02060086 CITY DONO
IVIISSINPERMIT CONTRACTOR INFORMATION:
c1 BUILDING ADDRESS: PERMIT NO.
10516 WHITNEY WY R A CONSTRUCTION 02060086
OWNER'S NAME: APPLICATION SUB DATE
RIOPEL DAVID P 15559 UNION AVE 06/13/2002
PHONF,: SANITARY NO. CONTROL NO.
(408) 369-9921
k OO ARCHITECTIENGINEER', BUILDING PERMIT INFO
k w BLDG ELECT PLUMB MECH
f i E I
�
n LICENSED CONTRACTOR'S DECLARATION Job Description
to
1 nereny cert mat I am licensed under provhsmes of Chapter 9(commencing
„_y= wimsection7000)ofDiv�ision3°ftnesnsinessand Prnmsslnnsewe.and an cense REROOF
is m mu force banerk�t
ticenseemss_L. g13c.# �43� 3 INSTALL PLYWOOD & 50 YR. PRESIDENTIAL COM
Date Cmume or
3 3 u.vii ARCHITECT'S DECLARATION
O; 1 understand my plans shill be used as public records
rso i
i ao O Licensed Proferamal
w o as OWNER BUILDER DECLARATION
1 hereby afford that I am exempt from the Ctramemr's License Law for the
E?¢ following reason(Section 7031.5,Business and Professions Code:Any city or county
4 D which requires a pewit to construct,alter,improve,demolish,or repair any structure
i 3 at Prat t issuance, 4 theapplicant f h permit fl signed statement -
thorn I< .im n700 postman, rte tConnector'sL : Law(Chaptu9 S Ft Floor'Area, a nation
ad ening„inscnrn7alaJd the basis
3 nn Boards,dx aP r nonseoaej t);�;, ;-'"v4•.ryx`..
or then he is exemptittierefrom and the basis for the alllgcd cxemptmn.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty
ofnot more than five hundred memos($50% umber Occupancy Type
°I,as owner of the property,or my employees with wages as their sole compensation,
will do the'wa k;and the nmm is is not intended or offered for sale(Sce.7044,-
'Business and Professions Code:The Contractor's License Law does not apply to an 307 - INSULAT IPoWlred Inspections
owner of property Who b rd -ma,mves th and whe d h work himself
or through has own employees provided that h improvements tintena d or 601 - ROOF TEAR OFF
offered fI If,how' - the bulding improvement' ld"im neyiarof ..-... - __..__
completion the o enbulderall have he burden of proving that he aid not bald or 602 - ROOF PLYWOOD NAIL '
improve ter parp se of sloe.). 603 - ROOF BATTENS
°l as owner of the property, L.- ._w- _. .. ... . ..ROOF
_ .. _..
c y vIv tions licensed h contractors to 604 - ROOF IN-PROGRESS
construct the project(Sec 9044,B d property f ns Cad )Th C ova tier.
s. o
Lice : La d t Puc t nor of acarriwho builds improves thereon
..and.. Contractsai .f h..P 1 t. wird a connanor(s)I scA P uant.w the ._. ._ ._ .. _. .._.. _ ���® .......__. _
ContractorL L F1.N
°I an exempt ima Sm. - B&PCfor tharemm� ,
Came, Data NOV 0 7 2002
_ WORKER'S COMPENSATION DECLARATION
I hereby affirm under Penalty of perjury one of the following declarations:
❑ 1 have and will maintain a Certificate of Consent to self-intme for Worker's BUILDING
�\ Compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this perme is ismed.
❑1 have dad will maintain Worker's Conipensmion Insurance,as required by Section
37W of the Labor Code,for the performance of the work for which this permit is
issued.My WorkersC p ip Insure c carrier and Policy be are.
Carder: 'Poli yNo. Inl2_5/2_D Z �x.v t.t�.i._ � �ti:: ( �. dc 1a.
Y
CERTIFICATION FROM WORKERS \ t d
COMPENSATION INSURANCE t _
` (This sect an n .. . . ,.' ._____ .._.... .._._. ........._
'Bed not he completed if the Permit is for one hundred dollars - `t' c"' f- -U t t t
(SI00)or less) . •,
1 nify that in m performance' of the work for whicH'his perm t is isw W.I 1 ,
shall not emph'y any person in any manner so as to become subject to the Workers' '
Compensation
`
tion Laws of California.Date
fimhu
NOTICE TO APPLICANT:If,after making his Cemificam of Exemptiom you should ,
0 Q become subject m te hWorker's Compensation provisions of the Labor Cade,you must
forthwith comply with such provisions or this permit shall be deemed revoked.
z r� .. .ONSTRUCTION. .. .... L.EN. ...
^� �' � -. CDINGAGENCY
a ' 1 but affirm that there is a construction lending agency Ride performance
of t
M1 weak for hichm Permit n issued(Sea.3097.Civ C)
LenName
_ ..._ _.. _ ..._. ..
Q " drs NS e
L . .... . . . ..... . ._ ... . .. .. .. ... . ... .. .. _.-
rid s Address ,
V'0 I comity that I have read this application and state that the above information is '
r.F cosrovrr,1 d,me a comply with fitI ty add carryod' ..ca bad Rod laws relating
Q (�
in ladlifingsivraniction,andhereby comprise representatives ofthis sityto candraparn
y �] the itorema,mi.madp ,ad,far inspectionp p .,
F. Y (We)agrom to save. tl iy adk p harmless theCity of Calamine agana /��
W liabilities,judgments.cost and expo h h y' any y against said '
V Z' City consequence of thegranting of thispermit. �s l./
APPLICANT UNDERSTANDS AND WILL COMPLY Issuedb Date
SOURCE'REGIILATIONS y
S,imunt,hApplicatNContrector' - "' 'Dare '. Re-roofs /
HAZARDOUS MATERIALS DISCLOSURE '
:. meapplicant nreb uding,ccp'al store or handle haramous material ..Type.of.Roof
Cacti, by
cvn M plcnd cnaw 9.cequipment
am at an and Safety ,- tPc,'�' p .. . y:'' g _g -.. _ _.. . .
Code S t ytheCapel r t t
tenth IDd
11'roo hall be ms acted nor to an roofin material beth installed.
Will to applicant future but ding occupant qu p If a nstalled without first obtaining an inspection; I agree to remove
c bmmmam a.defined 65 the Bay Area Air Quality Menagemem
Damon? rte arall new materia r inspection.-,Applicant understands and will comply with
( °Y. \ ,�N 1 all On-poi c 'egulati'
ons' --
!. I h a the hicumhua notiocallrequirements -nd Chapter 695 of the
Calf Health as Sof ry Cod Sections 25505 25533 d 25534.1understand that
if the bu Idmg Baas'not currently have a to a n,then it is my responsibility m notify in
occupant of the r meets;which must be at poor to issuance of a CerrEthe of
°cfupap`yature of Applicant Date
o aumoraep,agent - Date All roof coverings to be Class "B" or better
r,: - :..•:. , . .. .. _.. .. .. .. .. . OFFICE
> Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
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 1/a"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?4/ 9l 0e6L Z�(1/6
p —
Addreys:
Reroofing Company Na,:
Applicants Signature: '� Date:
Joe Antonucci
(Chief Building Official)
6/25/01