02080048L1
CITY OF CUPERTINO
CONTRACTOR INFORMATION:
: :,BUILDING DIVISION PERMIT
BUILDING ADDRESS:
PERMIT NO.
11851 PLACER SPRING CT
OLD COUNTRY ROOFING
02080048
6WMY P KWAN AND MUI IRIS
125—B GROBRIC CT
APPLICATION SUB DATE
08/09/2002
PHONE:
(707)864-5557
SANITARY NO. CONTROL NO.
ARCNITECT/ENGIN[ER:
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
L_L 1--I
LICENSED CONTRACTOR'S DECLARATION
Job Description
l hereby affirm that l am licensed under provisions of Chapter 9(commueing
REROOF
with Section ]000) of Division 3 Nine Business and Professions Code, and my liana
is in full to
f�
Lie. st
License Cl. Lim. tr
Date r
ARCH ll be used aspublDECLARATION
• 1 understand my phos shall be uud public
'f
U 1, I L 2002
Licensed Professional
. OWNER -BUILDER DECLARATION
1 hereby affirm Nm I am exempt from the Contractor's License Law for the
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following reason. (Section 7031.5, Business and Professions Cade: Any city or county
$11700
which rcquims a permit m construct. alte, improve, demolish, or repair any neacturc
_ prior to its issuance, also lrquhes the applicant for such permit o file a signed slow mem
derne i¢ licensed pumwmto the pQ visions of the Comracrors License LawlChaptu9
VSecdon7dWl,
�"j /(`��F[ �aI ree..��a, f T.r•, .,., Valuation
(commencing,isOh fnivision3ofthe Barir�cssand Profersimu Codcll
or thal'he 5's exempt therBioin and the basis for the als 1pol exempij,m. Any violation
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-of Section 70J I:5 by any applicant for is permit exispse the applicant m a civil pendsy
PIRIpl
'I"':; r. .: Occupancy Type
ofnot mnrc than Eve him aohars S".). -
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(
❑I as ms net of the propeny or my employees with wages'her, sale,..Iran.
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t
_
601 - ROOF TEAH&gf2Tf2R' Inspections
do the work:'And the structure is not intended or Offered mr ime (See: 7N.
.will
Business and Profen. ons Code: The Contractor s License Law does nen apply to an
owner or property Who Hailes or improves thereon, and who does such work himself
602 - ROOF PLYWOOD NAIL
or through h' employees, P J d nt h improvements t' tended or
' "ymor
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offered - le If. er'theoildingprovemenr sold -thin de
— ROOF BATTENSoff
ioi pl the a bu Id 'll have the burden of proving that he did not build or
604 — ROOF IN—PROGRESS
mprove br purpose of. le ).
_.... -----..._..__.-..
.co1.esownerofshepmpe.7 am exclusively licensed
_.. _.— --.. ... i....4!71.rr
And Profession,
ro omen the (Sec. 7001. Business and Professions Code:) The Contheror's
pi . �r, ," .,. ,
License Law docs not apply to aj owner of pmpcny, who builds se improves thereon.'
does n
and who contracts. (or auch.pmjecb with acontta<ror(s),Iicensea.Pursuum.to.me
_.. . .. .... .. . .... _. _ _....._ ._. _ __ ._......__.._._J.___.._..�_.-._____. _.. _.-... .._. _.__... _ ... _
Contractors License Law.. 1 i P _ .1
❑ 1 am exempt under'Sec, • :11 &'P C for this reason
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Owner WORKERS. COMPENSATION DECLARATION
rL a M1> n /nl 0
Y I hereby Aron under. pxhahy of peijury one of the following declarations:
❑ 1 heve'hnd will maimain'u Cellioi'Consem to selGinsum for Worker's
OCT 3 1 2002
Compensation. as, provided -for -by Section 3700 of the Labor Code, for the
1perfniounce of the work for which this permit is issued. t -
�py+,��heve and will maintain Worker'i Compensation Insum iN, as required by Section
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g700 of the labor Code, for We performance of me week for which this permit is
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issued, MY Worker's C pe . t insurance carder and Policy o be are
A S Z S
policy N
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( CERTIFICATION OP' EXEMION FROST WORKERS„
�- COMPENSATION INSURANCES !.
