02090145 TY OF
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BUILDING DIVISION PERMIT
CONTRACTOR INFORMATION:
B}1u�QlNQ q PERMIT
1153.SDTBUNTRY SPRING CT OLD COUNTRY ROOFING
PERMIT NO.
ffXBftTffG ZHAO 125-B GROBRIC CT APPLICtl§N/kL676L 002
PHONE: (707) 864-5557 SANITARY NO. U/ CONTROL NO.
p Q ARCHITECT/ENGINEER: BUILDING PERMIT INFO
w C BLDG ELECT PLUMB MECH
H Z LICENSED CONTRACTOR'S DECLARATION �.I��b�DD L
OZKE Ihereby alfirmmatIamlicensed under provfsionsofChapter 9(commencing REMOVE SHAKE, INS'PAPLcL°pL1° I'EWT TILE
p_t_ce with Section]000).f Division Sofine Bminessand Parfessa sC c.and my license
a�m as< is ce full force end ettFc1.
ore 6 License CIq,S.� D Coatrctnr L
K av Done
QQ
w 3 a ARCHITECT'S DECLARA OV
0 g 1 understand on,plums,h ill W used as public records
u3
is.S p p Lrccnscd Professional
OWNER-BUILDER DECLARATION
I I hereby affirm rho I tan exempt from,he Cmmacmr's License Law for me -
t_Z< following reason.(Seen..7031.5,Business and Professions Code:Any city or county $18000
E F p which requires a permit m construct.alar,improve,demolish,or repair any structure
pn t I al rega c'th p,li ,f h penny 1.file asgned want -
that h<slcga amSisnm,dahepfDivi fm meBusinContractoesLl Profew(Chapter 9
onsCss) , 3,65' FC4't�or0i@ea--• i Valuation
armmW �wJnsat m ,gar Division J of Business weoa4x:oms cm) �'x} 'I'n. _ . :f.gg= 1.'.r 'v>•!e frLT (�i•
arm he n exempt therefrom and,he basis for the allegcil exemption.Any violation
-.of flection 7031:5 by any applicant far a permit subjects the applicant,.a civil penalty
.of no,moreman five hundred dollars ISM 305 APN&vIU" 'r•!'zNI:-; .� Occupancy Type
❑I......crpf,W pmpeny,army'employee,whh wages.1 their sale cpmpemsaimi, 307 - INSULATION
-will do me'week. ad'Me'awnurc Irmo,intended-proffered-far sale Sec:'lllfa; 6 01 - ROOF TEA
BuiinBe imd'Pmfcssiona Cole:The Comrncmr's License law does ma apply m an & Wk Inspectioils''!'�"'�`•%`rr
owner of property who Wilds or improves thereon,and who dues such work himself 602 - ROOF PLYWODD NAIL
of through his own provided that such improvememm
s see nu, ended
,'offered for sale�If.however,the
pr
grmprovememra,alawmm one year a
or. ._ ...___.ROOF—BATTENS' • r , •.,';
co pl,i m Ja owner-Wilder Iter w II have me burden of proving that he did not Wild or ;,,...( ,;r ;C
imp w p rposorsmel. 604 - ROOF IN-PROGRESS
- - -- -- - - - ----- - — -Uaclo---... ._._._..
-----------
- -:.p Ql;az mvnerMme prup<nY,am exclusively<pntmming with licen.adeonrs 1p --------- - --- -'_--."'_'-'
a f'D
C r. cormmn me project(Sa. Business and Professions Cafea The Contractor'sIU_ILL I- Pc): FO
: Licenx Law does not
a mol apply,o an owner of propcny,who builds or improves mermn, IA� ' I'
_aM who,contracts-for-such.projects.with.u.contracmr(s).licenscll pursa,nl to.mc- _.-..-____.
Contractors License Law.
? 0 a mpt dcrS 11 I'M�)(1 f! '.a B'&PCfor theIV
a •n,,) { 'I•._ „_.
Gw DEC n s ?OA2
r r WORKERS COMPENSATION DECLARATION ,/ (`� J.,.
