02060079 (2) CITY BUILDING
DIVISION
PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT N0,
11289 TERRA BELLA DR R J BEAN ROOFING 02060079
OWNER'S NAME: APPLICATION SUB DATE
TOMPKINS KATHLEEN S AND JOHN E 15425 SHANNON RD 06/13/2002
PHONE: (408) 358-4028 SANITARY NO. CONTROL NO.
Mate
Ote ARCHITECT?:NGINEEW BUILDING PERMIT INFO
K
W— BLDG ELECT PLUMB MECH
r i
8P," LICENSED CONTRACTOR'S DECLARATION
-5�? Job Descri tion
1 hereby aRrm thou 1 am IicenuJ under provisions of CM1ap¢r 9(commencing P
ytW whtnscctmn7twojnrDimalgn3.,nneBusin=saanarrom.5aronsemeanamyhcense REROOF
in full farce and eH a
i ce<
is Class t-gas, Lie.a Li t
O W U Date P Commarr
i O y y I���Z ARCHITECT'S DPLARA'ION ����LED
19c nd my ploy. II be a ed as public records
a.ao Lie=ns= rnfexsicour JUN2 4 2002
�y OWNER-BUILDER CLARATION
w 1 hereby affirm that 1 am exempt fm t the Crumant m's Licence Low for the
following reason(Section 7031.5.Business and Professions Cale:Any city or county $8000
F wh cn q permit t constrict, Iter,improve demolish p w
y scturt
C prom.issuaticanct.elm requires Ne applicant for such permit m file a aimed moment
e3�
that hs, Ic dpursuant t the provisions - a - _..uati..
sof the G e B non L to (Charter) _
� "" Valuation
Rom g with Section raw) rhe Division orfeallegdes'adProfessions Acme) ,3 ; x,„.�,•
or thin he is exempt therefrom and the hosts for thea, he exemption,Any violation
-of Section 7031.5 by any applicant for a permit subjecm the applicant m a civil penalty
.of not mnnethan fr c hundred dollars($500). 3 0�,PN quMWE t Occupancy Type
❑1,as owner of the property,Lir my employees with wages as their sole compensation.
will do the wmk.*md the xtmnnre is nut intended In offered-for sale(Sec.70,4.
Business am professions Code:The Contactors License Law does net apply to an 601 - ROOF TEA]ZtluifWnspections^ I'
owner of propeny Who builds or improves thereon,and who does such work himself
or through his can employees.provided that such improvements are not intended or 602 — ROOF PLYWOOD NAIL
-offered for sale.If,howeve{"the building '- tis sold within one car of �` - - _.'_ ._”_.."_ ." '_." - _'
or tmprnx=men r 603 — ROOF BATTENS
completion,the owner-builder will have the burden of proving that he did not build or '
improve for putposeotaut.) 604 — ROOF IN—PROGRESS
❑has owner of the prnpeny,am Bovines,exclusivelya crntaning with ode:)Th contractors m
_ nems ct the does
(Sm. to a Business and terry whops Cade:)improves
Contractor's
thereon,
hem n,
License taw d«s not apply man owner
s,w of a commwho builds se improves thio the
.. .` and who.couoacts for.such.pmjcns.with a.connanor(s)licensed pursuant to the..
;�klyt�l�ser, ors RI order
raw.
e"l'ant exempt under Scc. ,B&P C for this reason _
Come, Dare
WORKER'S COMPENSATION DECLARATION
I hereby affimt under Penalty of perjury one of the fallowing declarations:
1 have .,to will mummin a Cenificam of Consent m self-insure for Worker's
Campcnaation, a, Providedfor by Section 3700 of the Labor Cods, for the
Forformance of the wink for which this permit is waid.
❑1 have and will maintain Worker's Compensation Insurance,as required by Section
37M of the Lilac,Cine,for the performance of the work for which this permit is
_. issued My Worker's Compensation Insurance carrier and Policy number an:
.- - Cane y 'Policy No s . .
' `CLKI'IFICATION OF EXEMPTION FROM WORKERS't _s ',� %; ^1� s .}f e
COMPENSATION INSURANCE
(This Is,I:' need not the completed Bible permit is for one hundred dollars
IS100)or lcssJ
" 'i cemty that in th pef TO k'f which tti.pe 'aauInd.l
shall not employ any Person to any marrep aft b lame subject to the Workers '
Compcmmion 1psmf�a�jnot Dae l9•�O
.Applicant qg; "M
NOTICETOAi.II NT If.after making this Ccmficarc of Exempron,you should
become subject to Workers Compensation provisions of the labor Cole,you must
Q 0 forthwith comply with such provisions or this permit shall be deemed revoked.
Z2 - _ ..- .. . .. . .-_ . . .. ._ _ _ - _ 1_.__.-.. .
`CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a ennturation lending agency for the performance
..t
'If the work for which if permit is issued(Sec.3097.Civ.C.)
CL, Lend .Name
- ..
Leader a Address
U O t venify Em I have=it this ppl cat o d state that the above infianaration is
W'Fy conn 1 agree to comply with all city and county ordinances d state laws relating r
to budding construction.and hereby olhorlm reptescinfluves of Ms city to enter upon
(� the atm(We)agree 1.ned pmpeny for inspection p hommis.,,
5 g (We)agree to save,and expenses
and keep ham y in tae wee of Cupertino against
h City liabilities,judgments.costs and<xpensex which may in any way acerve against said f 2
V Z City in cormequcnce of th=gmming of this permit. � U
APPLIc U.YD STANDS AND WILL COMPLY WITH ALL NON-POINT
sou tF I'S "+'. Issued by: Date
nawic of A60Ii,mVComm,ha. -' „Date Re-roofs
- HAZARDOUS MATERIALS DISCLOSURE " 't
Will the applicant or future building uccopant sura or handle hicandous material Type of Roof
as definm by on Cupertino Municipal Code.Chapter 9.12.am the Health and Safety
Soy,n,
I - II __ All roofs shall be inspected prior.
•' '- ' - [o_any roofing material being installed ..
rot
Will the applicant or future Initialing occupant'use equipment or devices which If a roof is installed without first obtaining an inspection, Itagree.to remove
emit hazardous air contaminants ax dewed by'he Bay Area Air QmIily Managemem
District' all new materials for inspection. Applicant understands and will Comply with
t oY §t" all non-point source regulations.
Jif
I h d the h a d al req "b is and Ch pm 695 of Ne
Calf 'Hltry&Saf C d -S s 25505 35533 and 25534 I u derstand thatI/ _ _the bu ld gd of correctly ha ten t that'll my mprsn ryblt notify the `x t 1'ROAA ccup t of the require ts xh chroust be met p o to cou c f C n fico¢at Sigr atur of Applicant Date
All roof coverings[o be Class "B" or better
OwnDate
Owner tJ agent
OFFICE
Building Division
10300 Torre Avenue
s Cupertino,CA 95014-3255
Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPEkTINO
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: -1 V i 1i
Address: ^i l28�`T�lrtrl- r&I1p- D✓,
Reroofing Company Name: - 4 I�Pa i �,i. J� I�cin/Kpo c�
Applicants Signature: dv Date:
•
Joe Antonucci ~_
(Chief Building Official)
6/25/01