(Tb s union need not be aimpined if sM1e perm t is for one hundred dollar
......... ........_. _ .. _.._ __.._..... . ...._._..._. _.. __._.._ �.-�-.....,..-...
` . _ �, it 1 ]�,• f '. (17
(SIPao •gr less.)..-
:. 1 mfythdt in the performance'of th k foi iidthkii this pi t -i cls
shall not employ any person in Any manner is to necome subject to the Workers
Compensation Laws' or c 1 f m -. DalS
' ..
.Applct : ..
. NOTICE TO APPLICANT K. ager makigthis Cmlmam"f Exemption, you should,
.. ._.. ..... _.__. .. _.. .. _.
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become subject to the Werker's Compensation provisions of the Tabor Code, you must.
� forthwith comply with such pmvisiom or this pcnnit shall be deemed revoke].
i s CONSTRUCIONLENDINGAGENGY
1 Acmtiy affirm thus perm is conste lending agency forme perfoimi n x,
issued
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,
con
s Se
s 'of Ne work for which thin permit is
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) L ria r Narrou..
I /I
Lendc s', s -
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oA
1 that c deo PPI t d imethatthe no ei f t s
<omect I eo ply with all city J ounty ordinances and sac laws ai ng
m g eme... inner
noserly rchyaminionpeposenhiives df this city to enter upon
.1bovegcuntooned
[ she,ho(We)agree
pmpenyfor inspectionphamile
1. against
(We) agree ls save; indemnify ane keep ham y in the City of coo, a against
] liabilities,j dgman i J expense which Y in any Y carve against said
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Cry quem nn gm s f th peons " -
;APPLICANT UNULRSTA4U j WILL C ",PLY W�I'1II ALL N0O T
Issued by Date
SOURCC REGULATION ! �Z
Re -roofs
kSignature bl;ApplicdMCom actor,: ,,, .5 Date •
,1 .'HAZARDOUS MATERIALS DISCLOSURE
lull dr app] t Imre lbmld goccp urea handl M1 rdoun ream],
-Type ROOF ..-.. ------- .-...
as defined by the Cipiarmo Municipal Code, Chapter 9 Li d the Health and S fray
CddeSection
❑Yds 255340) IClel!, s vh'
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f, u¢I "I.¢ yl.
All roofs shall be.inspected prior to to material,bemg installed.._,
devices
Will she app] ver future build g c pant se c9 pm m d
If a roof is installed without first obtaining an inspection'; -I agree to'remove
ement
< t h,avdoos Air coni rot a t a derined by 1h Ba Are,, A r Q.41, Management
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all new materials for inspection. Applicant understands and will comply, with
all non -point source reg'] ahon's.
u' 1 brioc rend the hnz dua, m, terials rcipurcontanus under Chapter 695 of the
�Califorma Health & S fesy Code. Sections 25505 2553] and 25536 1 und...w.d that
if Ne buJtlmg down t cuorcutly have at ant thatit smy po blrymnbiifY the
he oil I. once of dries c of
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-
oc< p m of the icquinemorm, vshM, mail poor
°q` pan `it�^ Q
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- Signature _of Applicant -
.. - .
All roof coverings robe Class "B" or better
i ,owners aea crit '�✓�� - '. •�
am"rie
-OFFICE _ ...... _ ._.. ..._. .... _ _..
- -
Building Division
10300 Torre Avenue
Cupertino, CA 95014-3255
Telephone: (408) 777-3228
Fax: (408) 777-3333
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/a" 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:
Address:
`%
'Applicants Signature: T)atp. r
W/o
Joe Antonucci
(Chief Building Official)
6/25/01