02080150 OF CUPE
CI UILD NG DIIVIISSIIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
18780 HANNA DR KEITH ROOFING CO INC ATION O2O8O1yEE5O
SUB
1!MUTTS WU 920 LINCOLN AVE APPLIcO8/26Aj2OO2
PHONE: SANITARY NO. CONTROL NO.
q (408) 295-8616
I+±O O ARCHITECnENGINEER: BUILDING PERMIT WFO
<E BLDG ELECT PLUMB MECH
I L.7
LICENSED CONTRACTOR'S DECLARATION
G z N I harcby affvm Hallam licensed undo pro'si sof Chaptm 9(commencing Job Des ription
_t wVfu � oi i nn3ntdeeumnaae d tsar rise a dmylmenae REROOF (REAR OF HOUSE
isat ' �1 s�'Arc LLic,il DCon�tp E®
30fARCHITECTS D N
Sy plans m records
oo leen SEP 0 4 2002
e' s 0 ER-BUILDER DECLARATION '+ �••�
to I here alG,m mad 1 am esempl from the Comrncmi s License Lnw for the B yI LYIN
to G
t < following mason.(Section 703 L5,Business atW Promeaiom Code:Any city m county 4 6 3 0
F, O which mi,ims a permit to conswet.now.improve,demolish,or repair any structure
prim.its issuance,al+o reopirestheapplicam f°rsuch pemunufile taigneA smsemem- -- - - -- - --- - - -- --- Valuation
----- -
Ihal ha is li=ned puisujnl tP sire oiovisiom of,he Con=toes Limnu law(CTapter9 . ..,, ��F a 1 -
(commencing with Secdont]0003 of Division J of the ane stip prp(essions Code) I x a a t a'C
or Nat He is exempt thehfromend the basis fm the alleged exemMi a.Any violation ` "a"� x `::kw.0 V:i a. ..l lo..a=^.. Q J•t_
of Section 7031.5 by any applicant for a permit subjects the applicant as it civil pe Wry
,ofnot mom than five hundred dollars(65001. 305ARNMISIN , . : Occupancy Type
°I,as owner of the property,or my employees with wages as their sole compenammn, 307 - INSULATION
will do the work.-and'hestructure Isnotintended or offered'for sale(Scc,nun;' 601 - ROOF TEA y(,� 'j inspections;,,,Business'end'Profc'mons Code:Temo
The Conctor i License Law does not apply an p `
owner of progeny Who holds or improves dwown,and who does such work himself 602 - ROOF PLYWOOD NAIL
or through his own employees.Provided that such improvements are not intended or
-offered fee sale:If.however,the building or imprdvamem is sola within one year of- 6 0 3- - ROOF-BATTENS-
completion,die ownenta.drar will have the burden of moving that he did not build or
improve for pu,pou of.]a.). 604 - ROOF IN-PROGRESS
- i °Bas owner of the property asr�m B au drat de Professions
with li—ca nsede Contractor's
ontr oto m --- i w� vf::�i r7.
_ License the does
(Sec, to a Business and property
who
Code:)The Contin thereon.
License Law does nue apply m mi owner of progeny who builds an improves Neoam I
-.and who con[mcu.for.auch.prolecu.wieh e.comrumor(+LEc<nsed pmuane.to.ehe.._._.._-._..._.__.-. _.._.__..____............._..-.,_._..__..,_____. - ..__._.__-___-_........--_. ..-
_ Contractors Liccode Law.
- C1 .am asnempe under Scc,t ',b'&P C for this rtas°n
Owir i Date
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declinations:
'f.l,• ° I have and will Maintain,ti'Ceniricam of'Consent to self-insure for Worker's
Compensation, as provided-for by Section 37W of the Labor Code, for the
performance of the work for which this permit is issued; i
°I have End will maintain Worker's Compensation Insurance,in enquired by Section
3700 of the Is T Code f r the perfomu c °f a work forwhich this perms i
imuW My Wo _r Coope eon rtsu c rand Policy tooda,ase:
-
`/K : ,CE TIB CATION PEXEM ON FROM WORKERS' � t�Lil lwtA .;f lS. a+'x�ksxl
COMPENSATION INSURANCE t i^
(This tion need not he completed if the permit is for one hundred dollars
15100)or less.)
I ceruf that i the rt rtnance Of the rk f - .•...• .- ... .M1..__. -.,-...-
.f Y fx or wits h d' perms s issuW -
shall nor employ any come in any manner sal as ro become sub3act 1.dw Woken '1"•_n t "' t
Compemation Laws of Califdrvia.Data
.:Applicant. '. ". •. -
NOTICE TO APo he Workers If.after Compensation
this Cenins or of Exemption,youshould
become subject m the Workers Colons or this provisions of theLiAm,eemed Cale,you must
w� 0 onhw th mplywieh such previsions or this pc it shall bed d rcvokeJ '
CONSTRUCTION LENDING'AGENCY,` h --
'_� I hertor which the,Ih its cremationSIc d' g gency far the petfarmanm iH • t
W; of to work m which this Permit s s veal($e J097 O Cb)
Lendc a Name--
.;z
ame_ ._... _ .__..�. ... ....... _ _. .___ -._. -. _
...;Z Lender Addres
1 m y Nm 1 in e tend this application and row met me above information is
corrtce I agree to comply with all city and county ordinances and sum laws relating
to building constriktiom.and lumb,aull nca repircs,nmove.of this irym enterupon
y 96 the b vee) 1 d save;
ipeny for inspection purposes,
harml _. .-
t�ti cn (We)agree m save,indemnify and keep harmless the Cuy o(Cupenino uguinm
Z Fw-V1 City in i, judge coos ontl expo us which may in way accrue egainsl said
V-Z City incyysaSF9u Rce of Ne Bramingg�f dirt permit. '
APPCAN NDERSTAN NDWILLCO VffH ALLN -P INT
s RCF' 'Gut r N. _ Issued by; Date
ign aanvOin; - - asp Re-roofs
HAlAR S RIALS DISCLOSURE i
Wil the applicant t dm ,aril same
o or handl haardous material Type of Roof,-
an
as defend by th Cupertino Munlci ode Ch m 9 II d Ne Health rid Safety d
Code S e n25532(a)t I r '' Y,kW' ''�il4 h l 3rf.� ♦ I. y
`w.
i ', I All roofs shall be inspected prior.to.any roofing material being installed .
i .
Will dw applicant orfumrc 0 g c mem mequ,meat or devices which If a roof is i ' Ileal Without first obtaining an'mspection'I-agree to remove
ind,hasumms air contaminants defined by the Bay Area Air Quality Management
all new at als for ins ection. Applicant understands and will comply with _
°Ne' ' all -p" tsoll r a ' - , .,
I hav d Sc haraMous annals rcgmrtmenu under Chapter 695 of the
Cal fo tart' afety Cade Sections 25505 25533 and 25534 1 understood that
1P1
h on
msntcumeml a arcnant@mu ismyrzsponstbdty nnotify the " ' 'n�' �" -.- �
oc p n[ the requ e e - Ph mu 1 t pror,
e leo zza 1,of a entficae of
up cy' i at ofApplica Date
an
,re Date All roof coverings to be Class "B" or better ,
T i-
.. :.a .._.,.,..-- . ..-..... . ... . . . . ._..._.. ..OFFICE- . .... .
Building Division
10300 Torn Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CI 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.
i 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 policy on reroofing and will comply with this policy.
Homeowners Name: �� nJl rte)
Address:
Reroofing Company N
Applicants Signa e: Date: ZG OLl-
Joe Antonucci
(Chief Building Official)
6129/01