02060109 CI BUOF NO
BUILDING DIIVIISSIIONPERMIT CONTRACTOR INFORMATION:
Bjw7Jl,Q1iYV`B5KbGRANDE PL OLD COUNTRY ROOFING PERMITNo. 02060109
oL/ /Lftll"MEN 125-B GROBRIC CT AMfTdnti '62
PHONE: (707) 564-5557 SANITARY NO, CONTROL NO,
w te0 o ARCHITECf/ENGINEER: BUILDING PERMIT INFO
¢w U BLDG ELECT PLUMB MECH
FF LICENSED CONTRACTOR'S DECLARATION
•O y Z I M1creb ffum that I um Iieemwil under Job Description
>z_o r a .nwi,mnersiom cr. 'd mmendag REROOF p
:ntw
is Section]000) f0ivislonJo(the eusin< ad Pmressions Cade.end my license
(ms3 i.in ranra e rr T/O 1 LAYER SHAKE, INSTALL OSB 30# FELT
c¢za Licenscgas. u<. (N633V & MONIER LIGHT WT TILE ICBO 2656
i d nate/ comm r
s a fn \(/ ARCHITECT'S DEC ION
m
g J I and crsnd in,plans shall he used as pub+c rccnrds
Y
3 n o O Licensed Rofcssional
% Oat I am exempt
from
DECLARATION
I hereby affirm that 11. exempt from the Gonion C s License taw for the
!' < followingreamer permit
]031.5,Business and Professions Code:Any city or county
F O which t il pe t re construct, h reprove,demh Permit
t or repair any statement C _prion am issuance, Imrtq ' theplo am for sucbpernuuofile asigned neapter9 .. .. .._.___.
that hue Jcgwithkioitdthepa viion3ofns of the CeBusinsLicense andPrLaw 9sions ode) S Ft. Floor•Area. s t41< 120@dIhation
(cam trc g 'thedre ]rill) the Division orf the Business and PefAnyssCodq f.�1a, v �4.:'S 9• (t-J 4\ II?:tl a. S'�. �•R
or that he ii 31:5 b tanicarotlicand the bates for the subjects
th d aemp+on.Any violation
of..more
]OJ n fiv any hundred
11 for o permil aubj¢u the applicant io a civil pcnahy
rornot mart tnmr Wnatea dollars rssW). 362fYI&`D1818TIlfPfJ Ir.:c:+ ::+ Occupancy Type
C 1,as owner of the propeny,or my employees with wages as arch sole compensation,
-
will-do the wmk'and'the stcion,is not intendedonoRered for auto(See:']Or4;" 3U5 - Re "
Busineii and Professions Cade:The Conuac or's License law does not apply to an Ulred InspeChODs'''''' .
owner of property Who builds or improves thereon,and who does such work himalf 307 - INSULAT IOI�
_err through his own employees.provided thn such improvements are not intended or
liizd mr
rere.If, ee
hawev ,the building err improvement is sold within oneyearor ..---'- - '603 -"ROOF TEAR- OFF'--
completion,the owner-Wilder will have the burden of plowing Nat be did not Wild or 602 - ROOF PLYWOOD NAIL 4i
improve for purpose of sale.).
C L ere owner time Fwon7.am Business
a contracting with licensed contractors to B:'+'is t
icensetarcprojectIsee.moanowaerosseaPrywhobildsorThevesthereoa 604 - ROOF IN-PROGRESS .r 1.%. '•r.; v :.
_
License law does not apply m an owner with..
.corny who).lids or improves thereon,
a.Licios fL s. p j pursuun
.and who rocas with.a.wmcctor(sl.licenmd. t m.thc- ._._.. .._..__..".._._. . _.. _.............._...____. .._...__ _. ._•..-. ._ ____.—__.-._....___
Contnctofs Littnu Law.
C l am exempt undo'Sec. B'&P C for his reason
Data -flu
i WORKER 5 COMPENSATION DECLARATION 1
I he by rc+m a d pe Iry of peri ry a f iM1e foil g d I ion a
!. C I have and will maintain a Ceni6caie of Consent to self-insure for Worker's /tq
Compensation, is-provided-for-by Section 37W of the Libor Cade, for the V
pm omunce of the wall:for which this nnit is issued., Q ZOO
10 I h will II tat Walker's chi pc t Ins Sea ace qu i d by V
W of the Labor Cale f th pelf re of th o k for h ch th. perm t �'�O'
is ad M W kers Compcn t I ndP licy W '
-
�✓!_ sy 'i I N�' '
Y+CERTIPICATION OF EX ON FROM'WORKERS�, f_f.J k.I w�!Yr, ell Y,._ nS..42 Y .l�I ILC t.
