02070121 (2) CITY OF CUPERTINO "
BUILDING DIVISION PERMIT CoNti!' -
CTORfIlNFORMATION:"�
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BUILDING ADDRESS: PERMIT
10821 JOHNSON AVE KEITH ROOFING CO INC N 82070121
GW'1'MhLACK 920 LINCOLN AVE APPLICATff/B Tf 2002
PHONE' (408) 295-8616 SANITARY NO. CONTROL NO.
t
0-,.- ARCHITEC 'ENGINEER: BUILDING PERMIT INTO
BLDG ELECT PLUMB MECH
dad u L-1 L:7 u
,On i LICENSED CONTRACTOR'S DECLARATION Job Description
IZ_❑ Iherebyaffimt that l am licensed under provision of Chvpmr9(commencing REROOF P
wt_y with genion 700%af Division 3af the Business and Professions Code and mylicense
4 ix;n full force an c 5 /_
:C 6 Licenu Class C N T V
3 u:+ ARCHITECT'S DEC
O g I undeaI
mmiid my plans shall be used as pubic re rds
Sp O Licensed Professional
OWNER-BUILDER DECLARATION
�-' 1 hereby affirm that I am exempt from the Contractor's License Law for the
F < follawing reason.(Section 7011.5.Business and Professions Cade:Any city or county $6450
requires pe construct,alter,improve,demolish.or reptua any structure
to poor to its issuance,ebartnnes0eapplicani for inch peril to file a signed statement. __.. ,__-._...._.._.-,____.__...____.__.._.....
F o which re rres a rit m n
C _ q
Wthe ls,licenud puisuaht ld lhC provlsfons of the Conwnork Licanu law(Chager9 3S¢�'J:�Ikl'drr/U'®d•'.
(eammetreing with genion;]000)ef Division Sof the Business end PrYlgs;ons Code) j'i('} €, .;, tt '-t''S�• Valuation
m that be is 6efn f theiefiom'ond the basis lonhe aIle ed exec =!.`, 1.�1 A.ir.i t_v.•.
p C gioo.Anyviole seemly...of Section e[him
iv any dreg oll term a permit mbjnts me applicant to a evil prnelty' 3 0 51PN WRWE .i,..
!of not more then five hundred dollars(5500). ;-N0 Occupancy Type
al,asowearof the propcny,or myemployces with wagesus theirsole compensation. 307 - INSULATION
' ill.do the work:end the tlroctnre'is nm intended or'bffB<d for'sale-ISea770,,1: 601 _
Business and Professions Code:The Contmetar's License law does not apply to an 6 0 2 - ROOF PLYW u' Vion§I r' -
owner of property Who builds or improves thereon,and who does such work himself LL
or through his own employees.Provided that such improvement{are not intended or
,or
for sale If,however.the building r improvement is sold within one car of "` - '- --
gr " "- "603' - -ROOF`BATTENS -
ddmpleoon,thcownerfWd.).will have the burden of proving that he did rot Wald or ' '�T ' -
imgoveforpuryoseofvle) 604 - ROOF IN-PROGRESS
C 01;as owner of the property. exclusively commning will]!caused esurnicton to - ---.. .............
construct the project(Sec.7044,Business and
" .. deCode:)Thpe Contractor'.
LicenuLaw docsoatapply en wnerofpropnywh.balideimrovesteesm.
and who conoads palma wash nwnodU licensed.pusem.to the _ .....
Co a cloLicense Law..
Cie..
Ia mptunrSec
'""' •'
@'P C for this reason '
- Owner
WORKER'S COMPENSATION:•:.. r:
DECLARATION AUG
UG 0 1 2002
i he cby a Rr i ndpeniter f V ll
y p,perjury one of the following daluations:'
heve'wnd will'maimain e'Certificate of Consent to self-insure for Worker's BUILDING
Compenanion, n pmvided-for by Section 3]00 of the LeB
Leber Code. for the B N
Per(erformance of the work for which this permit is issued.
prlwmout will'tnei to WoiA'er's Compensat on Insurium w[required by Section
Cv er m rxnc f the work for which th r permit u
I,S T1 My J CECRTIF CAT1, tIOP P] rec tamer erid Policy nuinbe eR.
a
.::F ,s.. Polrry TI a R '..i. .J, .'. 0-,
cit.'_• .e:.,.:: IONINNFlip E"'-'KE- .i, S .vl_ a �_ Sa iti
t.
