01090062 CITY
urnsIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10270 N PORTAL AV EXTERIOR SOLUTIONS 01090062
OWNER'S NAME: APPLICATION SUB DATE
JEFF & DENISE OLIVER 1771 SMITH AVE 09/17/2001
/I PHONE: (408) 358-1233 SANITARY NO. CONTROL NO.
I
O z z ARCHE ECTIENGINEER; BUILDING PERMIT INFO
C O BLDG ELECT PLUMB MECH
8x4
v z LICENSED CONTRACTOR'S DECLARATION
:S I hereby ction7")Ofmalam n3ofthdunder
ssandPionsofChapter%Code, ndmmecense Job Description
'_tw with s<neon]tH10)nfDivision3ormeBusincssandProfexsionsCede.andmyliccnu REROOF.
-a In full force an eRm
sJ amen Lie.a REMOVE SHAKE, INSTALL 30 LB. FELT &
%o s Dm �_�/ en ECaL!A y� HEAVY SHAKE u B n
j c vii ARCHflECT e DECLARA
1 m,dersmnd my plain shall M used as public records
ta
i ti
,0 Licensed Professional
o we OWNER-BUILDER DECLARATION
1 hereby affirm that 1 am exempt firm the Camrmmr'a License Law for the
t- following mason.(Section 7031.5.Business and Professions Code:Any city or county
3 mhatebte f9lee�appamaitaryt ,.mt prot h pmec.md o,tols=hrepair- any structure
do
M oduce who,routinesthe applicant f hennl 1.fl geed umme
...._ _—__
oor-Aea•, tion LINI � 'A 11s�: $14Y"common ng 1h5 t 70)(0) fD 'c 3 fm Busness.ndPoksionsaCod) L()ss• t k.,S Ft-
or that he is exempl,he ifnm end he hash for the iffiged.csomp,m.Any vinlal co
'.f Section M31.5 by any appl,nnt for a .if subjects this,applicant,.a duel penalty ,
Fof not mare than five hundred dollar,IE500j. 31�l�Rij 8igt�Tbeb 0 i \�r' Occupancy Type
❑I,as owner of the property,or my employee with wages as their sale comPcnation.
will do the work:and the structure is our intendedoraffected for sale(Sec:7041. .
Bomea and•P ofe,sions Code The Confidant'.,License Law does n0,apply to an 305 - FRAME Required lnspectionsl. 11 .1
Owner Or property Who Wdds Or improves merean,mrd who doer such work himself 307 — INSULATION
or through his own cmploye s.provided that such improvemcrns me not intended or
coffered for sale.If,however the building or improvement is sold Within ane year.r 601 - ROOF TEAR OFF i "• "� '
bmylction,the owner-builder will have the burden of pmving that he did nut build or
mprnvefim,orpnsear=ale.1 602 — ROOF PLYWOOD NAIL
O 1_.. p Pett 3- y gwi 603 — - ROOF BATTENS- ---- ----- - -- -- - --
s owner of them n, xdusisel cumruun N licenud comrvcmrs m
Lonstrucl the project(Sm.70,14.Business and Professions Code:)The Commerce's
icense Law does not apply to an Owner of property who Wilds or improve=thereon, 604 — ROOF I N—PROGRESS'"
:. .and who contracts for such projects with a contractors)licensed.pursossalro the
Contractor's License Law.•.. ...... ' , -
❑lam exempt unticc5ed:' ," , ��'•' .B&P,Cformis.,on tf0 1.w+,
_ 'Owner ,1' Date
WORKER'S COMPENSATION DECLARATION c
I hereby affirm underpeoal,yof pcUuiyone of thefollowing declarations:
F N •/ I`E
❑ I have and will mainmin'u tCenilica,e of Consem'to self-insum for Worker's
Compensation, as provided for by Section 3700 of the Labor Cade. for the OCT 1 8 2001
performance of the work for which this permit is issued.t
❑I haver'end will moinmih WVmkcr'x Compensation Insumncc,ey mucked b-y Section
3700 of th labor Cade for the performance of the work for-which thispem,itris
issued,M kr C.mpcnulo I . mnce cams end Pol ycy rte - .. BUILDING..—. ------ -__.—_
C.n; �V:r:.i[ VI4„xr.,1,P IieyN IC/'li U0' 47"AF - I
CERTIFICATION OF EXEMPTION FROM WORKERS
COMPINSATION INSURANCC'" r
(Thissm,%.need..,betcomplemd ifine permit is for win hundred dollars
fEllml or less.)
