01110018 (2) TY
CI
BUILDING UDPERTONNO PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
10401 JOHNSON AVE ROOFCO OF SILICON VALLEY 01110018
OWNER'S NAME: APPLICATION SUB DATE
SONIA WILLIAMS 844B EARLE AVE 11/05/2001
j
ONE: (408) 795-3335 SANITARY NO CONTROL NO.
opo ARCIi1TECT/ENGINET:R: BUILDING PERMIT INf-CI
BLDG ELECT PLUMB MF,CH
S y i LICENSED CONTRACTOR'S DECLARATION Job Description
1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing
'_C� w0Sodinn70(o)nromi' 3afineBmines3anaPNre35mn,Cnde.andmrfeense REROOF .
,imfell force
a 3S BUILD-UP.
s w 6 Data CIax3 L(Lie.»
O d O Data r-¢0A Conlraaor
3 3 ts0 T'J pR H Ec",DLCLAR ION
I undervam my plans sltall he used as puhhe ucords
i to
i M C O Licensed Professional
OWNER-BUILDER DECLARATION
w^ v 1 hereby affirm that 1 am exempt from the Contractors License Law for the
t?< following reason.(Section 7031.5.Business and Professions Code:Any city or county _
{ 0 which requires a permit to centimes. IIc%improve.demolish,or reps any shructum -
n3� -.pr on t L,requires_ the,applicantf <h frorm uofkeagn"Smmmem. - c
that nc.I'cen. dpu uanit thepo I. so(thcC no-n rS Licenx Law(ChaM<r9 f, Sq'-�'t.}FI000'A{ea t 't ,»v Valllallon
(mm rte ng wids sats n17000)ofDvvi n3of the BufinesS and PNfysions Code) •,--O r«_i3-. . t i\ tr N.
or that he is exempt drdefromrand the basis for she alleged eremphon.Any violation on
I
of Schon 7031.5 by any applicant lot a permit subjects she applicant to is civil penalty
.of not more than five hundred dollars S500). ._ APN Number ':fTO Occupancy Type
°I,a5 owner of the pmpcny,or my employees with wages as their sole compensation,
will do the work.and the structure'is-notitd'ided or offeried Por sale(sed.7044
Business 3 07 - INSULATBQl53ired Inspections' ` "C
and Pmk,,ions Code:The Conlmcmr's LlcemX taw does not apply to en
owner of property Who builds or improves thereon,and who does Such work himself 601 - ROOF_ TEAR OFF_
or mmugh his own employees.provided ince vucnjmhim is sats are not intended or -
-.offered tar sale If,how the buildm r m e m is ld tti -6 - - — - - - - -.. - "-`- '-"•
g p nue year nr 6 0 2 - ROOF PLYWOOD NA3 L. i.+ '
completion the owner hu Icer will have the buNcn of proving Ihm he d d not build or I
improve
fnr paryoX nr Sde.). 603 - ROOF BATTENS
-- - - ro- — - — - -- - -onr--ctorm- ---.. . . -----,- -- ----- -"--
owner or the pperty.am cedmisidy contracting with licensed cvs4 -- - - l
O1;as
e -
License
the project(Sec.
appl 7000,Business and Preceny who
Code:)The improves
thereon,
w con Lew tices not apply m an owner or property who builds se improves thereon,
-a".who commas for euch.projena.with s.comracmrtg licensed pursuam au.the _.___- ___._-_.—__..-_.__. ...__......___.._.
^ Conuactors License Law. -
_ °lam exempt under sec.' Bd P C fur this ren is
A
.'�
f HLL D
Own Data
WORKER'S COMPENSATION DECLARATION 1/ p
/'-
Owner I hereby affirm under penalty of perjury arra o(Ihe following dedatalions:' NO• 0 U 2001
C ] 1 have and .61 maintain a Cerifi<are of Consem m ulf-insum for Worker's
ompensa'on, a5 provided for by Section-3700'of the Labor Code, for the BUILDING
performance of she work for which this permit is issued..,
°1 have and will maintain Worker's Compensation'losmance,as required by Section
3700 of the Labor'C" for the performance or the used,for which ths permit is
issued My Wo rY Co t 1 so sdi carrier and PoGcyaumber,ese_ -
c`a�„t 'tpi�" a : - ,•. ') )..,.: I�.
t CEKTIFc...ON Or h%F.MPTION FR MWO ( i, yk,9.i J(!-�t
COMPENSATION INSURANCE'
P'.
