01110049 (2) CITY DFGmvSIONO
BUILDING iNPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10518 STERLING BLVD PATRICIA L FORKEY 01110049
OWNER'S NAME APPLICATION SUB DATE
PATRICIA L FORKEY 11/07/2001
PHONE: SANITARY NO. CONTROL NO.
wO ARCHITECT/ENGINEER: BUILDING PERMIT INFO
O
8 0 CC BLDG ELECT PLUMB MF.CH
y m LICENSED CONTRACTOR'S DECLARATION
1 hereby of rim that I am licensed under provisions of Chapter 9(commencing Job Description
vi'C lel with Senimr70(0)of Division 3 of t he Business and Professions Code,and my license REROOF & REPLACE SKYLIGTES .
ad Lice cell lass arca'' T/O & INSTALL TAR & GRAVEL.
z m a License Class Lit.N
'0d< Date cantmctor 4 SKYLIGHTS .
13 0.so ARCHITECT'S DECLARATION
°- I undersand my plans shall be used as public records
i
7 6 p O Licensed Prolessionvl
OWNER-BUILDER DECLARATION
o� 1 hereby affirm that I am exempt from the Convenor's License Law for the
C z a following reason(Section]031.5,Business ane Professions Code:Any city or county
P x p which requiro a permit m conswn,alter,improve,demolish,ueor...ir any stmaue 13m -pr on a' c 1. req ' th ppl cam for inch pemmnofleangrsad warrent_ n
Ibal tie Ic tedp rsuaM1l tp@e pro of the Convacmrs Licems aw(Chapar9 S t- FJoor,A e T+>• ation
(com g with Section]00(d fo 'on 3 of the Business and P,i fessons Code) C� ? - iW 1,vq` !.'r..k. J �. 4{�i?1 T �'J.V'i: $4 5V(4b'
or Ihai rte is exempt Ihcrefmaa and the bass for the alllgwl exemption.Any violation I
of Section 703 L5 by any applicant for a Pamir subjects the applicant to a civil penalty
O�ffnot
l!mom man rive hundred dollars, �I�IB($500). 3 7 AY !itr0 f � � Occupancy Type
I�s owner soba pmpeny,ar my employ.,with ages ea their sole compensation, '
,will do the twos,and the smicitre1,not intended or offered for .]a(Sao ]Baa. 3 0 5 - FRAME Required Ins actions
Business and Professions Cade:The Contractor's License law dao not apply man Q p
owner of pmpcny Who builds or improves merman,and who does such work himself 307 - INSULATION_ i
or dvaugh his own employees.provided that such improvements art not intended or _
dffcrda mi,alc.If,Howeve7the wilding ar improvement is sold within one Yor of 601 ROOF TEAR OFF ,
completion,me owner-wilder will have the burden of proving that he did not build or I
improve for purpose of sale) 602 - ROOF PLYWOOD NAIL
ii ❑i,a,Owner of,hct,.,d,,ton Bolusivsend manacling
Professions Code:)The Contractor's
603" ROOF BATTENS .._ .. . .. .... .�`.: i •T: --- -
p pc y,ore cxdusivd with li«nud convacmrs to
uc�u�w,a.).not apply man own.or property who edam or improves thereon„ 604 — ROOF IN—PROGRESS..
end who.<omreca foe such.projecu with a contactors)licensed pursuant to the _ _ .. . .. . .. . .. .. .J.__.. _ .. _ ..
_ Com actor's License Law. -
❑lamciemIn oder Seca - .B&P C for moon
f••' Owner P Dare .:
WORKER' COMPENSATION DECLARATION �®
I hereby tiff rim under penalty of peF'NA
: FINAL
ED one of the following declarations
❑ 1 have•and will maintain'.Certificate of Co..,I.self-insure far W"rker's. JUN 2 4 2002
Compensation, as provided for by Section 3]00 of the Labor Code, for the j
'psiformance of the work for which this permit is issued. .
