02040043 f,ITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDINGADDRESS: PERMIT NO.
18781 NEWSON AVE 02040043
OWNER'S NAME: APPLICATION SUB DATE
JENNIFER UMSTATTED 04/09/2002
PHONE: SANITARY NO. CONTROL NO.
ARCHITECTMNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MF.CH
S LICENSED CONTRACTOR'S DECLARATION Job Description
i¢=L 1 hereby affirm thin 1 am limnsd under provisions ofehapmr 9l commencing
withSenion701N1)ofDirision3nftheRusinesI.ndProfessl.nsCWd.aadmyllacnse REROOF.
;1�1 is in full
.sy6 LinnsS CfolarcsUmIs_ Livl�
T/O TAR & GRAVEL, INSTALL TAR & GRAVEL.
O ' u Darn/ U_a_ Comrein
i 3'i G ^ ARCHITECTS Dfcak(ATMN
t`' S 1 understand my plans shall be used as public records
i a.p O Li«meJ Professional
se OWNER-BUILDER DECLARATION
a 1 hcrchy aRrm that 1 1. exempt from the Gamma,C, License Law fnr Inc
fi Inch n,rwam.(Section....r,Business and ,v,denons h,tar AnY city or county
F o which its its a s permit re Lions the
applicant
improve,h Permit
t Fi repair any t recent
i 3� _
prior 't.issuance,also requires m ppl c I I such perm no flea signed statement - _
Ihalh kl' acdp amtotM1epm t- ns fthC ctonLccns lawlChaprer9
Qom gwttn.SwJ. '1000) fD si J rth BunnessandProfessonsCode) !s Sq.-F`;FloorArea, 1 i�. ,, auation
or that He is exempt dmiefimii and the basis far the aBbged eAtri,ni n Any violation
-of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty3:7
'ofnntmon,than fi.•ehundred do[].(s5n0). 5A?P umber . , Occupancy Type
°1•as owner of me pmpcny.Or my employees with wages as their sole compensation.
will do the work:and the nmaum is not intended or offered for sale(See.9014:
Business and Professions Code:The Contractor's License Law loss not apply to an 3 07 - INSULAT J�,Cffired Inspections r -'
Owner of progeny Who builds or improves thereon,and who dins such work himself
or earede i his own employees.provided that such improvements arc not intended or 6 01 - ROOF„TEAR_.OF F _
comple ion cols If,bow sti b Jve t tap cmrov is sold at within one year of - - ""- ""--"'-' - N _ - t ._.. .._
'cornrmrantneawnerb 'la unavem burden rpa,•ingmtn de notbuild ar 602 - ROOF PLYWOOD NAIL`
improve fit,pamn,aarxale.). 603 - ROOF BATTENS
01:as owner of the property, i'. ly ctuitracting.with licensed contractory to ._ .. q..q,- - ROOF IN PROGRESS.. ..
construct the project(Sec.70V Business and Proficssinov Cele)The Contractor s 11 1
Liccnsc Law docs oat apply s r of
und.who contracts for such projects with a contr ucmhroxb licensed proves thercon�
pursuant _.-. ... _ _. .. _ ._._.... ..__ ..... _
Contractor's Iscr License Law; . .. oOq
-' °lemcecmpt und<r Stt. ''�� � ��� '� .B&PC,fonhisr�n L .I(':'. !;:'• -:;.1;� ',
owni
Date SEp 3 2
WORKER'S COMPENSATION DECLARATION pa,
I hereby affirm under penalty of perjury one of the following declarations:
01 have and will maintain a Certificate of Consent to self-insure for worker's y
:• Compensation. as,provided for by Section 37M of the Lalver Cade. for the
pdrrmminee of the work for which this permit is issued..
