02070007 (4) CITY OF
PERTNO
BUILDING DONPERMIT CONTRACTOR INFORMATION:
BiB�14Nr0TRPPhAR LAP DR TEO ' S ROOFING PERMIT ZP2O70007
°ffffff : GERALD A AND CAROL J 691 IN SAN CARLOS APPLICANfs�lylBl 6sA' 002
PHONE' (408) 279-8797 SANITARY NO.. Vl/ `CONTROL NO.
^n Z ARCHITECf/ENGINEER: BUILDING PERMIT INFO
O C - BLDG ELECT' PLUMB MECH
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an
5 y i LICENSED s dunderCONTRACTOR'S DECLARATION ofC ON Job Description
K. Ihcrcbyslimethat1amofthecdunderprovisions,iChepeee9rdwylimaw, REROOF p
�� with Section 7oW)ar omi,inn 3 ohne esu ata rrofr„mn>code,ane sur R«n,e
l force 3 Q Lc.N G t o 9
yi¢ I.eca
u C a ARCHITECT'S UE AT
,�, 1 understand my plana shall be used as public records
i i p C Licensed Form tional
ae n OWNER-BUILDER DECLARATION I
1 hereby affront that I am exempt from the Contractor's License Law for the $12000
F following reason,(Section 7031.5.Busines and Professions Code:Anv city or county
F o which requires a permit In construct,alter,improve,demolish,or repair any ewemre
a3g prior tells issuance.also requires the applicant nim such permitto file a signedstmcmcnt - -- -
'hit hei.slicensed pursa,im to the pmvision.sof the Contractor's License Law(Chapter 9 r a Valuation
(commencing will]Smu..7")of Division 3 of the Business and Professions Codq r , f , , y'• I. ,
.,,but he is exempt therefrom widths basis for the alleged demieiun.Any violation
of Section 7031.5 by env applicant for a a meit subject the applicant to a civil panalty
of not morethan rise Imndred donor.S5001. 3UbAPN XiiiW Occupancy Type
❑l,as owner a the primary.or my wail oy sea with wages a,melraam compensation, 307 - INSULATION
will do the work,and the structure is not intended or offend for sale(See.711ff1,
Business and Professions Code:The Contractor License Law does not apply to andos HODS
caner of property Who builds or imperial thereon,and who docs sum work himself 6 0 2 - ROOF PL 8 N.v��
or through Itis own employees.provided that such improvements are not intended or 603 - ROOF BATTENS
offered for sale.If,however,the building or improvement is sold within one ya.,of ,
completion.the owner-builder will have die bordeo of pawing that he did not baud or 604 — ROOF IN—PROGRESS
improve for purpose of w11.1,
. contracting
❑Las rofthc p(Sm.74th BclusisNandfesins Coda:)
de Cncrersto
License
Law project(Sec.mat owners..and property
who
Coeeq The Conmeeo ...
License Ivo does not apply to of owner with
a arenty who builds sed p rstm thereon.e
emf who contracts for such.projects with a contmmor(s)licensed pursmmt m the .... - - _. .. . .. ..
' License Law.
0 1 am am exempt sends Sec ,B&PCfar this reason •• t
OwnerData
WORKER'S COMPENSATION DECLARATION f11�k�fI1 �k ff r�
I hereby i ffime under penalty,of permry one of the following deelamtion, �0 U v"+A.Cw E 0
). ❑ 1 have and will maintain a Cmifimn of Consent to self-insure for Worker's
aw_Y Comarraili n, as provided for by section 37W of the Labor Code. for the ,JUL 15 2002
_ perrormanec of the work for which this permit is issued.
❑1 have and will maimni'Worker•,Compensation Insurance,as required by Section
37W of the Labor Code,for the performance of the work for which this permit is
i, seed.My Workd,Compenm1`inn Insumna comic and Policy numncr arc'.
BUILDING
der5`i4T61if KO.i Policy N�7io%l1b3 Z36
CERTIFICATION OF EXEMPTION FROM,WORKERS' '
COMPENSATION INSURAN'Cli
'(This section need not be completed it the permit is for one hundred dollars
ISI W)or less.)
I codify that in the performance of the work for which this permit is issued,I - -
stall not ould.,any person in any manner so as to become subject to the Workers'
Compensation laws of Califnmio.Data
Applicant
NOTICE 10 APPLICANT.If,after making this Certificate of Exemption,you should
become subjecto the W'orker's Compensation Provisions of the labor Calc,you must
C) O
Inch,ith comply with such provision,nr his permit shall W deemed resulted.
�Za -t CONSTRUCTION LENDING AGENCY -
�i ' 1 hereby affirm that there is a construction lending agency for the performance
of Tho work for which this permit is issued(Sec.3077,Civ.C.)
P. Q Under',Name
Z Lender',Address
L.) (coati,the 1 have read his eptilioalm and dale Nm the above infomemim is
Las E. conch.1 agree re comply with all airy'and county wdinantts and stata laws¢Wing
C) V rebuilding conamelion.and hereby authorize repamnativcs of Nis caym enter upon
Mthe i loromeenioned progeny for inspection purposes.y (We)agnmeto save.indent and keep harmless the City of Cupertino against
h liabilities,judgments,costs and expenses which may in any way arrom against said ✓ V
.V Z City inn xllownsof Iagamungof I operand.
APPLIC NT UNDER ANDS AND WILL COA�IPJy.YpN'ITHALL NONPOINTIssuedb r Date
FLIM ��� /c+w 97' Z y:,/
C _ —
SigiaurcafApplicarm (-to Dar Re-roofs
H RDOIIS MATERIALS DISCLOSURE
Will the applicant or future Wilding occupant start or handle huardas material Type of Roof.
as defined by the Cupertino Municipal Code,Chapter 9.12.and the Health and Safety ,
Crisis.Section 25532(.)^ , •, I s•'' ' '
.0 Yes �fS rte - ' t All.roofs.shall be inspected prior.to any roofing material being installed.
Will the applicant ormmre wlding tecupant use egalpment or device,which If a roof is installed without first obtaining an inspection, I agree to remove
emit herniations air contaminant ax defined by the Bay Area Air Quality Management
Districts Ye, No all new materials for inspection. Applicant understands and will comply with
t all noTi-p int source regulations.
1 have read tem hazardous materials requirements under Chapter 6.95 of the
California Health&Safety CWe.Sections 25505.25533 and 25534.1 understand that _ �-S q
if the building does not annewy haven mwnL that it is my responsibility to notify the / (.lf�
occupant the requirements which must W met Into to issuance of a Car ificme of
Occuper..
7('U 2 , Signature of Ap nt Date
e,or mandindage Data All roof coverings to be Class "B”or better
„ - 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 1/4"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
Addr#ss: l'�400
Reroofing Company N9�e: -TZO5
Applicants Signature: e Dat : —L '0 Z
IT U
Joe Antonucci
(Chief Building Official)
6/25/01