02050146 TY OF
CI
BUILDING DIVISION O PERMIT CONTRACTOR INFORMATION:
BTTgreJDRftSTSHORE CT OLD COUNTRY ROOFING PERMIT NO. 02050146
Ort'A sNM'€KKILINENI 125-B GROBRIC CT AU13Ct'�515/J2i
PHONE: (707) 864-5557 SANITARY NO CONTROL NO.
�W)ijCZ ARCHITECTENGINEER: BUILDING PERMIT INFO
w_ BLDG ELECT PLUMB MECH
h a n, rI Cl C-_J L7
s y 0 LICENSED CONTRACTOR'S DECLARATION Job Description
I hereby affim,mat I am rcm[.d a der proal.lan6 of chapter 9(commencing REROOF
„� wen to Bonen dmrui.i[mn3ann.Baa ahaPraa[[ian[c deanemyheen" T/O 1 LAYER SHAKE, INSTALL CERTAINTEED
] al �V /— /�
i.icensell��'ygs.and eHrFi. Lic.x t5r�d7��
ioaa..0 ql n Qe / Comracto 50 YR PRESIDENTIAL COMP
1 3 a H ARCHITECT'S Df: ATION
4 1 d m1 d mJ�fn}I�dryY�.ns shall b coma
d o O Licensed Prorxsional n�
i
n y OWNER-BUILDER DECLARATION
w
I hereby affirm that 1 am exempt from the Connor's License raw for the
H Z< fallowing reason.(Section 7031.5.Business and Professions Core:Any city or mum,
F❑ which requires a permit m cnnswn,alma improve,demolish,or repair any stone,
an prior to itsissuance.also requires the applicator for such permit to file a signed statement - - - - — — - —
that lie ighcensedpuisuaortothe pinvisIons of the Contractor9'
Contractors License Law 9 S .Ft FI Dior Area. a ♦, ati0n
(commencing with.Section 7000)of Division 3 of the Business and Professions Code) `'. V.,;
or that he is.iMipi theref Dim and the basis boom alleged exemption Any violation
of Section 7031:5 by nn,applicant for a permit subjects the applicant m a civil penalty
of not mom than five hundred dollars($50o). Occupancy Type
D I,as owner of the propcny,or my employees with wages as their sole compensation,
will do 0e work,and he structure is nut intended'orailroad for sale(Sea 70,13, AML
Business vad Professions Cade:The Contractors License Law does......ly m an ired Inspections -
m, of property Who builds or improver thereon,and who does such work himself
307 - I NS ULAT
of mm,ngb rex awn however.[. building that win vementrmeol.arc hat intended of _-. 6 01- - ROOF TEAR- OFF-
completion.
for sale.If,hswcver,the buildin8 tar improvement is sold within one year of — •i.' � - ---
iompletion.me owner-buimerwin have me burden ofproving that hedid net bwaor 602 - ROOF PLYWOOD NAIL
mpm,rfm,m,a[caf,,0xL _. 6,03... .ROOF. BATTENS ... _ ._...
DLvsowner vtiecp(Secny,ton e:cw.mdyanomningwen drneeeCmaaurs's 604 - ROOF IN-PROGRESS
License
ct the project(See. 1. .,net o ane Profession.Code:)The Contractor'[
License Law doe, f apply a an owner of a contr who build or improves thereon,
:. -and wran,Lmcts for such.projuu wnM1 a mnwctorts)licensed pursuant to Ne __ .. _ ._ ._ _ .. . . ....... ... ..
' Commaor's License Law. �
....._.__.._ -.
❑lam exempt unecr Sec .B&PCfor this reason
Owner Doc -
' WORKER'S COMPENSATION DECLARATION
Ibrob,affirm code,Knit of perjury one ofihe following declarations:
�fO 1 have i nd'wlll maintain fa Cby Secti M 37M o to se Liquerc for Worker's �(
Compensation, he Dirk Tod for by Section 3]W of the labor Cade, for the
Performance of the work for which this permit is i»Lice.
