01080114 ClBUDGurnSIONO
BUILDING SINPERMIT 'CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10305 CALVERT DR. 01080114
OWNER'S NAME: APPLICATION SUB DATE
VERONICA JOSEFSBERG 08/22/2001
PHONE: SANITARY NO, CONTROL NO.
rt0 zp ARCHITECT/ENGINEER: BUILDING PERMIT INFO
Fj BLDG ELECT PLUMB MECH
�y L] L_.) I_J LJ
N 2 LICENSED CONTRACTOR'S DECLARATION Job Description
i Z—C I hereby aRnn that I am licensed under provisions of Chapter 9 lcomme"m
;_Er withfullf. ]Oft if tvision3oftheBusin<ssandProfessionsCode.andmyliccnse REROOF.
:.5 isiamClass mercgt COMP. TO COMP.
O6V Licenu Class Lic.p- _
a Q N Data S DECLARATION
RCHRECPS DECLARA ION
1 underhand my plans shall be used as public recoNs
r
I p O
Licensed Professional
OWNER-BUILDERDECLARATION
F—' 1 hereby affirm that I vm exempt(ram the Cessions o License law for the
.Z a following reason. amen t consum703",er,
Business and Professions Cade:Any my orcourry
'
F❑ which requires a pemut t c new t arch,improve,demolish or... y hrvcmrt
3 m _prio t t e,els egmrea NanPplicant for such permnmfle g d mmmen,. _. ..- ..._ _ -
thahyll eulprrtuonttoNSponsonsoftheCommcmrsLc L (Chapmr9 Sq Ft Floor-Areaa TT �--p��s t auation
(co inn n6 WWith Secton]") fDttson 3ufthe Busnes d Prfe.smns Code) dvy ','+,S\x4.:1.. r.r /'A\ g.W§. '. tS .1 e'_`�""
o that be s exempt thertfrom and the bass for the alleged exemption.Any violation
of Section 7(1315 by any applicant fora permit subjects the appliaam to a civil penelry
of not more Nan Eve hundred dollars(SMK))d I, kin. i:' .r.I l �., Occupancy Type
11
❑1,es owner of the property,or my employees with wages ox their
. sole compensation, t
. - PLP A.MR
will-d. m_wm and,rte structure is run intended arrema far We(See 70,44:
Business"itProfessions code:The Contractor's License law does not apply to an 307 - INSULAT Iced Inspections
owner of property Who builds or improves floors n,and who does such work Himself
or through his own employees.provided that such improvements art not intended or _ _ 601 ..- ROOF -TEAR OFF, '
-.ff d far suis.If,however,the Wildingimprovement m sold within one
- '`—'-- --- -- - —.
crtrplmmnNeowntt bate.).will tIturan rprovingm that da twin o; 602 - ROOF PLYWOOD NAiI L"
improve far puryose int sate). � 603 -_ ROOF BATTENS l�fr�
°i berofNepropenya4,Busirss t ugwithlc tl mr�mortm 604 -ROOF IN PROG-----
consumerESS
the prof t(S ]1.a Business d P f .o Cad )The s ntmnnr s
1 c W da of pply t an rte of P pony h halide a impose,t to h h C.J
Co h o tracts fo h prolene. rth t t h I licensed.p ant m the ___. __. J
Cons t e pee . Law
❑1 exempt underS s - 'sB&,PCfor this reason Ld;
OwvDamri
I ' r WORKER'S COMPENSATION DECLARATION
ts" I herebyiRrm under
a „penalty,of perjuryone of the following d<darations:
!8 ❑ I W4'andtwill maintain o'Cenifu6m of Conseat to self-inmrc for Workers
l Compensation, as provided for by Section 37M of the labor Cods, for the
'-— - perfmvmnee bf the wod for which Nis permit is issued.,,
❑1 have and will maintein,Worker's Compensation Insurance,us,miltiired by Section
3700'uf the Labor Code;for the peddimvntt of the work'fo4 which this pviont is
-` isaae'd.My Worker's Compensation in an carrier and Polic"numbar
Camsr� - Policy Nd
EXEMP110 - ORKRS C.- !71'k4
�- k 4.l� [ s d
9 CF IRT FI ATIO�NO
COMPENSATION INSURANCE•,,.
