01120093 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
10641 JOHANSEN DR 01120093
OWNER'S NAME: APPLICATION SUB DATE
CHARLES & SANDRA ROSS 12/21/2001
•' PHONE: SANITARY NO. CONTROL N0.
re0 ZO ARCHITECT/ENGINEER: BUILDING PERMIT INFO
a 6� D ELECT PLUMB hfI ECH
t'jE.
,
r
Z z LICENSED CONTRACTOR'S DECLARATION Job Descript n
O Z`-'o I hereby aBirm Na 1 am licensed under provisions of Chapter 9(commencing
F_�W with Scalon'/000)of Division 3ofthe Business and Porfetouons Cade,and mylicense REROOF
a a.
is in fall force and effeq �w
z s a License laas�s, C..3-1 Lic.N �77 7Y:J
°•OWU G ZI�G1 CDE'CLA
Date
F a Fn ARCH ll be u e DECLARATION /
S I understand my plans shall be used as public rccoMs
r
to i o O Licensed Professional '
c�R OWNER-BUILDER DECLARATION
1 hereby aRw that 11. ewmpt from the Contractor's is License Low for the, (�/^�
Fz following tcawaerm(Section tonstru5.Business andove,deioli Coca:Any city orCo.nty \ $7800
D
poor
t requires n Permit t construct,wa,epee Improve,demolrsh ore a signed r any swmurc
$ pyo a ucemeace,alsorequ the R¢apphcant fica metech Permit to alLice saw(Chapter
Cmemcm
n3- mmh0ol,ing s itpursdam to the provisoesof meCorralBusiness
ad Pl Law(Cn pier , A Valuation
or m e ng With there W00)ofhe mai n a t the lcj inexs exemption.
vi Code) t'� "1.•i'.L�3 /.Y"5 D./t�b� U U��. L �% ..' x
of Shut he is exempt zany p li and the baste for ab allegfd exemant on Any vin natty
ofSection art...than bye handrail
for,apewitsubjects She applicammacivil penalty Typ
,nrnmmo�emamevenanarcdammrs(ssW). 305APN��I� ..t.c •. Occupancye
°1,as owner of the property,or my employees with wages as their sole compensation, TQ af,
'-will ne the work:ssiona Code:T e is not intended a Lice offered foes act(Sec. to Busan - 6 01 - ROOF TEAFRp ieW4Inspections''
owner of and property
Whom Case:The oyes there i,mad wnse law dos not apply to an
ownerofproperty embuildsorimprovesthereon,mprwhodoes such work nded or
or fee
chis own employees.provided that such vement mems are not amended or 602 - ROOF .PLYWOOD.-NAIL __.._ _-.______ __ ___ ._ ----
offered .
completion,
ion,the IC howuilder will
building improvement ng that
he did one year of _-'-_ _ _ _.._
or tmpmvcmen y
ompinion,the owner-builder will have She burden o(pmving thio he did not build or 603 - ROOF BATTENS
improve for purp°se of aide.). 604 - ROOF IN-PROGRESS
_.w.. -_____. contracting __..._--- ..... .. .. _...___. -.._. ._ ,.. .. .._. ..
c I;us nwner of Ne pmpeny, ,exclusively dprofession,
with licensede Cum..ts,a
_ destruct the project(Sec.]to air
Business and property
who
Code:)The Cum „-
License Law dao nor apply mon nwner of pmpeny who bulicc s improves thereon,
...Co who.c Livens fLaw. prolene with a contractors)IicenseJ.pursmnem.tM1e. .._ .....__._. _...- __._-_..____...-..._.. .___........ .....
C nirvanas License Law. 1.
- ❑1 am exempt under Sec. B&P C for this reason
Owner' ' -"" 'Dine ' -
WORKER'S COMPENSATION DECLARATION
• �. . I ereby amw under penally of F.060 otic of the following recitation.aa:-
I, ° 1 ham vad will'mmmain d Ctnmficate of Conserv l'o self-insure for Worker's //\\
Compensation, as provided f r by-Section 3700 of the Labor Code. for the
p fmaiiaaca it thew.,it to, h It this pontotis tssuea
°1 have ad will n6intain Worker's 6rmpe s ttm losairance,us required by Section DEC 212001
37W-of the Labor Code f the perfo- fine work for which this pewit is
rsimed My Wrkers C m t Ineum c artier and Policy number ate:
... ,. �.o�..
C .". .... .L, ..... . ..._... _ _ .....�........ ._..__
a�Sers u•^"!+'.Polcy No. BOJ—CJyCX/OZ.Wte 4 � `.. .v.,.....s _ _.n ...;1;•
CERTIFICATION OF EXEMPTION FROM WORKERS'.