'61 cn,lat'.l'in ltiemf in da nee ref, ite nark fu cam, thipe-of the
Workers l li:811111,1 � :,{nr^ ,.,{ ••
shall not employ's"4 C:.n in any ami n so as fes become ubjaf to me Weiken'
'CPmicjrd an Lu'sof Cr,lifar I.Dote,' ' -
NOTICE TOAPPLICANTIt.after making this Certificate of Exemption,you should
O Qbecome. b) ,f the W k Cnmpc .thio p° ns of the Labor Code;you man
forth to comply vvilh such p r the drout Shull be deemed mvoked '
t"'. V] - CONSTRUCTION LENDING AGENCY
[C.' •"„t I he Ny affmt(hut,M1 co stry, le ti S sencY fes the pert rmin e
W ► or the'aorkfmwhich this perm) a.med(Sec.'3097.Civ.CJ .
L Q Lehdcr N m - --
'U ZI -Ifni
I ocnify that i have mad this apphcaion and stale that the above information is '
cm aret.I agree in,comply,wnh all city and county ordinances and stoic laws totaling
, building cnnamction;und herchy SuthOrize opreselanves Ofmis city to enter upon
4:
be above-mentioned property for inspection pf rpuus. .. .
► y (W'e)agree fid save,indemnify and keep hamilas me City of Cuperdrm again,'
h liahililies,judgments,cans and expenses which may in any way acerae again I said;
J�` City in consequence df the granting o6hiii pernit.
'APPI,IC UNDERSTANDS AND WILLCOMPLY WITHALI NON:Polw lssued b : Date
S .GULATIONS y
�rc.App�icah alta '., .....' 'pate'.•,. Re-roofs
.HAZARDOUS MATERIALS DISCLOSURE
;j.Wllln applicant futureWildingmelp , bare or handle ho.'dwe nsam.] Type of Roof -
-
as derined by the Cupertino Municipal CovCW,m,9.12 and cH W adSafeY „ r, It;�}:� iYf Fs•x• \...�,- -�-
CMe Section 255320x3 \ /\ .,'1 r -`'ii'v+ fl f t-s., `' ♦ 3 t -' { _ —
Dyes ''1 o r ) S __ All roofs.shall be inspected prior to any roofing.material being installed.
Will the aWlicantor future building Occupant use equipment ordevices which If a roof is installed without first obtaining an inspection-,''It agree to remove
mit ha b - contaminantsf d edby theB yA A Quality M
g'mem
D x,r t all new materials for inspection Applicant understands and will.comply with.
all non-point source regulations. , ...),t• ,.,t'
.f l have read.me'Wardn, I -al q uM
curler\Clue, 695ofthe
.
Calif H pct&Safety Code Seelitso,25505 25533 and 25534..l Lmdeouiund that �
ffthebld' g d,s nolo flubamount.thtiti yrespo ,bilityl notify the V -( OJpvi //yam `(6� ev�
.coop t or me mqupem t which must M pr m to issaxnce of i Cemffom of
OccVVVV / s..�-si
A% upy .. .-'., .• :. .
., et ,: '.: ,.: , •., ., Signature of App scant Date
e , .;:.;Irl'„ Dim All roof coverings to be Class "B”or better'
-. ,:. ' .- �• x,' :." '.... . . OFFICE
Building Division
10300 Torre Avenue
„W, Cupertino,CA 95014-3255
s'.��''� Telephone: (408)777-3228
ICITY 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/a" 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:
Address: /Cy 2 70
Reroofing Company Name:
Applicants Signature: /X;"( Date: 5- /( - cv
Joe Antonucci
(Chief Building Official)
6/25/01