02090004 CITY OF CUPERTINO
BUILDING DIVISION PERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
6740 JOHN DR OLD COUNTRY ROOFING 020}}900pp04
B GAT
O�49R9ffE:KUAN T AND HUI Y 125—B GROBRIC CT APPucATION/ 03/ 2002
(707) 864-5557
f PHONE: SANITARY NyO. CONTROL NO.
�
O zo ARCHITEC(ENGINEER: a BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
L-1�
Z ro i LICENSED CONTRACTOR'S DECLARATION ft, Job D ription
O
Z!2 1 hereby ufBrn Nat 1 am liccnud undo provisions of Chapur 9(commencing RER00 F ti
with Section 7")of Division]of the Business and Professions Code,and my license
is in full force end eff
Licenniflassa Dom Lic.. or O r-9 C— �l
ARCHITECT DECLARATION—f—
t�• g 1 understand my plans shall be Hud u public record, �`VO
5 m O O Licensed Professional
OWNER-BUILDER DECLARATION
3_C?zC wQOQhereby. yrth t 1 aa pt from the Convector's oras Law for the
followingrt fe7031.5.Business and ons Cask:Any city or ry
. �, .$. SOOO
imitates apermit to o wet her,improve,&mobhminory nonnt
Four rt its issuance,a1 requires the applicant for such Permit signed statement
that haq 31a spurs lij (pof don Convenors License Law(Chapter 9
(comma nglh Section 70( Divison7ofthe Buunspand ProfessorsCodel §51,D'ifiopXNValu
ati_o
n ... ..
or that he 1}ex8mpt there(om dad be bass for the alleged eapmpmn.Any vialm on
of Sectors]031.5 by any appliema for a permit subject;the,applicant to a civil p r alry-
let at mare to.five hundred dollars(35087. 3 0 5AP.N l5`iR*t[E '`,ie.;.':s." Occupancy Type
°1,as novae,true pmpaq,or my employees with wages as their sole compensation, 307 — INSULATION l
—willda'the work;and Ne-stoacture'Is'not'intended or offend-for-salC(Sec.']o44,' 6O1 — ROOF TEFF I l II1SpeCt10D$''^'sl!e ' "
r Business'endProfessio
' n Cade:The Contrecon s License Law does not apply m en q
owner of properly Who Wilds or improves Merton,and who does such work himself 602 - ROOF PLYWOOD NAIL
or through h' own a pl ye Provided Not such improvements are not intended o _ —
73(f d far'sale.IGH e s the hu Id's rm" ement is cold wand n one' r`�1.,,r" ,___._. ......
ge pn0 yorof
completion,ovefor the owner bu Idcr will have the burden of pov ng Net h<Nd not build or
improve rm purpose of sale.). 604 - ROOF IN-PROGRESS
----
co pasowner of p—ro-pen_Y...a.m._exclusively_contracting with—licensed- �co..n-ve--no—rsm
construct the project(Sec.7044,Busness and Professon Codo:)The
......;'•.O I't 6'd.%I`:
Comocror's i,;
License taw dives not apply to an owner of property who builds or impovesthemon,
rl: _fad.u1m contmcu for.such. o'ccts.widr-a co amctor(sl.licensed.
-: p ) pursuant.w.Ne..
Ciamatit License Law_
❑lamexempt under Scc; - ",B&PCfor Nis reason Yrh :...?_L!'CIu':
- Iq
Owner ,' "Dat
WORKER'S COMPENSATION DECLARATION
Ihereb affirm under It f,
y pcmm y o perjury one of the following declarations:--
.F ° 1 have and will"maintain o'Cenifcam of Comsem u,166insure for Worker's
Compensomr. uspovided for by Section 37W of the Labor Cade, for the
'performance of the work for which this permit is issued. r
h "-d will muntam Worker i Comm r n Iniurdnce,as required by Section
70)of the bar Cnde;for the perfom mance of the'work,for which this permie'is
is v d Mcy�W r�keyr�s.C�ompc T 'hose ncec rti<r endP l y mber`rr
tart¢r.�J.lfT/C+ s�I.7F.Poky,No. Qvi, rr i Ti
i;)CERTIFICATION OF,EKEMPTION FROM.WORKERS'.s', +-�••� L SM1 r E-.9 1 !YC a is -_�L-
`'•. COMPENSATION INSURANCE`'
"(' 'ITh 4 scciliin'need not be compleud foo perm t is formal hundred dollen
($")ar less.)