:,'.Yat .. ,..k
ITh coon vccd nq be bwnplcied d the .it is for one hundred dollen
(SI00)ar less 1q 'r
IIr m, �
-yen 1 tend Nat m the H'any ousgf the rk(r -rich u per m eWorkers
or d I
shallcom not employ any Person t any manner so io bee me ublect i N'WorAe
Compcnmlion Laws of Cahfoma.Dam'-' '
Ap,[cam r.:. ,.... .. . ....
I NOTICE TO APPLICANT'If, 0c aking the C niOttu o(Exe pi oyou should �•sa� -'
become subject t°the Workers Cmnpebsetion Provision,of the L bor Code,you must
Z
O forthwith cum 1''witAsuch'rovisions or this eemed revoked.
PY p _N.it shall Md
Fs.«,,G« � ' 'r. 'i, hi CONSTRUCTION LENDING AGENCY .. +'./
a ' , Ih mayaffirmth tthereresacn.t to lending agency for theperformance y
,tr of In.' rk(or h ch th pcnn]t s '.tied(S J09] C'.C)
o,,G Lenders Name .... . .,.. .. . ... . .... ....._ - __ .,..._. .. .. .
D.Z Lena 4Aa .
dre.
f..11 certify that 1 have read th v ou
applicn and state that Ne about information is ss
FT: cdrect.-Degree to comply with all,city and county ordinances and slam laws reining
� V to bolding construction and h by gualmitu mprceionivA of th 'city to enter.pon
the id,ove-mentioundpropertyf Pe do purposes.
f L (We)ajet s Memniperead keep hmayin theCry tuCon' eg'ria �.
V] City
liabilities,i,cq indictments.costs and ,ape u. h ch y . way reg nsr and
City n n quence of th gra t og f Nis'p((ttThTrt t '•'
APq}'�L�.ANT 1111 N AND WILHCOMPLY WITH ALL NONPOINT'"'
_ S( yCE'REGUY NS qqq�/ Issued by:
Date
a7
5'rgoamm oL�„HAZARDOUS MATE0.IALS DISCLOSURE Re-roofs
wl/i me appl cant sr(w bu id'ne occ pa t t Honer l deem - renal 'Type of Roof
codd�sttbytissiuPd]i 7u�ea,palcod en pt 91z edm Camaasuty
_ .AlLroofs shall be inspected prior"to.any
"mvit't hoWz ldlthcaapipcliocnotmamirn fuwt resbauedfidmdgboycctuhpe aBmeyunAareqauAipmQem InrygeMvatcnages m roofing.matenal being installed..
o.wntch If a roof is install' Without first obtaining anlinspecnehiovetio ;la
1
ria read Ne
all new materials for inspection Applicant understands and will complywith
w! n
acs tit°one uta all non point our ulations
N
t, .�t..f ,_
haxaNr meter is q ,remcnr ode Chopte 69la n(the �`
----- .m,a Health&Sa(etyCMe Seat m8505 Qfles rid 25514 mono dire
ifthe budding da es otcu, Oy haxust be thea slay rtspne,b !Ytonotfy the
!e9 rise h must be inn poor to ssu ce of e C ntflcam !
`
""Sig-nat4leof Applicant Date
✓_ wn ornz„,gc t'. t ate. . ... ..._ . . _ ..
All roof coverings to be Class"B"or better
} — _ .
� , \titOFFICE'
' ,r
Building Division
10300 Torre Avenue
1 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 pxogress 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: fie f O rl ie A 1To5 r f$ 8r'/' 9
Address: 10 C5 CA Vl' r l r C'OA-1'4;no CA 9 SON
t
Reroofing Company Name: S ^tort S A yS Ko o Cin q
Applicants Signature Date:
Joe Antonucci
(Chief Building Official)
6/25/01