02040140 (2) CITY OF CUPERTINO
BUILDING DMSIGN PC,RMIT CONTRACTOR INFORMATION:
s, BUILDING ADDRESS: PERMIT NO.
10401 A LOCKWOOD DR ABOVE ALL ROOFING 02040140
OWNER'S NAME: APPLICATION SUB DATE
INGMIRE DONALD W AND DONNA D E 700 NORTHRUP ST. 04/25/ 2002
BONE: (408) 292-4188 SANITARY NO. CONTROL NO.
O 0 ARCHITECTIENGINEER: BUILDING PERMIT WFO
BLDG ELECT PLUMB MECH
<i U C_I L.J U
fa.. aCC' LICENSED CONTRACTOR'S DECLARATION
zE, Ihercby alf thmlem licened under provisionsof Chapm9lcommencing Job Description
=h with�S�syion 7")of Di"I..Sof thea ,s and Professions Codc.andmylicense REROOF
og y_ is in'1yBforce and e
ere Lice. Class ic.a REMOVE SHAKE, INSTALL COMP.
o �
ap j Da h. CWll bo I'S D LARATI
!w0i .l 1 undenund my plans shall bW used m public TIMC
p O Livened Professional
OWNER-BUILDER DECLARATION
H w 1 hcmby aft Not 1 am exempt from the Contractor's License law for the
h?i following reason(Section 70315.Busincssmd Profeeti...Ccde:Anycityorcounry
E Z C which requires a permit to construct.alter,improve.demolish.or repair wy nrunurt
�Yii3$ prior to
its Wounuoalm nxuim theapplicent f."wh Permits.fileesigtd.w,mom __—_ _. -
mat he i3ilifd 66hmignt to ilia iiXIdons ohne Commlar,I License law(Cbapter9 5 Ft..FIOOr n41ea`j \'i --. Valuation
(commencing with Senion,7000)of Division Sof the Business and Rafessionx Code) I. e . 9' , �',j
or that he is exempt thirefram and the basis for the alleged exempti6n.Any violation
.-.of Section WNIS by any applicant foraPermit subjects the applicant Ina civil penalty- s +
of not mom than five hundred dollars(S5W). APN Number a,',r.:T,,.° Occupancy Type
❑I,as owner of the property,or my employees with wages as theu,.I,compcmmion• 305 FRAM
'WHI'do'tbe work.and the tpai'is net intended or offered for sale(Sec 7044;
Buslniais Arid Professions Code:The Convenor's License law dm not Apply m 3 Q 7 - I NSULATon 111I ONired Inspections'if`
owner of propeny Who Wilds or improves thereon,and who does such work himself 601 - ROOF TEAR OFF
er through his own employees.,provided_bet such improvements see not intended or
_. _ _- _ _ _ ..._.... _ ._
gpaedarthe.H:,,-Wilder owthis,imen,fmrmis hdwididActWildor
"compinion,the owner-Wilder will have the When o(proving that he did rwt Wild of 603 - ROOF BATTENS
improve for purpose of sale.).
j.
> OI'mnow net ofib e propenyam Basin,..lAnd tmthin,i.Ax ha:)Thconwctonm - 6.04 - --ROOF_-IN=PROGRESS--
cemwn the does
project(Sec.7044,Business and Prty who b Cade:)The
License Low does not apply m an owner of propcny who builds or improve,thereon.
•� .. _end rW cINemmu
ic
fur.such.pmjcess.with.e.conuec'tor(s)lensed.pureuent.m.the-
� `- Cootrunor,
❑lamexemptundidSic: B'87CfIN this reaso
Owner " Data
WORKER*S COMPENSATION DECLARATION
1 hereby tiffirm trade,pe ally of pe 1 ry one of the following dcdamtion '""r`
! - O 1 have'nnd'wili mainuin e'Cenibcnic of Comint to.)f- um for WorkAr', N
V Compensation;a,.pmvided-for by Section 37M f-th.-Lit Cade,-for me
perfornunes of the,work for with this Permit is issued. .
