01090002 (2) CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
7486 BOLLINGER RD DAVE SMITH ROOFING 01090002
OWNER'S NAME: APPLICATION SUR DATE
CARROLL JOHN W AND ELEANOR D 1052 KELLY DR 09/04/2001
!/PHONE: (408) 973-9427 SANITARY NO. CONTROL NO.
(a c z ARCHITECr/ENGIot WILDING PERMIT INFO
z O FOF L ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
5'? Job Descri ion
I herehy affirm that I am licensed under provisions of Chupmr 9(cummenemg
ml_ ssithiakfan]0001ofect. on3oftheBusinessunJPmfosionsCode,untlmYli°^^se REROOF.
roma amd effect. (T/O SHAKES INSTALL OSB &
z.a ams a < 3 i Cara , (_ `z -( 3 1
.0.V Iso¢ —b�Y-w II_ Contractor z
' ARC ITECT'$DECLARATION 40 YR. GEAF. )
i1 understand my plans shall Na used in public records 1
r
iO o Licensed Professional
6
OWNER-BUILDER DECLARATION
I hereby.Mirth on a Buscot from the Cnnlm,C s License Law for the
C?< following reason(Section]o3L5�Busitess and Professions Cade:Any city orr aunty
E$o which requires a permit m".rnssuuct.alcor,improve,demolish,or repair any stmcwre
i3c� ,patt,m int issuance,also requires the applicxm for such permit to file a signed stamnwnl• - _ _. _ ___ ____...____..______-_ __ _ - _ -
(commencing wimSecuanito00)oflsionsn ffic 3ofteBusinsLicenu Lnss ssions mr9 1e , } ,S Ft:Flo ,A -
(commeneing withSection7W0)of Division3nf the Business and Professions Code) •>_` , , s , _;tar•5� : .�J.' ' ' $B oya�tlatlOR
or that be is exempt thhmGotn'aml the basis for the alleged 6traftion.Any violation
-ofSecaon 7031:5 by any oppncant fora permit subjects the applicant m a civil penalty
of not more than rive hundred&B...rs($300). 3 5 9Y Tbff0 OccuP anay TyP e
Cl I,as owner of the property,or my employees with wages as their sole compensation,
-
will do'the work;and tna-structure is not intended nroBerea for sale(Sec.7044. Required Ins actions"
Business and Professions Code:The Contractor's License Law does mol apply m on 305 - FRAME 9 P "I
owner of property Who With.or improves Thereon,and who does such work himself
_pr through his own employees..pros;ded Oat such improvements m,nor intended or _ .. 3 0-.7-- 1 NSULAT I ON
offeredtt sthe. stho a th lhavngonrdemof Moving
ethinone yawof 601 - ROOF TEAR OFF
iompl i the owner bu Id TII have the buNen of prm�ng th t he did not built or
mprove mrpurpose citric.). 602 - ROOF _PLYWOOD NAIL
con tr f je property,4th Business
d Professions
ng with licensedcontractorsContracts m
603 - ROOF BATTENS
construct theproject t(Sec ]to a Runness and napery
won th Cade)The Contractor's , t
Lm nsn c.mincsw sfo-say matctsa..c,ofwnpmpmor,lonbt lds .ed M vas hi,tn 604 - ROOF IN-PROGRESS I'
'
..and who-mon icenseL such.Prnjects.x lM1.o ctnoauarly,l'censed punnant.to aha
Cot t e Lt undeL
❑I cont antlers c ' T'"' ° "T',B&PCfor this reason 1',�
Owner' -
aYt' '-' WORKER'S COMPENSATION DECLARATIONit. '
I hereby
id M.underpc by fpepry eattheo lownon,for Woo
y C 1 h arid will n I C y fico f 3 n.enf'tt self bore for Worker s /
Co n at -' ,pr I A T by t Section lk,u f the L n Cole for the
,. Osl h d will maintain'W�he is n in e eo n In crar Creno ret by 5 2t n
Pert a fdcw Af htl pent s J
ue
El I h f the Labor CNe f n iformpenomumc f Ili rl,f which ed permti
Pe Paliryadrrohc,lm,
ern Sf"•t-li^1 ti� Fol cY No.. ��� 6J X01 sd�
:'.f CERTIFICATION OF EXEMPTION FROM WORKERS." ' 1 - •^ ♦, •+ 's 1 `�
- COMPENSATIONINSURANCE, ......
