02070118 (2) CI BU DING DIVISIONN� PERMITCONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMITN .
11842 SHASTA SPRING CT OLD COUNTRY ROOFING 82070118
T69&MkLSON T AND SUSAN S 125-B GROBRIC CT APPLICAT`61'JYDATy2002
'•PHONE: (707) 864-5557 SANITARY
l/ / lNO.
7/ CONTROL NO,
0-,z ARCHITECfrENGINEER: BUILDING PERh1IT INTO
u p BLDG ELECT PLUMB MECH
It-- LICENSED CO,NTRACTOWS DECLARATION
z yy 1 hereby affirm that I am licensed under pror s of Chapter 9 ommmencing REROOF Job Description
.a<7 'ith tion 7000)of Division 3 of the Busin s nd P{el�essionyC)y 7 ylittnx IL aa� ra�
'rce and /V/, G //(
z z¢ Lice s Lioc. tG
O c le C samosa
3=G ARCHITECI"S DE(,'�A�q ION (1
1 undcnmM my plans shall be used ax plGliu rtcaid, OCT 'f 1J A 2002
ceC 0 Licensed Profeasimml l L L
'6e,� OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License law fm the BUILDING
�19 ®lglg/1 $15000
L'? following reason.(Section]031.3,Business and Profmions Calc:Any oily°r county ll• NV'Vl
O which requires a permit to construct,alter,Improve.demolish,or mpalr any structure
nam -pnur to its issuance,also requires the applicant for such Permit to File a signed statement
IRI he"iilimnspe pouuam mthe prbnsions oflhe Controcmrs License Law(Chapter 9 �.,�..,4 6Cp alb®r• :,,• Valuation
(cammcncing with Smli°n]0)0)of Division 3 of the Business end Professions Code) r"3
, y
or that he is cxempC Iheiefrei and the basis for the alleged exeinpiori.Any violation
of Section 70313 by any applicant for a permit subjects the apdicma to a civil penahy-
�ofnot more mail five hundred dollars(S30% 3 0 51PN RUMIF Occupancy Type
°L as owner of the propeny,armyemployees with wages as their vole compensation, 307 - INSULATION
win do'the work:end the'unlnae is 6.1 iniendislor offered far ealc(Ser.-]044,'
Business orM Professions Code:The Contractor's License Law does not apply m an IODS
ownc
r of propcny Who builds or improves thereon,and who does such work himself 6 0 2 - ROOF PL tM
or Ihmueeh his coin employees.provided that such improvements arc not intended or
,offered frr sale.If.however the building or improvement is sold within one Year of. .' ._ 603 ----ROOF-BATTENS. . _........ ".. .. .._.... . - --. .._.. -
'completion,the ownerbuilde,will have the burden of proving that he did not build or i,1 ' s ' �•1
improvef°rporp°xafsme.). 604 - ROOF IN-PROGRESS
- -- --- _
°1,as owner of the P,.,aY am exclusively .ommning with licensed contractors a p: r i..; _..
- construct the Profen(Sm.70,14,Business and Professions Code:)The Contractors � , �,t..,t, 1_il
License Low does not apply to an owner of propcny who builds or improves thereon,
' _and who contractfor,.such projects with a comracumil.IicensM puuuanbsn the
Caroni License low,E1,; --
0 1 am
❑lam excmw
pndcr sec: ,. . '.B&P C fortis rtason I("'". 1 il':
Owner.. .. ..fq:.Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penaltyof perjury mie or the following declantions:
•� ❑ 1 have and will'oumm.in•a-CmiOcal,-of Consent to xl6insure for Worker's
Compncrooko, as-firovided for by Section 3900 of the-Lidor Code, far the
- - perfomunm of the work for which this permit is issued.
