03010131 CITY OF CUPEBTINoBUILDING DIVISION PERMIT CONTRACTOR INFORMATION '
BUILDINGADDRI3S: R E ROOFING & CONSTRUCTION 'PfC^'NO
20711 SCOFIELD DR
OWNER'S NAME: 152.30 CLYDELLE AVENUE APPLICATION SUB DATE
FRANKLIN KENNETH AND BERNICE 01/23/2003
GrONE: 408) 925-9995 SANITARY NO. CONTROL NO,
ARCHITECTIENGINIHER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
�00 .LICENSED CONTRACTOR'S DECLARATION JOT)Description
F I hureby affirm Nat 1 am It...d under provisions of Court,,9(commencing p
��cue with Sect aAM)(holOyy 3of a Business and Professions Code,qand my license is
N in rob force and ctfcc,.lf 5, . "I Z qct l REROOF
OZMKo°zq� Ltcen cla REMOVE EXISTING ROOF INSTALL 1/2" CDX
Dom � onuacmr r a
nscifth.crs°ECL N 30 #ASTM FELT & PRESIDENTIAL TL ASPHALT SHINGLE
I underswnJ .I plans shall he used aspuhliC iccnrds
F40 Licensed Professional
OWNER-BUILDER fr DECLARATION
a I hereby affirm that 11. exempt from Ne Comms Co License Law for the
w X p O following notion.(Semina](OLS,Business and professions Cod,:Any city it county
e $ which myuires a pcmti,m[imawcl,nlrc¢improve,dcmnlisM1.nr«pair any suuamm
to
prior m its issuance,also reclaims the applicant for such permit to file a signed stammenl
�pp•x�x<
that he is licensed pursuant to the provisions of the Contractor's License Law(Clasper 9 Sq. Fl. Floor Area Valuation
afFa (commend ng with Section 78(10)of Division 3 of the llusinessand Pinfessions Codc)or
Wy _
that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a Permit subjects the applicant a civil penalty of APN Number L C Type
not more Nen five hundred dollars($500).
Y Yp
❑I,as owner of the rampantly,or my employees with wags as their ode compensation,
will do the work,and the structure is not intended or offered for sale(Sec.70ad,Business
and Professions Code:The Co n amer's License Law does not apply to an owner of Required Inspections sprop1�,
men coywho syces,pnevi imprat such improvements
whoN,notes inendhir ofred for ugh slehis 305 - FRAME • II ALAE®
ownert In obuilds fha News thea r,andw oarmor int
ended rkhimelf or for sale.If,
however,the Molding or improvement is said within one year of completion.the owner.
builder will have the burden of pmving that he did not build or improve for puranse of 307 - INSULATION
"ctIv.)' 601 - ROOF TEAR OFF FEB 14 2003
❑1,a owner of the property,am exclusively worn ting with licensed emoream.to 602 - ROOF PLYWOOD NAIL
construct flue project(Sec.70/q Besimss and Pmfessinns Code:)The Cmaremor's Li-
ceriseLaw does amapplytoanOwner ofpmpereywwhoMrddsorimprove;thereon,and 603 - ROOF BATTENS - BUILDING
who cunuam for such projects with a commeaf fs)licensed pursuant to the Contractor's
u,em,Law. 604 - ROOF IN-PROGRESS
❑1 am exempt antler Sec. ,B p P C for this reason '
Owner Data
WORKER'S COMPENSATION DECLARATION
I hereby affimt under Penalty of perjury one of the following declarations:
I ham and will maintain a Certificate of Consent n self insure for Worker's Compcm
cation,u provided for by Section 3700 of Ne Labor Cafe,for Ne performance or the
w for which Nis permit is issued.
have end will maintain Worker's Compensation Insurance,as required by Section
3]t nI NC Labor Cnde,for Ne perfnrmancc of Nc work for which Nis permit is iasucJ.
My Worke's Cnmpensalin 1a1mmo ace cavi.'and Policy number a2:
lia
Carrier. /`"IZ% r4 Policy No.; tJ0
CERTIFICAM0 EX EM PTION FROM WORK ERS'
COMPENSATION INSURANCE
(This section account becumpleted if me Permit is rmone hundred dollars(51 W)
or less.)
1 certify that in the performance of the work for which this permit is issued.1 Nall not
employ any person many manner so as to hecume subject to the Worker'Compensation
Laws of Calif ami..Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's COMNOMllon Provisions of the Labof Code.you must
O z forthwith comply with such provisions or this pbranit,oll he deemed revoked.
O CONSTRUCTION LENDING AGENCY
I hereby aortoNm
m there iso comwnion lending agency lar the performance of
Cd 7 the work for which this per , s issued(Sec.3097,Civ.C.)
Qlander';Name
z Lender's Atldress
U O 1 certify Nal I have read this application and swee that Ne above information is
^F
cancel,I agree to comply with all city and county ordinances and site laws relating hr
V building conswction,and hereby au,honee representatives of his city to enter upon the
W above-mentioned pmpeny for inspection purposes.
G (We)agree to save,indemnify and keep harmless the City of Cupertino against
V) lubili,ies.jutlgmenkx,costs and expenses which may in any way acme against said City
7APPIA
h,f Ne graining of this permit.
^' DERSTANDS AND WILL COMPLY WITH AL NON POINT Issued by: Date
I NS.
Re-roofs
pplicanpCnnvacmr Due
�"'��HAZARDOUS MATERIALS DISCLOSUR Type of ROOF
Will Nc applicant or fuwr,MrilJing occupant storcar hand le hri, marginal
as defined by the
Cupenins unl xl Cude,Chapter 9.13,and N,IlcalN a,ly
Cade.seeoenlss3l(a17 All roofs shall be inspected prior to an roofing material being Installed.
0]Yes P P Y g g
Wm the applicant or to building acupam use cyuilarp car devices who If a roof is installed without first obtaining an inspection,I agree to remove
mil hauNous air contaminants, defined by the Bay Arca Quality Management all-newrrhklerials for inspection.
Di[Iricl'/
❑Yes n „�
I have read Ne hammous ma fialsmyuimmen¢unde Chapteffi95ofthe Ca far- y ��
tk Safer .Sccoues2tu15.2553and7S53d.l on readthmifthebui ing
d_x nal cu y ha am.tha ie. resrym iry,o nWy rue .1 Pan,of d e-
rcyvire • c us, ,, ' ttui. ccofa ifica 'R-Y.L3h .— igin'ature.ofApplicant
GwncrnraUllm a•em DFFmc All roof coverings to be Class °B" or better
Building Division '
*C10
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Fax: (408)777-3333
CURINO
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) Pinal 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 V"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: 2 U 5 Co 1' 1�ELV !!
Reroofmg Company ame:
Applicants Signature � / 61 Date:
S •
Joe Antonucci1
(Chief Building Official)
6/25/01