-._ _ _... __.__...------
not
- _not be completed Rine pannus for one hundred dollars t5" \ ' r, ,r„ I r1:'
ISIWlm less;) +
1 Certify'that" the pert oiler of the walk for which this pernut is issural l .t i•iC;a� � �- -�{ A"~� v
shall riaL employ any piromin pity manner so as to become subject to arc Workers' i
Compensaton Lows of California Dale'
N come subject
u j APo the Wirker's Cher makingalta this Certificatesof of Exemption,you should • ' r`
Wcomeb compmthe such
Compensation provisionsof thelabor Coale,you must
cc fd6hwith comply with such provisions or this permit shall W deemed revoked.
'4 t ,'CONSTRUCTION LENDING AGENCY
E ' ' 1 hcieby'afnrm that Neie s p construction lendigg agency forthe performance
of
N okfor vouch lhvi errail is coroulISco 3097,C v C) •. _ .___.. _ ._.. .. ._....._._... __._ ._. ._. .._....... . .. .......
-Land 'Name a .�_... .....,.. .c, n
arQ _ _. - _ . . ... . _
r^7i2, Lenders Addrexc Jl 1'
V`0 1 ccnify that I have read this application and some that the illative information is
Bn-t.. coiner.I agree to comply with all city and county.ordinances and statelaws relating
,) to building con.amction;and M1ereby'authonze representatives of this city to enter upon
the eWvememionel n for inspection s
y}-til. P'°f'<„y pec ikepurpou_.�
L,O.i IW<)-ngice t..coc,mdcmnify sc keephamayat thi vale of Npe.,.lat said ((��
LL z liabilities nts,f and expenu ich may m I wry recce against said
V.Z City u a R:tB g t f s pc h H '6
SAPP,OUR n TI N ATIONANOS D 11 OMpLY u'ITH ALL NON POIN 1° IssDed b Date
SOUR ULATIONS :: � y
ignore Appli UC t - S ,D Re-roofs
HAZARDOUS'MArERwus glscLosuRe' iI:”, _Type of Roof
NFII Ne applicant r foto
building ottupant store haMlot lurmdom and nd ..
as defined by th Cupen n Municipal Cod Chepmf912 d the H hh d Safety -
CoEe Sm on`25532( ( , y a ,y y 4i 4} t S F ' e '.r \S I< '.: 1 ♦(k'. C r, 7
+, ; ,, ._ �° ,., , „ ,• ,, _ :: _ All roofs shall be.lnspected,prior to any roofing material being Installed._
,willtheeppliculan or f buildingoccupantusecquip t devices which If a roof is installed withou btaining an inspection,I agree.to'remove
conn haouidoui air coinemmants debnW by the'Bey Area A r(I'.Iay Management
Distnatn all new materials 'inspection. plicant understands and will comply with
- ❑Yea +. t I - all non=.binregulatton - .. . i I ;:;• .. . .
l 1 has,'rtad,Ne h d i materials q menta and br pt 6.95 of ibe
Cabf ie Health&Safe Code Sections 25505 533 and 255341understand!that / O
if Ne W Id doe c ptly have a tetwn I t t is my responsibility to notify the
ioceupam of N in- nu what `uste ti n m c issttuanof a Ce 'acme of '
OrFUPeridy. :.
•. :� Signature Applicant Date
wn<, rad d:cera ., . D All roof coverings to be Class "B" or better
w.'
. +.�'• r .. .. ,`- ( - OFFICE --
r �
Building Division
10300 Torre Avenue
Cupertino,CA 95014-3255
" 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 1/4"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: Z- 6 4' C kfi 0
Address: '070 020 G K_f--7 c=
. Reroofing Company Name: d L�2w)
Applicants Signature ���i f _ Date: ' / - --Z
Joe Antonucci
(Chief Building Official)
6/25/01