❑1 have and will maintain Workcr's Compensation Insurance,as required by Section3700 of he Labor BUILDING
usE.MWorker's'Com far the
nsauon Insur�ancne tamer end for vire:
RwhichP<rmdtis
CaEiee' .I.+1"- t !'r!Z 1...^Y`Policy Nb.: . . s-r-7 sr e} $ '-ii.�:•pp sass, - r• {°;,,,G'•i l. ...
h'r CERTIFICATION OF,EXEMPTION FROM WORKfRSI: t- 1 4 a\.�'.L� Jil.t'_'l -.��L ftJ' .. t V_(!s Oby; '
. -COMPENSATION INSURANCE• ��_ - ____._-_ —..—_ .___._—___...._..._ .__._ _ ._..—.—. _. ..— _... . ____ ....... __._...
'(Thsscormih need nal bcrompleted ifmc pcmtn is for one hundred dollars il{'1.I ls' ,f. -
(3100)orlccc) I
-- " Iccnify that in the performance of the work for which Ih permii is isxuM.l :,{.n,�; ,•,I .•{., -�i, ,x
sIt *nm employ any person in any manner so am
to become xubjen ro me Workers'
Compensation LOw3 of California.URIC
Applicant _ .I - .. . .. -. 1 . '
NOTICE TO AP..ICANT:If,vfter m.king this Cenifc..a of Exemplioa'you should '
Z become'object a the Worker,Compensation Inwisions of the labra Coda you must
Q O forthwith comply with such in
or this permit shall he decmN.coked. -
CONSTRUCTION LENDING AGENCY -
'''1 hcteby tifirm that there is a consuudion leading age y f the performance
of da work far which oris permit is issued(Sec.3097.Civ.CJ -
,� Q Lender's Name— -'
r•-71Z Lcnder '+
s Address
U C I certify that 1 have rod this application and stale than he above information is
correct.I agree to comply,with all city and county ordinances and state laws mitring
Q U to building commotion:and hereby buthoriiterepmsentatives ofthis city m enter upon
. ',,,,rte, the above-mentioned Ptolemy for,mspccuon poryous.,, .
rCks (We)agree above,indemnify and keep hinnless the City of Cupcnino against,
(n liabilities,judgments,cost,.and expenses which may in any way acctue agaimt,said
(� z City iii con ming D this L COM
^ APPLICANT IS AND WILL COMPLY WITH ALC NON-POINT Issued by: Date
SOURCE R< NS i"'' �• t
Sig t f A t o .D te Re-roofs
\_ HAZARDOUS MATERIALS DISCLOSURE s m t 'el
Type of ROOF
WJI m ,ippliwnl or f t wilding e.Chant taro 2,h dl hazard /
as de5nm bypbe Capers M pal Coati Chapter 9.12 and the Health and Safety i -{ar 1 1,k a
Cdde.❑ ihm 25532nd ...tlNo'.., ,, I,)� ..fJlto q.Ns - i-` s f •.i•t l:.S,m .sec's.
:i +f
"•' '•rr •••" • All roofs.shall.be.inspected prior to anyroofing material being installed..
Will the applicant or rnmrtbuilding mcupant use equipment or device,which' If a roof is installed without first obtaining an inspection;'I agree to're
emit hazardous air commonena°i defined by the Bay Aro Air Quality Management
District? ,- all new materials for inspection.. Applicant understands and will comply with
oyes 0N all non-point source re ulations;.
P g ;
1 have read the hanalous materials'requirements under Chiper 6.95 of the
Cxlifomia Health&Safety Cade.Sections 25505,25533 end 25530.1 undersand that
ifinewildingd.s not currently have a mount.that it is my maponsibiliryr ccanythe
occupam Bf Ipe requirements which must he cI prior m issuancto of a Cenifcate of
?ig�nalure of Applicant Date .
-n amasses agent - - Date All roof coverings to be Class "B"or better
. _.. . . .- OFFICE. ..
•' a- A
Building Division
10300 Torre Avenue
, Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
ICUPEkTINO
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/" 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: �C 0- (2 '\ �& 7� d`+� - - I
Address: ( 05 l
Reroofing Company Name:
Applicants Signature: Date: ./— f
Joe Antonucci
(Chief Building Official)
6/25/01