02090148 `' CITYQ F,C LUPE RTINO -
,
BUILDING DIVISION' - 'PERMIT ' CONTRACTOR INFORMATION:
"Wrl'OMS ONDAS WY OLD COUNTRY kROOFING PE'M090148
i t s RICH! L AND MANON M 125-B GROBRIC CTA.....6'97' BOJT 002
PHONE , SANITARYNO.LU L CONTROL NO.
(707) 864-5557
❑
Poo ;ARCHITECT/ENGINEER: i 'BUILDING PERMIT INFO
s"i S' - '•1." -. '.:� ;- ' f.BLDG , ELECT_ PLUMB MECH
z �Z - - 'LICENSED CONTRACTOR'S DECLARATION Job DeSCnpllOn
o z o _ I hereby affirm that 1 am licensed under Provisions of chapter 9(commencing REROOF
p-gym '
with Section 7000)of Division 3 of the Business and Profgemm,n1/ do and my license
=Ynt w:6 is in full force and eBys LA Lie.g 6.2 / in�aatt
eV Dle` Con Caramel.,
ARCHITECT'S DECLARATION
FS Qg T'r'yt�+l5anderstend in plans shall be uud as public rtcoNs
Licensed! , OCT 2 5 200
0 `Licenud Professional :�. E _ - Z
't OWNER-exempt RDECLARATION
�;;,.,,I hertby,ARrn Nm 1 roes exempt(roan the Contractor's License Law for the
followV. 'whichingrtasoa. Permit 1703L5.Business and Professions damns Co de:Any city or county
,�t�7 -which requites a pconit m comwct,vha,improve,demolish,or repair any structure BUIL
w-w Pam in issuance.also rtq ' the applicant far such Permit m fila a ngmd nmemem - ._ .p _--
'tlpthe3lcercedpdrsuanit theprovnbnsortheConuvchne.License Law(chapter 9 - t 369"Y?>Ff1,TR)orQ ea w
d(cammen to wdhsecu 7 f 5 TrT", I Valuation
8 000)of a Division J of the alleged
and ibA.Any vi Cade) 1.4 Z S 1!:'.•. 1 :71's g;'a t'J�'� 4 i s h TON
or that he is cxembt from btnand the basis for the alleges applicant
on.Any violation
-of Secnot mo them03 0 iv mYdred d l for a Permit mbjttn the vpplicam so a civil penalty
sof not mom Nan five hundred dogars asBd). y 305 A-PNH'YiAf$$ .e Occupancy Type
,0 1,as owner of the property.or my employees with wages as their sale corNaginion, 307 - INSULATION
'-w11Fdo'Ne'wark;adi de'nneum ii'mu1nromoill or oRered'1.ads(Sec]Om;' _ I�AJ -- --- - -
•Business'atitl Professions Code:The Contractor's License law does not apply to an e d Ins eCt10DS " '-
.ner of pmpeny Who Wilds or improves thermn,and who does such work himself 602 - ROOF PLYWO D NAfL
at through his own employees,provided Nat such improvvmcnnrt anot imended or
uRfied'foi Bale:lG However;die boldin"o,im"vemetn is gold within one year "' '""-`-"
g a pro year or - - ROOF' BATTENS---'-�s.
completion:the owner,laukhr will hese the WNcn of proving that he did nut Wild ur
„improvefm P.a,gseofgma.l. 604 - ROOF IN-PROGRESS'.
co I mettOwner f shot(Sec.7 am Business a summering with licensed The
to
c 'tan t the p jeer(Sec.]Ban Buoness and Professions Code.)The Commnor's 0. s Fll f; s q.
License Law does not apply to an owner of M ,my who Wilds or improves thereon. I`
and'who'emarans;foe.such.projact"withj it eonsracmgs).limned.pursvmn to the. ...... -
;Cnnuam',License Law_ ._. ..._-..__ _..___.
0
?, ❑Ivan exempt antler SEe''1) 'I''" ,B'&PCfor Nig rtunn I'.'.':` ]'�, ;';l;fi'% ,
.D iterDm . .
.jN y S WORKERS COMPENSATION DECLARATION J
. .
:I It by inTmi nude,Pe,li,of pe) ry no;of the following dixelarmion,-
` O I hu end"ill t n a.Ce"niG I 1 6oruaam to self-insure for Worker's
-Compsimapon,. as provided for-by Section 37M of the Labor Code, for the
perfosmance orthe ark for which this person is lasuvd.-I
y -DIhavemid;sdl'mmm nW 4s"ComPnmtrinsum a smqquetlby Sectil,.
