02040003 (2) CITY OF CUPERTINO
'BIXLDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10115 CAROL LEE DR 02040003
OWNER'S NAME: APPLICATION SUB DATE
BARNEY JAMES R AND JO ANN 04/01/2002
{ONE: SANITARY NO. CONTROL N0.
,
eco O ARCHTTECf/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
a c LJ f__. 1= 1-7
z, LICENSED CONTRACTOR'S DECLARATION Job Description
i z u- I thereby affirn that 1 am licensed under provisions of Chapter 9(commenting
:t. withSection7")ofDivisionSof the Business endProfessions Code.and mylicense REROOF .
is,S in unl r¢�e cera er IlapO-J07
Hu u Lic Liu -p
'LL O`n GOn12oo�,a��� 4.✓a PsAUi!s "A IN
ARCHITECT'S DECLttRAT10N
5 1 understand my plans shall M cited as public record
'ce
I S p p Licensed Professional
OWNER-BUILDER DECLARATION
u� I hereby affirm that 1 am exempt from the Contractor's License Law for the
t < following rcawn,(Section]031.5 Business and Professions Code:Any city or couny 9 O O 0
E F o which requires a permit to consent alter,improve,demolish,or repair any structure
tSlpurSblm lq ffixt dravisionsolC wt 's
or Net he,Selempt tncrcf o 'd the basufor the DllcBW eNLemitty ,uupdl.uAnyICvhioplamtiro9
(comma Ii gs n _ . ` nm-
Valuation m�e, h xJ �
x '
-of Smtion]031.5-by any aWliant fora permit wbjmM the applinnt to a avil penaly-
.fnm mere,than five hundred dollars(S500), 3-PNNt E - .rt Occupancy Type
01,as owner of the prepeny,or my employees with wages as their sole compensation, Q 7 _
-will'do'the arms;and the structure is not intended or offered for Ola(Sec.7O ;'
IBaslnesx and Precisions Civic:The Curimcnr's License Law d.is.apvlr t^an 601 - ROOF TMkilbirBEEispections ":;;,;":I
.Or of proper,Who bulli or improves Ince.^,and who does such work himself
or,hnmgh his own employees.provided that such improvement,are nn,intended or 602 — ROOF _PLYWOOD NAIL
'fo&rind per"sal' If n we 'the W. Id'
g r Iix that he did am build or 603 — ROOF BATTENS
eempinr.n me owner be mer will Wase me barren or proving mat ne did not baud or � •' � � �. -
improve for parpoxaefxma). _ 604 — ROOF IN—PROGRESS
Q 1.as Owner of the
for
0.ver am_exclusivdY .Ira-n. ewh do_t...actra
swn the project(Se ]Bat Business a Professions Cad )The Contractor_s
License foe apply to an Owner of pinwho Wilds rep
and,who,contracts fo such prejects,with a c t t (s)licensed Parmarat.10 the -, ----
Contractor's License Law. ._"
i
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. __.
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0 1 annexcrep, ntler Sec _ ';_B&PCT thrtawn
Owmil Date
e WORKER S COMPENSATION DECLARATION
I hereby tiffirrin nd< pensity.,lilryry o f the follow g d lent ons:
1 have and will maintain a Cenificate of Consent to selfansure for Worker's J�
empc,tution, as provided for by.Section 3700 of the Labor Cade, for the
performance of the work for which this permit is issued:
_ ❑1 have and will maintain Worker's Compensation Insurance,as rav,fired by section
..
3700 of the Labor Code,for the performance of the work for which this Pcm n is
isued.MyWorker's Com1.pensat. l ante mid Policy number are '
e,`TA7FI,F.VND' !PokeyNd
-aFsaa�9 qq
t C7 CERTIPICATION OF EKEM FRIM WORKERS'- _ .S f. k.�..3 ,.t `S �. F.r !S ..4� . .1,A .
"COMPENSATION INSURANCE"'"-r--' - '
(Th shortno.NO completed if the pectin is for one hundred dollars
(g100)Of less.) - '
1 each fy,h t in the partbaspermcc of flactaymik( m h this penced,is,. seed:I t Y, 1
hall not employ Y person y t w ncgt neoome mbJect t th W rkers
Compensation laws of Cahfomm Date,'' `
APPliani.. : . . :.. ... ,
O Q ' Provisions
' rtons
_.. ._..NOTICETO APPLICANT1fafmak thsC nfct fCIY should
zbccm i Work s Compt provisionsofthe LaborCod you
fonhw I cin,li with such p o 's ons or this Permit thII be dicepacal recover.
t . ." . . . .... -.. .... - . ...
'
CONSTRUCTION LENDING AGENCY -
a1 'I h by aB'rm that th sec w t n lending agency for the performance r n t r a!
Of da,workfo hlch this permit id sce.3097.Cic CI
d.Q 'Lender,Name . '•, �. ,w... ._. _ - _.o�.e_•_ ___.._. . ...
._ _. .._ .. .. _.... _ ........__.
Lentil
e dei Add ....... - -- .. - ._. . .. .. _.. ...
1.
1—1 can fy Out 1 have read this applicationd sum that he above information is '
w.f~ c-1 1 agree m comply w th all city and coumy ordinances and stain laws relating
D:V to building construction,und h[,e6y Bmho$se representatives of this city to enter upon
W the above-memionad propeny for inspection� purymes.�`y A; (We)-ince et save, d n'fy and keep harm) .sth'City ofC pen '¢gyms
W liabilities.judgments.costs and expcnua which may in any way action,upunst said
V.:Z Cyin auq c,of the,dad9 I
Is LICANT UN AN fA'O WI PLY WITHALLN NP 1 / w
S URCEREG Ns �y /7 Issued by: Date
ignamreor APPlicam/Commew •y .. •Dam Re-roofs /
r HAT RDOUS MATERIAL$DISCLOSURE r
°Will thcapplam o,future tiuld'igncc -
s aernea by thc pen d M Pam r rc handle Hamid -. ta;al
Type of Roof -
palcode,Cnpm913 ales Health ds try -- - ..
C.d,S u zss32(U 6 1 hl..n > t 'M; , '', \:' % - a;t ` i•,f .. .
All roofs shall:be ms acted nor[o any,roofing"matena]_being installed.
P P
.tire the Applicants m r t building fin « p t ca p , deviceswhich If a roof Is installed without first obtaining an ins ectron I a ren to remove
niha iU contaminants refined ByA ArOmryManagement g p g
�m all no pmt
_QY all new materials for inspection. Applicant understands and will comply with
p
11 I r
n o soocce regulations"
"1 ha a eaa'the hamrdous ream cels scgmrc this under Chapter 695 of me
GI f m FiaRh&S f ty Code S eco 25505 25533 d 253Ja 1 understand that `'
f1hiWltl Wilding not curemlyh < mnent ht yrcPnblym t theOrei
pilo f N q 'nu rn LCbe m o t uanc fa Can f-to of - -'
Signature of-Applicant
act
menagent Do, All roof coverings to be Class "B"or better
( . a — - - n...........
OFFICE-
... ...... .. _ .._.. ._.__. ._..-- _ . _ -"
Building Division
1 ?" r 10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPERTINO
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) Preinspectioh 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: TAMOK S A P-N lam'/
Address: / 6) //E� C A"L- LCA Z)p
Reroofing Company Name: I-OS (!�'A7-D3 A00f-)nl6
Applicants Signature: -/� /Date: 4/ /oY
Joe Antonucci
(Chief Building Official)
6/25/01