02070192 OF
CI BUILD NC DIIVIS ONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
19641 LA MAR CT KEITH ROOFING CO INC 02070192
OWNER'S NAME: APPLICATION SUB DATE
CHAN DENNIS AND MABEL M 920 LINCOLN AVE 07/30/2002
PHONE: (408) 295-8616 SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
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BLDG ELECT PLUMB MECH
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ZZ M Z LICENSED CONTRACTOR'S DECLARATION Job Description
OZqq Ihereby a1Rrr, lam licensed under provisionsofde,(commencing REROOF
withgmion7000)o(Dw ision3of the Rosiness and Professionsn,Code,and my license
q9a� ism full forcane ffeosC
W u License CI s J Lic,p
u°J1 Dom - Corner
3 u ftCHITECI"S DECL
t 5 1 understand my plans shall be used as public mw
p O Licensed Professional
6. OWNER-BUILDER DECLARATION
y
1 hereby affirm that 1 am escmp,firm the Cmarcoo is License Law for the
Y
Z and Code:An cit o Dore
C, follow g reason.(Sm on]OJLS,Business an y y r county B
o which i qua n e.suremain s construct,aalter,pplicant
improve,hper demolish,or repair any awcrm
3 ,p o b its issuance. Isoreq sees the ashms;oftheColi permit in BenseLaw(statement .,.. _ _ —
thnt4gfh¢nsed pumuanttpthe pof Dvi,aof she Contractors License Law(ChapterCoal) S,O�S(.,gI��psOr,{�ea s Valuation
(cm "king with Sectio 7000)of DivtsionJof she Buliness and Professions CodU ? i+;^` 53�64zFLAt1 g'.k ;I rtlp„
or that he i4 eeempm donbcm and she basis for the alleged eiroopuon.Any violation +
of Section 7031.5 by any applicant far a Permit subjects the applicam m a civil penalty-
ofammortthentoo.hundred dollars(E500). 305APNAM" . .mc,•t Occupancy Type
❑I.es owner of the papa".or my employees with wages ea coheir sole mon,mmion.
" will'do-the arms, ad'the'svuctmeis-nos Intended'or offered for sale(Sec:7044;
t Busmesi end Profusions Code:The Contnwor's License Lew,does or apply m an 601 - ROOF TEARe99M Inspections -
'owner of property Who bu ld. irrroves,onson.and who does such work himself
or through his own rat provided that such improvements am not intended or 602 - ROOF PLYWOOD NAIL _
';,dToad for sole:wiser ober the building' r m proof prat n gold M one year of
- ..._.,_. - -
'compleiion,the owner bu Ider will Mrc the burden of prowng the,he did nor butld or
603 - ROOF BATTENS -"" •' "'' "
irruption far purpose of cola.). 604 - ROOF IN-PROGRESS
as
- Q i au owner of (Sm.
7 am Business and Professions
luc:)The nu ctors ro "+ m
- ., License ilia deana fga.]645,Business anderdmhonsilda or The Contractor's - ,..:(' q,;%- '.G•.;;
Y' -
License Lvw dm not vpplY,o an owner,of property who builds m impmva Merton.
.,and,who cpnwcts for such.proltt6 wuh.a comractnra)licensed pursuun,m Ne .._. _..._.._..... _ -. ...-_..,.._ ... .__........
_._.___._ ..__...._....
Co recmrx LmenapL w ,i+1 " uS
Olam esempt uaser Sec'' BA.PCfor Nu mason 'm
"
WORKER'S COMPENSATION DECLARATION AU 1 sn 2002
/ u.,r. _I hembY efRnn utMr penult of perlury.one of the followin8 dttlamtivns: -.