.r-
r, y n the perfonna ce of Ne ark fo hi h tht peon t u rtsued 1 - s
shall nrteml person npnYm sivepasa 5}gEp<am ,hien lhW kers I\.j velJj) „i11t', \L":•`
Cbm ensat b p.11 w of CaliforniaDate •/ Y �< t
O NOTICE TO APFLIt j,�— .., o 1 _ _
P Y Y
fimbw
F
Abeast +'1^_ ._ . .. _ _ __.. _ ___ _. _ -. __.. .__._.. _ _ s
CANT If,eft makmgnus Certificate of !Exemption . should +` 1
Q became subject tothe Workers Cropes t par n of the tabor Code y t
h inch pm s o histpemw shot be dearrid resulted.
"ICONSTRUFI'IONLENDINGAGFNCY -
��ii I heimliy Oirtn hot there is otaiiismolks lending tg y for the performance f \ 1 L -
W ”
.6hii w d far which thosiscraii I,issued(Sec 70] C C.)
C6 Lender's Name....
.. __ ..__ ___.-.. _,.-. _.- .-
�iz Lend;s Address'_' \,,
.
V s y I certify that I have ad this application d sura that the above information is
fryz F. corece I agree to atoply,with all city and county ordinances and state laws relating
_ ,Q< to Wilding lding conswction,and her2byethoomaxpreumf
aaaNxx this city to enter upon
�s-rte the,above-mentioned properly for inspection purposes.„ ,
-i E.,-;6 (We)agree Nsuve,indeinriifyond keep Imodsis ial'Ciiyuf Cupeninoagmnst
Gn liabilities,judgments,costs and expo des.which may in any way accrue against said
V,Z Cty an"quhce of to g' tall of thisperms.- c
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT
SOURCE REGULATIONS 4 ( Y,,.,,. Issued by; Date
Signal rApplican Conveeto Re-roofs Date" ReOOf$
y HAZARDOUliMATERIALS DISCLOSURE -
Willtheepplicanto !Ware Wilding occupant store ur:handl hauNwsm kd :_Type.of-Roof
as defncd by the Cupemmn Municipal Code Chapter 9A2,and LhaNcalth and Safety
Code °cYes 255J�(el : t °N t a-•, a tq ' 9 e 1 +y. .j t ° sl"{!LMJ t�. dj..a.',.
All roofs shall be inspected prior-to any roofing.matenal-being installed...,--.---_
far..Wild ng ocapoat uequ p at or devices hien If a roof is installed without first obtainingan'ins ection;''I'a ree to'rerhove
emu hazard us mr comm ort as d f ed by the Bay Area Air Quality Management P g
Dixrtat _ .. . . ._ _.• PApplicant , r comply,with
all new materials for inspection. understands and will
all non-point source regulations f . I.
.;, 1 ha e lt d the et zCWus vutedals ream nts under 4. q cnt
Cebf o Health&Safety Cad Sect av 25505 235)7 arta 23574 1 ndcrsund Net
ifibalmildia,dox,amoctaronlyhola tenant,rhmit sray-responsibilityt ufythe
;occupnat or the requirements which,most h•met prior to issuance of a Ceri fi,,me of
,Oce P Y t 1
.._,SignatureofApplicant.._. , Date
c, T � �. 9>3:-floc - - - - --
`.
trainer oauNoniedaseat 1. Data All roof coverings to be Class 'B"or better
,�:.. y ';_•t .._. :.,. _._. ..__. .._OFFICE-.._. __ .._.._._ ...._..... -. .. _... .__.. .. . _ ...--'--- ' --- _..
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
= OCIOF Pax: (408)777-3333
CUPERTINO
`wilding 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.
IWORTANT:
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: �I U�� OSI 6'H
Address: �`f D �0 14/0 Da I ✓c�
Reroofing Company'Name:
Applicants Signator /� /- / Date: g - 3- o a
' Joe Antonucci� 1
(Chief Building Official)
6/25/01 . .