❑I base aM wilfinelntiin WdrkcA Campe,ns,'ation Initinntt,as required bj Section
I
3700 of the Labor Cade for,the peifan. Tei of the wank for which this perem n
I. d My 'rkeh Compansadon IDI ce 'er nth Poliry number tie
rner�� oliry No ' OMWORKERS'
OR ,:1 t:'i p r =e, 1'd:...t•. _n. . _ - _.
C IFICATION D EMPTI FROM WOR S t r
c MPENSPTION INSURANCE:~_:_
,nation need note completed if the permit is for ane hundred dollen .• ••.c' .. i'a,.a 1 ;�C..L.'. ',l;
IS100)or less,) �
1 eendY(batinmen in
WiniiiNe workforoeh thispetiteworkerI
Coll ed employ any person in any manner w a,to'bxome subject to the workers'
Compemeoon laws of California.Data"4777 7
g . .. ._...... .. --_._. ..__..._ -..__ .. _... ._
•+ subject
1 tome ofE empuan yen ahould -
Z N0TCE TO APPLICANPaf fte mohln tNrC ni of th Labor Code y,umus,
becomeh comp y the such
L pr Compensation provisions
0 Q fenA m comply with such pro seons mild,peter shell be deemed revoked.
CONSTRUCTION LENDING AGENCY - -�--
'Oj� ^ 1 hereby morin that the .5.nswci en I'Miri)Merry for me paphim.. ,. I t,
fr efthe work forwhich ths permI, s ssued(Sao 3097 C C) t'
y c -Leader061m
ta.7 Z Lender,Add • '.'I
.9.that I ha a read,h city
said n nth note that the as a Daws Talon u
W t y iINmcW acme tr comply with allhereby
city and county ordinance,and state laws e,upon
�'V to Wil.,v-.n,i.N,d,.pmyereoyauthodierepreunutives ofNiscity toems upon
}� 96 the ebo(We)agmned propend Tor inspanioe purposes,
L.6r ' IWe)egree.mcord ndiail'fns whiheWayin thanes ufCuperilnugemat
U V) city,
An l dgmen4 rise AM expetyes which mer m anY way Accrue egun,t sae, ^ T J
U Z City m ea umce of the yymm9un`of ml's pct,
A I ll `
pLI V\DER TAi`DS AND If 0\1PL)°tA1-TN AL N,b, POINT n'
Issued by: Date
tC� Z'loyo
S�¢nam pppliconVCom aktIN s'�r' •�-� TDete••-
j;HAZARDOUS MATERIALS DISCLOSUREI� yS� j [ Re-roofs
Wdl Ore dppbcont INrumre Wddmgampant namor handle nuldoos memnel Type.of Roof ._._
As defined by the Cupertino Mumap Ode Chapter 9 I2 end the Health and Safety r- ( -
c6de O t)toKn 55321eI7,r Sa Na f n.t h,
r ' ' '•v! t .
p l All.rocfs shall be inspected prior to any roofing material being installed._.__.__._
,wdl Ns eppueen,ar mmre W 1, occupant a equipment arae ren ainmh If a roof is installed�witbout fust obtaining an inspection`I agree.to'remove
emit hkWHI Ms'nr coiumir fum ss tie by Ne Bey a eq ip ent As Manigement
D1 mC1° _, stands and will comply with
a new materials or.inspection Applicant under
❑Ye *„i. t Na p; .rs ':I ', t;;'; : -all non- o t souice regulations'. •..I t t.:,i. , ., -_.
t )hese,reed the M1eufdoes mmerttls requiremenss order Chapter 6.95'af the
Cold. is Health 4 Safe ll Code:Sections 23503 25533 and 25534.1 understand chat
if, Wildi- dnei. surra dy hate p enantrthefIt ii my refp eatattly to nmifythi
'obcv t the m¢cn> <,h coast be ma p'or u,Issuanceof a Cenific, of
4 .
m " ignature of Applicant ate
Owe ra tha da n, All roof coverings to be Class a B"or better "
'9ri•uL Dine .
.•;� , . r' , _I !,.� _.... "OFFICE .. ... . _._. ...... .. . . ._- -. .
5 H, Building Division
4 10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
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 V"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: lO'(o/
Reroofing CompanyName•
Applicants Signatur . Date: 22
Joe Antonucci
(Chief Building Official)
&25/01