02110140 7
CI'T'Y OF CUPERTINO -
BUILDING DIVISION PERMIT ''CON„, CTQR INFORMATION:
BUD.plgcm9_12ESCOUNTRY SPRING CT WING' S ROOFING INC PERMITNf02110140
owNggRIUNKI AN LI 561 RUTGERS ST APPLICATIIN1sIfB2,e31'2002
Ahk
)NE:or 510 4 81-3 818 SANITARY NO. CONTROL NO,
ARCHITECf/CNGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
0 0 0 0
p0, LICENSED CONTRACTOR'S DECLARATION
rc ae P I hereby affirm hal 1 am licensed under pnnlsinns of Chapter 9(commencing lob Description
<i with Section 7(XXB ofDivi.sion 3 ofthe Business and Professions Code.and my license is REROOF T�p /[�5�
in lull loroc send t I_ / o ALE a' Z License CP ss_ Y Lie.N_ Y V ILm
OZ Dam T'S ECL J 1/U(
�OWU ATION
I understand my plans shall
ARCHITECT'S
dDas public records DEC 11, 2002
y Licensed Professional v
F'- OWNER-BUILDER DECLARATION
<P 1 hereby alfno that 1 am exempt from the Contractor's License Law for the fs�0L®tk�1G $6500
p O Ikdlowing rmst ss n,(Seen 7031,5.Busineand Professions Code:Any city in,county 1 V
K$ which requires a pmmit to construct,alter,improve,dcmnlixh,or repair any structure
prior to its issuance.also requires me applicant for such pwhit o file a signed Statement
i<
that he is licensed pursuant to the provisions it(the Contractin's License Law(Chapter 9 3Sq�B.T"4At6:0 Valuation
y1-$ (commencing with Section 70XB(11Division 3 of the Business and Professions Code)or
y - hat he is exempt therefrom and he basis for he alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects he,applicant to a civil penalty of
not more than five hundred dollars(SW)f 41?N-NNWRFE Occupancy Type
I,a nwncr of the property,or my employees with wages as their sale compensation. 307 - INSULATION
will do lW work.and he structure is not intended or offered for sale(See 7044,Business 60i - ROOF T
�pl8( e^� p
add Professions Code:The Contractor's License Law does not apply to an owner of 602 - ROOF P Y W V n LVH LIS
property who builds or improves Ihemon,and who doessuch work himself orthrough his
Own employees,provided that such improvements arc not intended or offered for sole.If. 603 - ROOF BATTENS
however,he building or improvement is sold within one year mcompletion,he ownef-
builder will have the burden of proving that he did not Wild or improve for purpose of 604 - ROOF IN-PROGRESS
sale.).
❑1,as owner of he property am exclusively contiocling with licensed contractors las
consumer he project(See.7044.Business and Professions Code)Tho Contractor's Li.
cense taw does not apply to an owner of property who Wilds or improves IW reon.and
who contracts for such pri with a convEmr(s)licensed pursuant to the Contractor's
License Law.
❑ 1 am exempt under Sec. ,B&P C for his reason
Owner Date
WORKER'S COMPENSATION DECLARATION
/ Ihercbyaffnnunder pe mllyofperjuryowofmcfollowingdeciwaiions:
IJ 1 have and will maintain a Certificate of Cnscnuo selLinsum for Worker's Camper-
cation,as provided for by Section 371X1 of the Labor Code,for the pafmmance of the
work lo,which his pcnnit Is Issues
is
have and will maintain Worker's Compensation Insurance,as mquimd by Section
.7 )of he labor Code,for he Performance of he work for which his permit is issued.
My Worker's Compen bnnlni ursneccamieradd PolicynumMram:
Can
Policy No.: I4 2d S3 9�D j
CER [FICA OFF.XEMPTIONfROMWORKERs'
COMPENSATION INSURANCE
Thissenion need not W completed if tW permit is foronc hundmd dollars(31(X))
less.)
1 coni fly that in the performance of the work for which his perm it is issued,1 shall not
employ any person in any manner so as to Mcome suhject of the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:IL after making this Certilicale Of Exemption,you should
become subject m he Workers Compensmim provisions of the tabor Code.you must
0 forthwith comply wash such provisions or this permit shall W decided revoked.
'-O CONSTRUCTION LENDING AGENCY
f-' Ihereby all!on but there is a conswnion lending agency forte perlinmamm in
C4 7 me work for which his permit is issued(Sec.31197.Civ.CJ
W� Q Lender's Name
7 z Lender's Address
V U 1 certify hat 1 have read his horimmion and sus that me above information is
L, correct.1 agree m comply with all city and county ordinances and sit¢laws relating to
V wevingconswniro,and I or inyectionprposes malivcs ofthis City tocmcrupon the
aM1nvc(We)agree
roe toperty saw for inspection an nd keep ha.
F nst
0 (Wjudgmects,save.indemnifyexpenses
which harmless whe Cityof against said no City
fn inconsequence judgments,cocas and Of Six rmet. may in any way acervc against said City
V z A APPLICANT
NDER TANof his permit.
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: Date
SOURCE GU AT16.`1,15. �1
Re-roofs
Signatures A icon Cc Vann Date'
HAS RUOU S MATERIALS DISCLOSURE Type of Roof
Will for applicant or future building occupant store or handle havarduus material
as defined by the Cupenin,Municipal C dc.Chapter 9.12,and the Health and Safety
Code.Section 25532(x)?
p Yes 0 N All roofs shall be inspected prior to any roofing material being installed.
Will the applicant Or future building occupant use equipment or devices which If a roof is installed without first obtaining an inspection, I agree to remove
[mit ha arcous air contaminants as defned by the Bay Arca Air Quality Management all new materials for inspection.
dnden P
❑Yes ONO
Ihaw lead line haaaecouss 25505,25533rements under Chapterfi95 of tat locidi - �� v
Iia Hath&SelbtyGdc,secants met
i2myrnJ35534. to rich
lost if ate Willing
hes nrn comedy have a tenant,that it is my resrymsihility m notify the
occupant of me Kin
requirements which must Ise mel Prior III issuance ofa Cell-Wof0.j upancy. Signature of I 'aI
V.I rn14 CHt?�k Ilt1.3, g PP Date
ownero nmori,<dagnt Date All roof coverings to be Class "B"or better
f
OCIOF
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
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 Vi"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 t G � O-Y\, L
Address:
Reroofing Company Name: (S r
Applicants Signature: ---6�= ( SGL Date —�
Joe Antonucci
(Chief Building Official)
6/25/01