• '"a the by R d penalty of Pe l ry ,o, 1. .oll g d I tat our - EWILC9NU
Cl I h d "'11'n t C n fic, f C m io If' . for Worker's
comperseuu as provided far by Section 3)011 of ,he labor Code, for the
_ re,dormanee'of the work fur.which this permit is issued.,
211 h -tl will aunitin Worke is Coupe wf Insurance, s reviewsby,Sem,n an
3700 of m Labor Cal r the,perform of bh �oilkf -which this per ,s
io J MyWorker'sC pe t insurance comer and Policy"no 11be
S/ ••
-rte T`'x'hxF''
Ca STZPOI cy Nok L'2DJ S \.Nt IaS 1'..i �1 !•`.�,�Y_ t01,-Ai ,a
1TCERTIFICATION OF,EXEMPT ION FROM WORKER '' - ,_ 1 f '~sn;
COMPENSATION INSURANCE x.u� -
u+.':11 ITh seain
n n cJ nm h cnmplcmJ time perm t is future hundred dollars •-'y N rV' ❑ tl(;(..{il _ y p2 --..•,�_.�w
(Slott)nr less)
q ' s,I'e mfyN,"n the pera' rte the workforwhich,h permit itsucd;1, ^,tl..l - lrr LI'll'- .al
CM1ull , mpiny any Pe n a ry man ai heron.subi,el,d the Workers I
o peo u Lowy ofC llnin:Date
.'APP(c - __. ,a l^:i _...____
eNOTICE TO APPLICANT If alter ,k gbh Certificate' I Exomp, y should ;•)p,•,
Z hcCn ssihject,the Work C mpc , p safm labor Cal y'u mus' '
Qz Q feanhw m complywim such pros i ons or this perrnu shall be deemed revokes.
.r'.1 a (CONSTRUCTION LENDING AGENCY-
T IIS e'.\l'
�•a`> ;° 1 he by off.that the p co s, t o leoE agency ncy fp the pert mo nese' 1 nl.r LEC-, ,
r� fth w kr which thispe bt .sud(Sec ](W] C CI11.1.1
Q Cendc Ni ._ ._._------ -.__.-.__ ... _
1 nfy bhatlh dNt' .plata o' dstase ma,the boy rf mu,
Gs. E. sunnier I agree m c ply Ih 11 coy and i,mvvy mrionso5cstind t a laws rel i ng
Q.0 m budding conswcuon,and he by ato i nepresentatvcsofm,city 1. atertipub
fin,Gil. tthebo t J P Pent r sp 't p To
0. (N1 c) S.to s ir:dem f to keep hatml<, in Cry of Culp,.mafi`n.st
N iiabilhlics,., Jg , V,u , and s which not any way accuse against said
U z City se he S flu pe ,
J NP LICA ND fl 5 DIWLL COMPLY w'1 > NO <
SOURCE ,.,o r, Issued by• Date
Re-roofs
;r , HAZARDpUs MATERIALS DISCLOSURE -
w u n ppr , nu w m mg a path score o-na:m1 navrdo n,aw„I .Type of Roof- _.
as dcfned by bhe C an no Mu pal Cod Ch pt 9.12 a m He Im nL safety , '- v-•^^'•��•�•-•---�•-
Cod Secy n 3532( 1 q v _ f f 1st f a r t :_I lDt7 j� ,
OY -,ltlrl -tl rl tj`, -tel i�r�F I �s.t s to +I _ _ to s s,
All roofs shall.be inspected prior to-any roofing material.being installed._.__...._-
wu m p�l¢e t r f t h -IJ'ne upam use cqu p em, a ces. tach `
< itnazvd - 'r con, ant agOern<dhym B yA A Q a„yM gem If a roof is mstalled'withour first btamtrig an inspection LIlagree to remove
D" all new mate ' r inspech .,Apphcan[understands and will comply with_e
❑Ya
n
p (I all non po so ce r'e' ' ns < r. ".
I ha read the h xi d s m,nal q mem 1 rid Chap, 695'pf bh< - -
Czl f m Health&sof ty Cade Seco s 25505 y53J rid 553J I and band that
p a gait etlyhme arabth, b my respo ,bltyb ifyme
:I O discu an,of the requirements which mutt W met poor to issuance of a Ce rifima 6f: ) ,• - -
ccebulldn a e rip -
_ -- Signature of Pelican[_-
, .. .- . ._-
g Dale
'ow aim <a agent t t c . Dao; All roof coverings to be Class, "B" oi•better '
y •' t. .: t v _..r— _. ' - -OFFICE--
Building Division
10300 Torre Avenue
1Cupertino,CA 95014-3255
NX 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 V"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: On 1 tJ G Z! I Iq p
Address: I �c'33 C—pctjjjje y Z��r-�K I IV C• �
Reroofing Company Name: OL!�� CO
Applicants Signature: 6547L&a� Date:
,P -_9 Z04Z=1'�
Joe Antonucci
(Chief Building Official)
6125101