 Z lender's Addmss
O Q 1 certify Nal I have read this application and swat that the above information is
W H cornier.1 agree In comply with all city and county ordinances and state laws relating to
OU building construction,and hereby aulborim representatives of this city In enter upon the
r W above mentioned property for inspection purposes.
(Wed agree to save,thdemnt ly and keep harmless the City of Cupeni no against
F" y liabilities,judgments.costs and expenses which may in any way seems,against said City F/
V Z in consequence of the granting of thin permit.
�+ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL ON-POINT Issued by: Date
SOURC- GULA
/2�a Re-roofs
.ignawrc of Apel n Cora. r Dale
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future building occupant store or handle hara Lards material
as defined by the Cupenimt Municipal Code.Chapter 9.12,and the Health sad Safely
Coce.sectinn25532ho? /' All roofs shall be inspected prior to any roofing material being installed.
Will thea applicant or building Occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
pP d by the a Air
emitict? usair cumaminantsasJCMCJbythenayAseaAirQuality Management all new materials for inspection.
District?
E3 Yet
I have read the harardous material.,requirements under Chunmr 6.95 of Ne Califon
ria BealthS Safety Coak.Savo 25515.25533 and 25!00e.[understand"dobuilding (
does rail commit,have u tenant,chat it in mY espmeibilily m nutily the rcvuPant rl Ns,
regWre nmwh an mpdorm; b faCatmca Oceuparey. Signalureo pplica t Date
r
Owner or oalhorr agent Dale All roof coverings to be Class "B" or better
Building Division '
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF 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) 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 YL"per foot slope and demonstrate that
there is no ponding.
2. An LC.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: 17,0'e]A S
Address: -?aq
Reroofing Company Name: Lis;;l i ,�,/—�,�i ('e
Applicants Signature: Date
Joe Antonucci
(Chief Building Official)
6MI01