COMPENSATION INSURANCE"" tl' "''i '
f n i scnion ase d not be wmp leied if the m permit is for one hundred dollen F.41Y`I i'�
IS1W) last (�
shall
,1 comfy 'n in the n'!army manner
the o to become
th s cerin t leW d I """ ^^ •••--^ -
shell not employ any porton m any manner so u m become subject to the Worker!
Compensation laws of;Callfo.1 Dem,'
t NOTICETOc'm the W.Ace aOc irmini this Ccnificatof Letter Code,
•:I'1'.r">•`1 ^�I'+"
Z becomi ffi co coo thea such pi Compmmois peomstom of be d .W Code,you muse
O fnnhwiN eomyly witti men pmvisian or Ns permit shell W dcamed revoked.
> •j1 ,'CONSTRUCIWNLENDING AGENCY
a '" 1he by which thatthenus construction drygg agency for du perform nee ,
Le Ne wok for which tMs pe t issued(Sec 3097CI C) .I
l P' r 1 ,
'kende sNeme.• ....,. ,......v,. ,.a.. .....: ........:,,:. ..._.. . ...._.... ......_..
�.z Lepders Address'•• .. - On R hiP,
0 V9.
1 cecfy Nat I have read this applionan end nate Nat the above information is
ker F cbriaaL I agree to comply with all city and county ordinance; su
and u lows reining
C);U :a boiling construction;and III authorise reprtuntadva of this city to enter upon
,'y W the hove==bonedproperty for in
purposes.
L.t LO' fWe)epee to u e indemnify mtl keep harden tAe'Cny of Cupemno e`einn w,
rq liwbduia ludgm esu end expenses wh ch may m any y ecame age asst yid
G'Z City neon en' of the noun f0 a _" /)�
�' SPPL� ERSTD N ifLL C011PLY NTI'H'ALL ON d' Issued by: at
Re-roofs
I' ' HA77ARD aTERIALs DISCLOSURE " t �' r'
'� WB Ne epplkmt m furvre dulEing accent nom ser Mndlc herudous nincnal Type of Roof - — -- -.- -
o def ed by th [aconin Mumn Code Chept 9 11 rid dm Heehh end Safety - -- - _
Code,geetmn]5532(q Yl jt - s.., 7 i .. - . . '. It ';:' IL k t.:{.'f r'•Cf f'j le': .,-. `' 01.
-it
All roofs shall.be inspected prior to any.,roofing material being.installed.,_....__. _ .
"I',L WII Ne,epplicam or furyrt building occupem use equipment or devices which If a roof is installediwithout first obtainingan ins ectidll,I a ICe.IO ieillove
emit hazardous nr conummanu a defined by the Bay Area'Air Quginy Menegemenl P g
-pit+ .: ql, f ? ", q all non-materiource re ulations,`Apphcan[understands and will tom I with
nonnew P,Y
g
` '01 1 have ieelli the h zvdous mnenals rt oirlment{under Cha er ti 95'of thi
California Huhn&Safety Code;Sections 25505:25533 and 15534:I imdemmd that
ifjhebulldnigdeeSybI cturentlyhtive.tenent that it myrespon ibibty to notify the
occup the a uirememi which mail be mit Orionto tsiumce of Cem111 1.Of
an '., i
Igo f Applic Date'
_. -
t
r ed agent ,' ie, roof coverings to be Class "B" or better
.— 'OFFICE., ..__._... .. _ - . ._ .... .. ...
i
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CI OF Fax: (408)777-3333
• CUPE�TiNO
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) Preinspeclion 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: ar.I
Address: v,-h,
Reroofing Company Nj
Applicants Signa e: / r Date: �/
. Joe Antonucci
(Chief Building Official)
6/25/01