37M of the Labor Oah,for the Performance of he work far which this Permit is
y s ed MyW rke%s Cab nsun n Ink hoes c Policy numbs arc:'
':Cam STA/2 i�'lr's''t` .;Z$-9 2440. s,
;) s CERTIFICATION OF E%PMPTION FRQM WORKBRS �3 bl l ) +t- 's�Yl t Y r4 y �v,AAsj I _•I
f"11t COMPLNSATION INSl1RANQE
t' I (Thit seFI im need not be complmed if the permits for one hundred dollars s ,
,
1511%11 rlcssJ ' '
Icen fy tIt.is nlie pert ' t to Mthel kfor'. I lilt l res it f:' uell ..-: �.. -..,,•::.: ,. ..,. ..•.. .. f �,� ... _. -._:..
shall t P1 n 1' f.Iat i v l Cci. h. - .
P Y Y Pe Y t won r t became hl t t°lite Wnrkery
C top ori Lnws fC r '(Oban "'
...APP( a s
z b a m a_. P vkimn lr(1 deemedrevoked
on ,y hmst - ' _._..
r aki gshsCe n ate of Exes Pt n
CONST mUCT(n°u nPan 'rife e&r Cel you most
th e k J
CON
bed s h eti the WorAe C s .. _ ......_.. _..._ _.... ........ _.. .. . ..... .... _ _._ _.._
APPLICANT II 0 m
1 Pc
O (a thWuh nPly Ili such pro i on
ON LENDINGAGENCY-
j I hcmby ebfm thatthe e A on t t n Icodni6'agency r the pert im 'ce r! :ll:, ; v, I B /I
W-ar :of the Work farwhich this perm t soeb(Sec Jbl] Civ C)+Cender's Name
-
L d r Add ess rs .,
L,
I I., a to c I li e s d this city
mi oo a d st le th t Ili above haws relating
elu
tgvi E" c rtea 1. gree to comply. th.ull city mid my oN nances and nate laws relm ng
_D r, m building coswcion,and hereby amntie rtpmsenmtivn of lhia eny,m enter upon
(�] :the eWa niiadedppeny(r impact P .q- _ _
gL (Wel agree to gave,indemnifyand dike ermlesiihe OtyofCperiino against
i•n N 'li byydtues p dgme s d apense ch may a any y seem against
said r�
t..) z 'APPLICANTq DE f fAND15 ag LLerem 1. 'WITH L NPO
souRCEP - 10 G Issued by; Date
3g am pplicm me Re-roofs
ZARDOUS MATERIALS DISCLOSU E'
Will ithe applicant or future WOdi Occupnt store or lwMle hwnrtluua mamnal _ .Type-0f Roof -. - _
as defined by the C pan n o Mu cip M Chapter 9.12,and Ne Hmlth and Safety _. "....'.- -- - -` -- .,.^•-^^^••--•- ..�....
CodeSection 25532(.) h r - t ! t f kp "F� a `t
e ❑Ye sl ( 'NUC tx �rs xsgf.�• 5 it ...La y.
All roofs shall be Inspected prior to any roofing material being installed—____
. 'gym W'll theapplicant t bu" gore p aces p t e ces which If a roof is irisfalle&WIthout ft st obtainingan'ins ectidn,IFa tee to remove
t heard a emitam mss m fined by Ili Bay Area Air Quality Management p g
Districtall new materials for inspect ._Applicant understands and will comply with
.-v Dyer _. . '.-�.. - - - - -
"°:'T all non- omt s ere a s:..
ha a read the ha
y that'nutenals requirements undo Ch pt r 6.95 of the �1
C.i v Health&S fatMe Sections 25505 25533 and 25334 1 understand than _
'if the WtlJing' not currently have vt rthnit is my responsibility to notify she - - _ - -- "- "" C "
pecupsun of the rcquirprnenn which..it be mei poor to isxuance bf a Cenifimm'of
Occupancy., r• ..
_ ._Signaturelof plicantDate___ _
..
Owner orauthorized gem riDmq
Al] roof coverings to be Class"B".ofribetter
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Ocio Pax: (408)777-3333
CUPEkT]NO
Bnllding 'Departnient
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
an&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 r/4'per foot slope and demonstrate that
there is no ponding.
2. An LC.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: f' C N A CM /b/(,(S
Address: / O S//�2 I- /-I .S oN�,rq C (�/J(,9 y
Reroofing Company Name:
Applicants Signature
• Joe Antonucci
(Chief Building Official)
6/25/01