°1 have and will maintain WVmkcr'a Coinpeitsation Insurance,as Inquired by Section
39(q nr the LuMr Code;for the!ierfprmm�ce ohhc,work'far which this permit is
is'
d-M�yrW(rkcrs Co pc s t on locum c d Pof y be m: _
Ca1
ls�r 74sOPG1 l S i PnlicY N �'f) J 8 O q'/ ..
CIL
.,CERTIFlCATION OF.E%EMPI'I FROM WORKERS ' ' 1 •.. . . ( . . , L._� s .. :
Tlnsxctlorinced not tie mwplened if the .it is for one hundred dollars •' "' ... 1,..!6." t..
($1001 or less.l
1 n fY that in the performance of the work for wh¢h tti pe t s issued:1 _- _._. e ` , 1.-._ n'1,•' �. n• r. --a - -` -
shall not employ any person in any manner so as to become subject to she Workcri -
Compensmion Laws of California.Dam "
hccoicant coo theWorker's
.. .. ..-_._. .. ... ... .. .. . _ .._ ... __ _ ._.. ....
Applicant
NOTICE subject to
ftmakingth Cenfio fE pi yo, Mould
j Wok s C riipe t p v I nail 'he cont Cod you mu t
Q 0 fonhwllh reply with ch p cions or thispermit shall be J d revoked '
stn I`I' 1 's4CONSTRUCTIONLENDINGAGFNCY
F',r 1 hembi'ITrrri that them iiii constractionInd g g ncy f m pe Po"- ' -
ac
of the work for which this Pconnit . issued(S c J099 C J C)
MLenders Name.: :'_._s_ ..._.. .t.._... .. . .. :._ _ __ ._ ..__ ._- _ _... _.. .. _ _ .._ _ _ _-._ .
G Lenders Address" """ " '• -'t.701cmfy that <rtdall pitied dortances bo form bonis
g �k�
0con il 1 gyrs .m. sh all city and countyord hives and t t I slating>. U thea la' g con tl h by lhonz p i s , , ly s t rt.A. the W i d p pend f pati n p hart .F.I 14 es,I greet sae M m Ipe and k p hamtle-s chi C ty f s pen o ego oat
W Lab nes jdg s.,f he d penses h ay ninny y tt eagainst Bald D_ /V Z CIs ronscq a of th g m g ' tmn l/
APPIICAST ERST W LCOMPLY WITHALL NON-PONT ' Issued by: �/ Date
SO CF, LAT � L Y'
St tnture ppncanvcoro ort Re-roofs
a•' HAZARDOUS MATERIALS DISCLOSURE
i0'll Ib ppl ce t o f r rt b IJ g s cupant to or handl hazard 's ondimal Type of Roof
s defined by the C pen n M m p 1 Cwt Ch pt 9.12.and theH •
Ito and Safety s, s ,
Cod Section 25t532(a) r •.... `.s ''t - t .• - .t
°Y " n h Ia a _ All roofs shall be inspected.prior to any_roofing material being installed..
Will the applea t of r none building Occupant s use equipment or deviceswhicn If a roof is installed without first obtaining an inspection, I agree tdremove
cou,hazardous- c m m n !- defined by theBay Area A Outlay Management
Dirt c, all new materials for inspect _ . A pIicant understands and will comply with
° ec B1" all non- t source re'U1 0
1 h d the Incidi nominal,requirgm ts under Ch tpmr 6 95 of the
California Health&5 f ty Cade'S ctons 25505 25533 and 25534 1 understand that
ifthebuiIdingdoes nofcurrently leave a ocot that it . yresponsibility to notify the �(! ✓✓✓cow` -•��
rue t f -- tremens xhiel u. he met Prim,m ill nee of Cendicte of `
cqu
' - _ q-OZ Sig tore of Applican Datenet _
tap i a ag Dam A I 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: -Jeno : fcr U'l
Address: -)&/ lye-� so--, ASC
Reroofing Company Name: Son r s c fL o o P
Applicants Signature: Date: `�" 9-0 2-
Joe
Joe Antonucci
(Chief Building Official)
625/01