J
see(an n ed'no
t,e crimpleiea tuna perms Ts ror ane mm�area anuars
s . . .... . .., ._. ._. _.__ ..._...,.._... .. _.....�. ...
1cmfythat, then I.toy
ark farme.t pe-"t is issued,1 s t
Compensation
om not employ any f nn California.any manner sn as m become subject td the WorkersComicturt on Laws of C ' a'
A0pl
NOTICE TO APo the Worker's
ork is after n nvatio powni ficoze of Exemption ,you mind'
0 form th comply with h m ' ons or this t lin 11 baa d
bac ub eci I the Wo keI C
pe a rpm so sof the L Iw Cod
pY p D kd
Y
� 'CONSTRUCTION LENDING AGENCY >
1 ' 1h i ffrTithat d ^ osl e J g pe )f theprfnm
me o
W of kfo huh'hisp is oied(Se309] C .C) "
itsQ Lendrs Name .. . .. . ... . _ _ . .. ._ ._ .. .. _ . ... .._ _.._.
;D:Z Lender's Address *'...•. ...• s'r,,. _: _. .. .__.. .. _..'. '
I minify that 1 have read this application and stem that the above information is
[..
compact.I agree to comply with all city and county oNinnnces and state laws relating
�.V to building constmctkmnmd hereby andrrize representatives ofthis city to enter upon'
Vis:W
he above-mentionedpropen,for inspection purposes.,
�.T 0•T r_W)agree to save,t indemnl ry and keep harmless the City ofC Pemno ng 'nsl
F•T V] (hub I i .] dgm ,n,costs and expenses M1 h ri y any y llon st oid'
C.I City n clC fthe gr t' g fthisp cot '
APPLI U1 STANDS'ANDWILLCOMI'LY WITHAL1 NON-POINT'
soU ExEeI)(A7 _ Issued by: Date `t" a/
gnathreDf ApplTcant/Conoemm�s..'..•'."t,' f Dare;,+t Re-roofs
HAZARDOUS'MATERIALS DISCLOSURE "
Will the appfica t cr.fit building occ pam store or handle hazardous mat nal _:Type of Roof._3^ -
eerChapter
dnad byte CPenn MHrmhad - f-
Code Section 25 (a) !
Municipal Cod 9 I s7 I{ Safety•r F .'. .5' I r .•.
❑res { ' ' El No t zr r, f: ,_,_All roofs shall be inspected prior to.anyroofing.material beim installed._
g ...... ...._..
,p:t Will In,applicant r(mom binningnrcapantnse<gnp into ilevict..which If a roof is installed without first obtaining an i spectiori I'agreeao remove
emu hazard it contaminantsas defined by theBuy Arlo Air Quality Management
District? _all new materials for inspection. Applicant understands and will comply with
❑vaI.Ts ❑Na all non-point source regulations:,
I have rendrthe hazard.x mdmnals rcqu rementi under Chapter 6.95 of he t
CalTfyma h&:Safety CNC Scnions25505.]5533 and 25534.1 understand that
Oocc ,'dfOore currenwhich ..ranto(. mfitoa the,
c ty,. q1. whichmet Prior t roof
Oc panty � ., is,§ ce of a Cenifico '
Signature of Applicant.
_ Date
owner ria nation, .. .._.. ._ .._ _ _ ._.. .. .
Z. idea ag t , ; . Data Al] roof coverings to be Class "B"oi'better
l r
OFFICE
Building Division
10300 Torre Avenue
d Cupertino,CA 95014-3255
Telephone: (408)777-3228
408
Fax:
CITY OF ( )777-3333
7 3333
CUPEI�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) 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 l/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:
Address:
Reroofing Company Name:
Applicants Signature: ( / Date: `("C'
Joe Antonucci
(Chief Building Official)
6/25/01 I