❑ 1 have vud'will manual.Is" eiufiurk
u'of Consent m self-imme for Woer's ��'�®'��
Compensmmm'r.a"mvided for by Smim. 3700 of the L.Nu-Code; for me
'performance of the Work for which thio permit is issued...
wt71/ta a red ill m ntan Worter a Compact i xury e v req trcd by Section
the Labor Cade forthe petfotman .f Ithf wor,for which this'Psnultms
Isimni My sCampctrain Insumme Lamer eatl P l y ourrither am. s ..•.u...�...,.+a =
Cam 7 .e?polieYNo.:' �' 11 " Ay t �..b.N 1 it� 1+47( I` y.) Y/7 - n 'Ef y pi
1�71 CERTIFICATIO OFEXEMP`DONFRDA�WORK RSI" . -
COMPENSATIONINSRANCE a ' k� " _ .....�.,..,..
ire+r a IThu uc,ion need imot harempInd
ed ,he Permit¢fir one hundred dollars -
I in
Icfy that th' peRo enc of the"ork for which this permit iii dI .• ,.i1 'll,.. -R,•'
"hall of employ'any Person ren any man i an is to become subject t ,he Wo kers `
C mpcn,tion Law f Calif ria.Dn
NOTICEtTOAPPLICA ).afar makms rhsC.niRcam of EaemPtion. _.._._... ...... ._._ . __..,........._ . ..... ...... .. _. _..... ._ .. ._._ ...._._....._...
youshoult
become subject 5o th Wo ke/ Compenut on Prov,moria f the Lobo Code,yo mit'
..
Q Q forth-ith comply with- h provisiom o N permit shall be deem d invoked.
""•� t :" - + CONSTRUCfIbN LENDING AGENCY nor .til '
�.:; I hembY affl thin the uS'mmwn I tN',g g ty fo the performam, n z. I t
-----------
tion
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W E^„ cortcn 18 .tis reply th all city d wnry Ninanca antl t t 1 a nearing
Q;:O to bmldm g n.w t nand herchyo,h rep eienwf ftfi acnyt enoci,upron
W ,,h abo a enu neJ pr perry f r,inspat puryo .-
._ ;Fi (We)agree to save:iMpmmfy and kap harimess the Cny of Cupertino agunst
Vi I bdT s.judg , d- ape u lwh¢h may in any py rve agen said
U'Za Coyy nen a of the 6mmm of Ilii perrmr'. r
A)'PI UERSTA WILL CO ITHIA .NON 'OIVf"
g e EG' T N ,;'; ' r Issued by: D
S mansof Re-roofs
HA DOUS MATERIALS DISCLOSURE
dl die appl con,of Twort bu Id g ac pa s tort or handle haxmlous ma¢ al �I a Of ROOF ••�_ �+>r_^�^v^-=
as defined by the Cupemtro Mun ampul Cade Chapter 9,12 snd,he Hu1N red Safety `Jp � t •_,rt -�.,., f I f 1 ;m
Code Sttuonf` 1 • ' xa , Di " - i"it, :➢
❑Y x :, t 1 ,,,. , I _All roofs sfiall be inspected prior.to any.roofing matenal being installed._,--__,
Will
emit hazardous OY ppl t PoN bu IGwg ocupeon tic p or ret deiaa which If a roof is installed without first obtaining an inspection'I agree t'o'-remove
mnuarninnius is definetl by to Bay Area Au 0 of ty Menegemem
D+amw all new n0tedals for inspection. Applicant understands and will comply with
all no I source regulations ,e,
1 have rei ,he hatallou.a ream 1 qumumants under Chapter 693 of de
Cal fdiri s So fiery Cade,Sactmm 25505,25537 red 25334 I understand that //;
-mf the in6 P not<umcmly hare e,nam that it b my responsibility to notify the
(/
Pit
oc i ( requ rcmenm h m the mer pct t issuance of Can Tcetepf
Si Of Appli y Date
o nrvea s ret a. , 1 ,,, Data 11 roof coverings to be Class B of 'atter
OFFICEIt
Building Division
410
10300 Torn Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
F= (408)777-3333
= CUPEI�TINO
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 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: h G
Address:
Reroofing Company N T
Applicants Signa e. Date:
Joe Antonucci
(Chief Building Official)
6/25/01