'QTii uciioli need not tie compin"if the permit is for one hundred dollars " ''i�' '' .-.ni i;eal-' "ti
o.
_ I m l I-a inthepert anceorth 'wary forimm, u permit issued a,kd 1
shall not employ any person m any mnnh<r,m u to became subject Ir the Worked -
Coinpcnution Idws of Califorde.Dare.'
Applicant'-.. - " ,.
NOTICE TO AFPLICAN'elf,after making this CeniG<ate of Exemption,you should
become sebjccno the Worker's Cumpensalion podvi,ions of the Labor Code,you must
C C forthwith Comply with such provisions or this Permit shall be deemed revoked.
,Z,.. r' ' bcrebY v.. .__ _ ..- .... ._.
V] CONSTRUCTION LENDING AGENCY'
oft
there iia eonsrumion lending agency for the,puformanoe,
i..,
Under
lk faffrn that
n which thispe h'. d(Sec 3097 Civ C) ,v
WQ - 'de N e _...u.... . 1 _,w_,.- .._ . _ ._-. _.- ..__.._. ___ .... .. .. . __..... _.. ._. -......__ _ ... -.. .
�.Z 'ditersAchdoes,
1
V C 1 certify that I have read this application and sm.drat the drove information is
_.La+-[.. ci irt<i:1 agree tr complywiihall city.and County,ordipanees and sum lawn relating -- - -- -- . ---- .--------" —'"--'-'-"___ --
C U to Wilding cmewlelion,and hereby amWd;,e'oToo,clmlve5of,Ws city I.imerupon
r (a] the abuv�Nentlomed propery for inspection puryoses.�, . . ,
F-y ( J agree to Save;i dem. and keep humles9 dse City of Cupertino against - -
VJ Ii.bllllles,)a en10.[n5 d e XS Wlil[h may In Ny Wiy K`NC 8ga1R31 bald
U.rZi City in cons nee of the min �thispermyy�.,- �•s _
pPI'LICAM1 ERSTA S' /JMPLY WITH'ALL NON-POINTI' -- Issued b ! Date
SOURCE'R! TI Y
-Signpmrc of Appicam/C nactor - : :;' r Dare Re-roofs -
HAZARDOUS ALS DISCLOSURE
_
..Will'dse appueatil -r cert brew. pant m or haul l n„atd«.a maierd .Type of Roof '— - --- -
u defined by the Cute n Mu \#
C c Chapt 912 and she Health and Safety - i '110"
... - _ .. ._ -
Co'de Sen on 1551](e)kt y' 1_ , I cl --•`< ,. . .. z �3� rP,.��' 1f lsv , .kr.. '1/��l. r 15 .
«°Ye��• -y ttoNp-1,; a.'. ''it'.'t _ All.roofs.shall.be.inspected.prior,toany roofing.materiaLbeinginstalled.--.. _...._
Will the applicant ofuture Wilding pant use equipment or devices which If a to is install without st obtaining an inspection;? agree to,remove
emit hiscandous air contaminants as d find by de Bay Ancis Air Quality Management
m3melY - all rte aterials f igspec:o Applicant understands and will comply with _-
If °Yo5 °N all non Sint source agora
''read.the zardous m e Is rtquirem ndx under Chapmr 695 of the
Call,, raids&Safe -Code,set an 25505.35533 a"2553<.1 u"oma"thal _
_ifiheb n d«snot sit so le teat it ismy respon5ibilifytas
notify the ----
occ p lcquimm whi Is us ci p t isdounce,cif is C mficat of
Date. _
mer pr odea asenl '- I Date All roof covt&Vto be Class"13 or better
Building Division
j� 10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
IDCUPEkTINO
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 reroofingaqq will comply with this policy.
Homeowners Name: w1 C� I 1 1 l LPiI 11^
Address: ��7t-)-�A A Q MA, hV�
Reroofing Company Name: O
Applicants Signature: Date: /
• Joe Antonucci
(Chief Building Official)
6/25/01