D 1 have and will maintain Worker's Compensation Imsdrmue,as required by Section
_ 3]00 f the labor Code,for t c performance of the work for which Nn permit is
isSu d.My Work rs Compans on In�sura� ma and Pol cy number ars; _
Pd (yN . 200
.C13RTIPICATION OF E%�MPI ION F OM WOR ERS ,r I s Y r, r� k s
COMPENSATION INSURANCE. _;•" t t
" car la sshnion nccJ not be complm<d if the permit is for one hundred dollar[
(3100)Of les[.)
I cenify that in the petfor6nce oldie work far which this pcmtit is issued.1 qc-„
shill not employ any person in any manner so as to become subject to the Workers'
C ii,mmicur Laws of California.Date
.Applicant. _ _. .. .... _
NOTICE TO APPLICANT.If.aper making this Certificate of Esemptirm,min should `
Qbecome subject m the Workers Compensation provisions of the tabor Code,you must
forthwith comply with inch movi,max a this recruit shall be deemed revoked.
FCONSTRUCTION LENDING AGENCY
' 1 hereby affirm that there id"con,tranon lending vgancy Rothe peffnrmano,
w w of the work for which this permit is issued(Sec.309],Civ,C.)
Q Lender's NameZD z _ ..._.._ .....,
ZD Isndef[Advjm,,'
U' (certify that Imine read this application and state that above information is
fact'P correct.I agree to comply with all city sena county ordinanancesesand stain laws rclainis
Q U to building construction.and hereby umharim reprcsenwtives of this city to enter upon
fW the above-memioned property for inspection Purposes.
L.i p. (We)egue to save
,Inde-nify a ndkncphumlcsithe Ciiyol Cupeninoagains[
f—i Vi liabilities,jud cote.costs an axpenses which may in any way ec rue against said
U z City in co he o!t g ting alibis phut[. c r ,Cl s
AOPP'tC UN DER."A S AND WILL COMPLY WITH ALL ON NT Issued by: Date
S ZTDZ �
Sigmimm or plicantl ontmnor - -' Dam • Re-roofs
HAZARDOUS MATERIALS DISCLOSURE "
Will theupplicante future building w'cupma some or handle hbmrdou6 mamd.l Type of Roof.
as deal by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety ,
Code.Section 255341.)^.... \i •.•;
dermal ,-:,•1 '.s P ,.' .
oys"
No
All roofs shall be_inspected-prior.[ ny roofing.material.being installed. ..._. ._ _.
Will the applicant mfuture building occupant use equipment ordevices which If a roof is installed without first aining an inspection, I agree to remove
it haeamous air contaminants at difinal by the Buy Area Air Quality Management
u�ftde'! ,y all new mater o inspectib Applicant understands and will comply with
t - - -Dive[, ,t, ,rJNo all new
inure regal .
"I h.,a'mrd Bri:1nmNous materials requirements under Chapter 6.95 of the
California Health&SefcOCode,Sections25M:25533 and 25534:1 understand that
ifthe building dues not currently have at it is myrapomihility to nuifythe
rccupam of the Ems which qmn n List mei prior m issuance a Ce ificam f
°"°p'"`y _ Signature of pplicant _
neror vd>ala t ' Da 'All roof coverings to be Class"B" or better
.: :..
.. _
r.- -• „,.-, .... _ I OFFICE -
' ;,:,,. Building Division
10300 Torre Avenue
./ Cupertino,CA 95014-3255
'!w r` Telephone: (408)777-3228
CITY OF Fax: (408)777-3333
CUPERTINO
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 1/4" 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: �J /�� / �//�/�!G //V e/✓�
Address: // (X S (N�S/ �(�/e
Reroofing Company Name: G�
Applicants Signature: P� Date: --0141d2-
Joe
-0 dZ
Jo Antonucci
(Chief Building Official)
6/25/01