03010058P
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CITY OF CUPERTINO
BUILDING DIVISION PERMIT
INFORMATION ,
„CONTRACTOR
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BUILDING ADDRESS:
KEITH ROOFING CO INC
PERMrr NO.
18705 LOREE AVE
03010058
OWNER'S NAME:
920 LINCOLN AVE
APPLICATION SUB DATE.
SARA SEYEDIN
01/09/2003
41
IIONE:
(408)295-8616
SANITARY NO. CONTROL NO.
ARC[IITBCf/ENGINVER:
BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
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LICENSEDCON RACfOR'S DECLARATION
Job Description
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I hereby affirm that I am licensed under provisions of Chapter 4 (commencing
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withsetionl ))fD'isionl therlis pod Professions COJ, and my license is
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n full fu ad,e^IynA.ry /"
License lass ` Lic.X
REROOF
T/0 & REROOF W/BUILT—UP ROOFING
Dare Comma
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ARC]IRCA
ars my shill be uuJ a, cores
plans puhlic
Licensed Pro(cssinnal
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OWNER -BUILDER DECLARATION
I hereby affirm that 1 am1. exempt from the Contractor's License Law tat the
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11131.5. Business and Professions Code: Any city or county
EJlowire reason. Co
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Permit t
which requires a permit le uirswn, alter, improve, demolish, ore asir any mrunure
its issuance, also requires lorthe Cohperminaicense itw(Chgund temcm
that he U) the inion the 9
Sq. Ft. Floor Area
Valuation
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provisions of
scwnsod pursuant pro of
r Business late)
$
O the of
(commencingthe nd ProossiorC ode)
and on, Any vi
(cat he is xempth Section and O basis f
that he is exempt therefrom and Ne basis for the alleged exemption. Any violation of
$5400
APN Number
Occupancy Type
P i' YP
Section 7031.5 by any applicant for a Permit subjects the applicant to a civil penalty of
not more than rive handed dollars ($500).
3 7519013.00
ff I. as owner or the property, or my employees with wages as their sale compensation,
Required Inspections i
will do the work, and the structure is not intended or offered for sale (Sec. 7W, Business
Profession Cork: The Cn [.a.m. Law does
and lmorims net apply In an owner of
3 05 — FRAME
property who builds or improves thereon, and who does such work himself or through his
own emplowea. provided that such improvements are not intended or offered lav aide. If.
307 — INSULATION
however, the building or improvement is sold within one year of completion, thc owner.
6 01 — ROOF TEAR OFF
builder will have the burden of proving that he did not build or improv for purpose of
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602 — ROOF PLYWOOD NAIL
C1 1. as owner of the prepeny. am exclusively contracting with licensed contractors to
603 — ROOF BATTENS
construel the project (Sec,1030, Business and Professions Code:) The Conbactofs Li-
cense Law does not apply to an owner of property who Wilds or improves themon, ard
604 — ROOF IN—PROGRESS
who commum for such projects with a contracter(s) Licensed pursuant o the Conlow ur's
License law.
❑ 1 am exempt under Sec. B & P C far this reason
Owner Dale
WORKER'S COMPENSATION DECLARATION
FINALE0
lherebywrome under Penury of perjury one or the following declarations:
I have andwill maim am a CeniBcals of Conseal«,self-insure for Workeh Cempen-
ffstit ((�y
MAR '4 2003
satins. as provided for by Section 37(X1 of the 1a Wr Code, for the performance of the
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work for which this pcfmit is issued.
❑ I have and will maintain Worker's Compensation Insurance, as required by Section
3101 of the labor Cade, for the performance of the work for which this permit is issued.
BUILDING
My orker' Co Ipensat{ifWInsu. acarrier and Policy numb c:
C cL r(E�] Policy No.:
CERTIPICAT OF EXEMPTION FR I RKERS'
COMPENSATION INSURANCE
(This section need not be completed if the Permit is Intone hundred dollars ($101)
less)
1 eerily that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so az in become subject to the Workers' Compensation
Laws of California. Dan:
Applicant
NOTICE TO APPLICANT. IL after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Cade, you mast
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forthwith comply with such provisions or this Permit shall he deemed revoked.
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CONSTRUCTION LENDING AGENCY
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I hereby effort Oat there is a consouction lending agency [Or e Performance of
1 QLender's
the work for which this permil is issued (Sec NN7, Co. C.)
Name
Lender's Address
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1 certify that 1 have read this application and late that the above ons rmation is
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1 agree m comply with all clay and county nladwscof and emm laws rclming to
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building of his city mcnmrupon the
gcutionedinn, and notchy antbon
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above Prposeumativcs
above mentioned afire propene I'os inspection purposes.
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(We)agme In save, indemnify and keepharmless the City of Cupertino abains
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Iiabilitiex.judgmenu,c sand eapenuswhich mayor any wee ac cmc against said City
mconuquenc e�� ming of Nis permit
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APPLIC UN)S:RSTANDS AND WIL PLY WITH A N NPOINT
Issued by:6i Date
SOU RE ATION /
Re -roofs
Signal r caul/ o ter um
I]AA S MATERIALS DISCLOSURE
Type of Roof
the appliwn nr future building occupant unrc or handle haismonsmaterial
par CoeChapter9.12, and the Ilcallh and Safety
s defined by the CuPcninnYY*
Crae. 0YC5255121°'
All roofs shall be inspected to any roofing material being installed.
prior
If a roof is installed without first obtaining an inspection, I agree to remove
Will the applicant nbuilding occupant use equipment or devices which
emit hazardous is connlmipeR�apslprined by the Bay Arca Air Qunliry Managemem
all material 'nspection.
gofnCO
❑Yes ❑No
;new
I have mad the havamnus materials requimments under Chapw695 ofthe Colifor-
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maH fry Cole, Sado.255115,25533 and 25533.1 undersunJ that iHM huilding
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no ocmly haw a tenant, that it is my responsibility to notify t occ pant of the
re monswhichm mel pct rissuanc .Ccrdficwr, p c.
o licant y�te
" B" fir
thn, ale
Al of coverings to be Class better
A
11
CIO
CUPEkTINO
Building Division
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: (408)777-3228
Fax: (408) 777-3333
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
Wand 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 Vi" 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. -
Homeow:
Address:
Feroofing
Applicant
Joe Antonucci
(Chief Building Official)
6/25/01