°1 have and will riiainiain Worker's Compenulion'Insennce,as required by Section
3700 of the Labor Cade;for the Performance of,the work for which this permit is
iss cd My Worker's Compe ton 1 iuiance carrier and Policy be r
'er� 74.1'c':No 242 a t a a ' Ys I� 3 r l L _-• _•- _. __
1 CERTIFlCATION OF EXEMPTION M.w, KERS'
«.. ._COMPENSATION INSURANCE,.—",'-" S" . .-__.. ..... ._ _. _ _... . .-_ � .._ __.. .. _....._........_..,___
)
his)cition nedd'nbi be colnpleicE if the permit is for one hundred dollars
i
E100I00).1or less,),
1' lien(y th un the perform f the walk for which this perms li rssucd,l t l t .I i;it t
shall not employ any person In any manner oror,"m become subject to the Wormo
Compensation laws of Califomia.Do,,
Applicant .... ._ ... __ ....
. ...........
you
NOTICE TO APPLICANT:Workr's Cmpersing olon p Cirions f of Exemption,y6u multi `•
it
b rthwi Subject y the sisib ps Com ssa,dos pro rat 1ha of the Labor Code,you muss
forthwith comply with�suah provisions or Nis permit shall be deemed rtvokcd. �
Cat `t`CONSTRUCTION.LENDING AGENCY'
work
,which
shat them is'a construction'lendiag agency tai the performance rs' -'! '',.., Of the rk for hlch 111 S peon not S Ss d IScc J09T,CIV.C I ... .._. .. .. .. .... _ ... _.- . .. -_._. ._..
LcntlN me - .: ._ .. _. -
o-1- Z lsid Address tl)•'s /+�
U 0 1 fy that 1 ha i aapplicationa d State that bo formation,
W t:4 cone t I agree tot I ban th 11 a IY and an a n c s ata ... la moos
O U to Wilding mneaueton,and hertby amhorite rcprcsinimw'e this city to elder upon
r k] the abova-mentioned pro inspection purposes.. .. „
E„ y' (Wa greet ve,'inde dy end keep harmk City of Cupertino ageinn
r N liabilities,ji dg i costsv expenses wh' any way accrue again.said I'
U'Z' CityAeon. a of the of ' I
soPU JC t : e 0 idyWft,IAL�N �: .'T"' Issued by: Date .
DER L
7
arvre of Appl can o Da
Re-roofs
RDOU IALS DISCLOSURE
',Iwll Oic' cant or future budding ocupsnl stare houle harallous 1 al Type Of Roof. ... s - _ _ _ •-.
ss defipM by Cupertino M n IpaI Code Chapter 9 12 and the Health and Safety
°Y ;b All roofs shall,be inspected prior lova offing material being installed.,_,. - -... .-.
1 x,nth apPl.FI t bu la g occupantequipment e wM1 eh If a roof is installed without fir o ai ng anlmspection, I agree to remove
t h yard s a r co gamma is defined by the Ba Area A Qu I ty Maaagcment ,
Dian .. all new material r nspectl Iicant understands and will comply-with
^ ❑v t 1l 1-:Il ,) :L "..' ail non-poi urc egulations _......
`✓ 1 A ve read the' iobt i'arorri is oil a, i under Chapter 6.93 of the
Celifrom.Hsa1 ife Code.Sections 05,25533 and 25534.I undenuna Net
ifthe building >nin nentlyhnvea ant.that it is my responsibility to-notify the
of recut cars w !lIt,met Prior to luuvn<e of cnifcs of
1, Cana" - - Ignature of,9 pplicant
,, r [ All roof coverings to be Class"B"or beiter
OFFICE. ..- -
' _ Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
tl , a Telephone: (408)777-3228
a
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 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: W I L 5 O n) (n7 On)(-%
Address: I i PY2 S ��i�-
. Reroofing Company NameNL
: _ S') C- 0 UNC O r'1 lt,(2
Applicants Signature—.-7—
ignatureNaI— I / 7� Date:
Joe Antonucci
(Chief Building Official)
6/25/01