_ -COMPENSATION INSURANCE'` •'' _ _- --,,. _ _ .By. _ _-,. __._ ------ _
"(This section need not b<completed If the A. is for one hundred dollars
SI W)or less.) ,
l c nil'th ;6 mance f the - - -' - - -
rwn<nm p wt xi:. ed i.
'shall nm em 10 nY Per' n on mite r s o e. bl t the Workers'
'Compensation I.ws meta.D s'— �
NOTICF.T LI ANP.If,atter makin eniflem,of Exemption,you should
Q 0 bedomes Perim the Workers Compensation provisions of the Labor Cale,you must
forthwith comply with'such provisions or pewit shall be deemed revoked.
z . _ - ,. -_. ._ ,_.. ,._. -..__.. _.. -_, . ___ _._ .. .. ___-__ . . . ._
r 1 hertby aniw that rheic is a consw<f DING AGENCY 1' "'
�CONSTRUCTION CEN
_a j ri lending agency for the pedowance
of the workfor which the pewit is issued(Sec.3097,Civ.C)
'Led N e- •.., -r_..._
�' Z
Lender's Addmo;
1 candy.that l have mad hitrpplcmo and QF•t'L uceomert thatll on c n up on
h plcity. rid county ordinances and state laws relating
riag
to liabilities.) agmenns,costs and ea,,ma,which may a.any way occorm against said
t1 g ossetplydhnhe pectmi'vestflhwcttywentrupon
>.. the abov.-maat ua teny,for impIc o paranoia.(W) Bres a Jemnifyand W the Ory of -
'to _
gaii
C.1.Z Airy in conscqucnce of the graining of th¢permit.
NMIAPPLICANT UNDERSTANDS AND WILL COMPLY WITHALLNONIPOISTl' Issued by: T Date /�_ �/
SOURCE REGULATIONS. I" y12 A�a�
Signmum of APPlicam/Cmmmctor)I'• ';Dam. Re-roofs /
'14HAZARDOUS MATERIALS DISCLOSURE'
Will the applicant r,I chase Wilding occapaint store or handle huhNusmaterial —Type-of Roof.. .:•. ,... .. .....,. . ,. «.. ..-.. .,,..,.`._.__...._
.va dartped by the Cup nn Mu tp IC Je Chept 9.12 Jthe Health and Safety
'Cod Sect on 25531( 1p S'r 1 t .• s 3,e'�.1' - t
El yes " # All roofs shall be inspected prior any roofing material being Installed.
.Will theapplicant or future braid g occupant - equipment devices rich If a roof is in's[alled without first o ng an tnspec[wn'-I agPee to'remove
••
emir h Ado s air conmm vans a cf d by theBay Are A Go.Iry Mimagemens -- - - - - -
Dt met _ all new terials r irispectio Apg}i�cant understands and will comply with
°Y all putt E so ce r6 ulatio s.
�.. 1 have read the hazard us materials q i menti -ride Chapt 6.95'6f the
Cnl f iota Health&S fcry Code Section OS 5533 and 25534.I ndersr rid that
'finebu'Id' t m,dy hav a tShattsmy'c pbnxb fry room ready Sfie CJ
accup of the re m t<ments'w tic m mel dor toy esu ince of v CenifFme of
Oc' p ncy' �' r
nature c f A D hcant ate
aamnrixea ag n - qme All roof coverings to be Class "B" or better ,.
.,,Y r.. ,_..-_:. __. ._...... . . _. _... .. OFFICE
Building Division
10300 Torre Avenue
• i Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkT1N0
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.
S. 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 V4"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: TAlL &4L L(��
Address: ���— 13 �l9�.� f/ cSai✓ (Jvbz C/ b`l zG
Reroofing Company Name:
Applicants Signature- Date:
Joe Antonucci
(Chief Building Official)
6/25/01
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333 •
CUPERTINO
Building Department
REROOF TEAR OFF POLICY
revise&6/25/01 .
1. You must schedule an inspection for the tear off the day before the date you
wish the inspection to be made. The procedure is to call the Building Division
(777-3228)between the hours of 8:00am and 4:00 p.m. for next day inspection.
2. When the roof is torn off, the nails removed or driven in,and all of the dry-
rotted wood has been replaced, then you must call the City Building Division. •
An inspector will be there within one hour.There are special hours for this
service: between 8:00 a.m. and 11:00 a.m. and between 1:00 and 3:00 p.m.
3. If you call for the tear-off inspection and the job is not ready there will be a
re-inspection fee of$100.00 charged,which must be paid before another
inspection is made.
Joe Antonucci
(Chief Building Official)
•