01090098 CITY OF CUPERTINO
(;. PUILDING
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
ADDRESS: PERMIT NO.
11557 COPPER SPRING CT OLD COUNTRY ROOFING 01090098
WNER'S NAME: APPLICATION SUB DATEJIANG 387 UMBARGER RD #B 09/21/2001
HONE: (408) 362-1111 SANITARY NO. CONTROL NO.
90Z ARCHITECTMNGINEER: BUILDING PERMIT INFO
kC BLDG ELECT PLUMB MECH
5 y 3 LICENSED CONTRACTOR'S DECLARATION , Job Descrition ..
Z y 1 hereby affirm shat I nm licensed under provisions of Chapter 9(commencing
with Section 7000)of Division 3 da Bminessend Pmfessions Code.udmylicenre SHAKE TO SHINGLE RERO F
t Y t is in full forMind «
1 ad V License Clue k Lic.11
C /
Dam .mmnoI
I Oa Ci. ARCHITECT'S DECLARATION i
s y 1 understand my plans shall be used as public records
T
p O 1 Licensed Professional I '
o y OWNER-BUILDER DECLARATION
1 hereby offlon that 1 am
1- exempt from Ne Conoarmr's License law for the
C Z
following reason unit t ]oortr Business addmp ove(ammrs Code'Any city node ary $5300
t] ,
which regmrea limit to construct,alter improve,demolish,t fi repair any swemre
$ gprio i lissuance,alreq trciorbvi nsoffor such Permit to ftlnWUw(edammem . . -•. ._... . .. . .. _ -..._ _ _.. .. tion —
NathealcersWparstion7 : ofDivisim theCRBicynrsuadsefioui.Code) ,mss pppOfT ��sr��
for that
ingemptthonom,andthebnonooftheBu;trcstRod Hrl. ntmrsCode) ��': :" '�3CTtP5 t0�fT�,VC7aA1��.ivi3l.Ati• Valuation
or Chef o b exempt therefrom and the basis for the alleged aemant to Any violation
. of S«tion 7031 by any applicant for a pemdt wbjecaa de applicant m a rnil penalty t�I,,,�I,a,.,
of not mom than five hundred dotlan 15500). 3 0 5'4�T'tCHTaT�C� Occupancy Type
❑1:as own«a the propeny,ser my employees with wages m deb sole compensation,
will do be wo&end the Romtom is not intended or offered for sole sec.70,14, t
Businesa and Profession Code:The Contractors License law does not apply to an 601 - ROOF TEPRIlIURV Inspections
owner of property Who builds or improves dcreoa and who dos such word himself
a through his own employ..provided that such imvemere
proents not intended or 602 _- ROOF PLYWOOD NAIL _
.tiered for sola If,however,the building or improvement is sold within one year of 603 - ROOF BATTENS i
compinion,de owner-builder will have the burden of proving that he did not build m
improve for purpose of sale.). 604 - ROOF IN-PROGRESS
O 1.Re owner of Ne property am es.howely contracting with licensed conoaemts to -
-
immunities the project sec.7044.Business Real Pmfessions Code:)The Camnnorr f
s Licrose Use dma am apply to so owner of Property who builds or improves Hereon, ) t
and who cones for such pmjects with a mntractorts)licensed parent In Me ...I .. ..
j Comost.e.License Law.
❑I am exempt under 5«. _ RkPCfor d' '
Owner ''D'am, . � bj!'
WORKER'S COMPENSATION DECLARATION \
I hereby affirm under penalty of perjury one of the following declared 030,1""n /\/�
L7 1 have end will maintain a Certificate of Consent to self-insure fa I ric rs j
Compensation,'as provided for by Section 3]00 of the Labor Coda torythe._ /6Yo/
perfmmunce of the work for which this permit u issued.. -.._ r_
} ❑1 have and will maintain,Worker's Compensation Insorance,as required by Section
3700 of the Labor Code,for the perfor ance of be work for which his pemdt ie
issued.M ordara Compensation Insurance terrier and Ppli�n
... 1 1 -
Cantieh EN .'M... . /���3 f' i f. ' ii f• IC ''r.uti. .�•itty.V� , . y..
Policy No.:
,
CERTIFICATIONaFE%EMOTION PROM WORKERS'I' t'- . 1 •, s i _ .. i .-'v ts_F.�;
COMPENSATION INSURANCE;".'•..,. ......
._ ... .__ .. ..
(This section rived nut be mmPlmol if the person is fa ase bundred dollen i. 1 t' .. t::s;,"!,;.
(g IOOlalevJ ,e
1'ceMfy ihed in the performance of the wok fa which this permit is issuid 1 -
shall ria employ any person in any menner,so ai to brcome wbjw to the Warden' -
Compensation Laws of California.Date
Applicant' - i _... _.
-NOTICE TO APPLICANT`,If,Her making this Certificate of Exemption,you should _
b«ome subject to[be Workers Canpenwtam provisions of the labor Code,you muni
Zforthwith comply With such provisions or Nis Permitshill be domed revoked,
a= 'CONSTRUCTION LENDING AGENCY -
1 hereby affirm that here is e contraction lending agency for the,performance
�,Q of the work for which this pemnt is issued(S«,3097,Cie C.)
Lender's Name
tz Lenders Address) "GI
V0 1 certify Nat I have read this application and trate dad the above information is
kT+` correct.I agree to eamply with ell city and county ordinances and state laws relating
Q-� to Wilding construction,and hereby auNmire representatives of this city to enter upon
the abovcmemima d property fa inspection purposes.
(We)agree m as ,indemnify and keep harrotese the City of Cupertino egaimt
'F V] liabilities,judgmenn,costs and expenue which may in any way accrue against said
V City in consequence of aha from of thio permit. '
.APPEICANT.UNOERSTA' AN WILL CON LYWIIHALL ' OI Issued by: Date
SOURCE REGULATIC 11 q
Signamreof Applim.V anracor. - Dore Re-roofs
HAZARDOU. 1A77iRIALS DISCLOSURE
Will the applicant a f son building bedpans nae a hatiandle baxardau material Type of Roof, - .. . . — . ...... . . . .
as d f ned by the Conen o Mumcipel Code Chapter 9,12,anal she Health and Wet,
Code,Section 255321.)7.1 . ��:' ^I +.r... ,I. t ! ^.r •�� ,1. sal. ( i - } !i.r r. t .-,
Duca U,, , All.roofs shall be inspected prior.to any roofing.material being installed.
Ted . . ' .;
•WiH M,,pplicantorfutprebuilding occupamuseequipmemadeviceswhich If a roof is installed without first obtaining an inspection,I'agree to remove
:mit harnMous ear ronmmiRunis as defin by the Bay Ara Air Quality Management
irmm all new materials for inspection. Applicant understands and will comply with -
ore: Na all non-point source regulations.
"Phave read the hazardous materials requiaments under Chapter 6.9$of the
California Health k Safety Code,Sections 25505,25533 and 25534.1 understand that
if the building does not currently have a tenant,that it is my responsibility to notify the /,/ OI
«cupam of the requite eras which must be met prior m issuance of e C ifie to of
O«nparn, C Signature of Appli ant -_ Date .
Ownermawbodaed agent - / D.I. All roof coverings to be Class "B"or better
OFFICE
Building Division
f' 10300 Torre Avenue
al �wo
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Fax: (408)777-3333
IRUPEI�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 plogress 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/"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:
Reroofing Company Name: —
Applicants Signature: Date: O
Joe Antonucci
(Chief Building Official)
6/25/01