02080049_ :,... ... ,.. . � ........ . _.....OFFICE -.
'CIBUDINGmy SIONIL
CONTRACTOR INFORMATION:
SIPERMIT
BUILDING ADDRESS,
PERMIT NO.
,11872 PLACER SPRING CT
OLD COUNTRY ROOFING
02080049
OWNER'S NAME:
PHIL DICKINSON
125—B GROBRIC CT
APPLICATION SUB DATE
08/09/2002
PHONE:
(707)864-5557
SANITARY NO. CONTROL NO.
Z
ARCHITECTIENGINEER:
BUILDING PERMIT INFO
O
BLDG ELECT PLUMB MECH
n
b LICENSED CONTRACTOR'S DECLARATION
- Job DCSCITphOn
o
I hereby under siofsof Chapter 9
REROOF
,.J
sionsCiacommencing
ction7")ran:haln3oftheBusinesandensed
Silt Scnion]:lOq of Division Jof the Business and ProtasionsCwc. and myli<ense
mfull fare ea
U
License Lic. N
Dam Cbmmc
ARCHITECT'S UF,CLA ATION
' 1 tioderctand my Dims shall be used as public records
OLicensed Professional
OWNER -BUILDER DECLARATION
<
' 1 hereby affirm that 1 oto exempt from the Contractor's License Law fm the
following reason. (Section 7031.5. Business and Professions Cede: Any city or county
$20000
O
which requires a pemlit to con.wct, alter, improve, demolish, or repair any xuunum
es
prior to my issuance; also acquies:he applicant for such Permit to rile a ,signed statement.
r -p asn
5 0�d V[Fj
, Valuation
- tM,he'RlicrnfedWounnumdine prevismns of rhe Contractors License law(Chapter9j
b"Ilkf Enh Pram"ons Code)
(co Scene. 7fX10) of Division 3 ofthe Business..
{: (�;.;''�•i3 ., a,-'AT1011;
'
,
INei 1. 11exempt ,h�rcfrom ani( the basis far the alleged aemmipriuh. Any violation
-of Section ", I.5 by any up,lamm for a permit smblecu the it"her at to o civil penalty
tip
if ',:' "•„ Occupancy Type
bitter marc than rive hundred dell. (s5013).
3 0 5APN AIME
111: bthedror mY employees enon for lecompenmrion,
-
601 - ROOF TEPAPqQffInspec[ionsl .• ., .: :
ded or offered
work. and the ade:The is intendedaLaw Yoe sale (See. ]O.W.
will cl .and the structure
`Bmlimu and Professions ewe: The centra<ter N License law a«a not apply to an
Business a
mvrmr of progeny Who Wilds or improvestharem, and who does such work himself
IL
602 — ROOF PLYWOOD NAIL
or through his own employees. provided that such improvements art not intended m
...of
- - - � � � -...__ _
offered forsale:If. however, the building-'"" "- et is sold wirhiii me
burdn of
A
603 - BATTENS `
ROOF
I cbmpletion, the oymantui(der will have te proving that he did not build or
604 ROOF IN
impryermrpamllmm'sld.r,
- -PROGRESS
_.eko,asctthe
o11hc rt am eanhasivd trofess it
PmPe r rens Swm
.. ...... .. ....
.m'... :.. ,
_
Business and Professions Cbaca The Contractor's
onswa the project.iSce.appl eamn.
, q .;, „ t ,
to a property who builds improves th t
License Law dace not apply won owner
!. ..and
h s t to e
whgcs fLa mCh,Pmlats.with a, conuanor(s) licensed. pursuant to the.
_. __. ... . ..... ........:. '......_..... .... _. _.._ .._.-_.____.___ .. ...._ _____ _ _..._...... .....
-------
_- -- -
_
Livens.
Contractor's License Law.,
Ol am exempt under Sec:' :B &'PCfar Nis reason
. •
I� qq p���L�_� s'•:':{'l:i�d
lC— N"V. tela "� 1=l
OwnZ.h •' r' Data '•
-: WORKER'S COMPENSATION DECLARATION
W;ebyor. under penalty nfp;ryone bfthe following declarations:
DEC 0 9 2002
Cl I have,ad will maintain' a Cenlfcam of'Conscnt'm .self -insure for Worker's
Compsnimon,-as provided -[or by Section -37W of the Labor Code. for rhe.
'peifomwnce of the work for which this parmit is ivsaed.
"..I ,. .
y g'y p�/±
B1.JiivUiu'E Vl
`-
.
1 have and will maintain Worker's Compensation Insdmncc: as required by Section
A]Bn of the Labor Coate, fur the phformonce of the work for which this permit is
._
:'
:s seed MY Work r" conpL i c an Id Policy be nyeC.
j
a Policy
,?CERTIE GT EMPTION FROM WORKERS;
S •.. s ..-.. { ,•1. „( ,1,4 Pm C:, s }. .4.
COMPENSATION INSURANCE .... _
...
- __ ....___.._...___._-._ "-•- _- _ _ �..._....., ..
..! •_,.." - ....
.. ...... ....`
"' `.I' :; ,. II; 'D�C� 1y
...
(ITii section neeJ norbe'complcred ifthe Permit is for one hundred dollars
�—
S00)or leash .:... ,. .,.
.,• .... ....:. r_ v_..:a ._:-_ -_.._..
a 11octafy Jtxt fl pc formance or the work for which this yarmit is isaucd, I
"shall nor employ any person in any manner site as'at become sub), to the Workers
Compensation Laws of California. Date '
. APPlieant
NOTICETOAPPLICAN'D If, aper making this Certificate of Exemption, you should
- -'
Z
a provision, of the L.W, Code, Yama,,"
'with.
froults, kh comply a'h provision, or this p ran 11 shall be deemed revoked
''CONSTRUCTION LENDING AGENCY
this, ,h re is can wcfen agermy for rhe perfonwmc
which s 097,0
oftheName which this, permnis iisued (Sec. l09], Co. C.) -
.. _._.._ ... .......... _._. .... .... _._ ._.
Q.lid`
Z
iN me ..._. -. .. _..... _.....
'L nJ s,Addressapt',
.___. .._.. .. ..._
r.. 'lull m;,i•
0
certify that 1 hove read this opplica,inmi and state that above mo minion is
E.,
ua'onttm: l agree to comply, with all city and county ordinances and state laws relating
T,
to Wilding construction. and hamby nmhurimrepmsentankex'sif Nis city to enter upon
W
the above-martioned property for inspection purposes. ..
iL
1pXe g 'to demify and keep h less the City fCpertino against
V1
iz
liabilities jid,atems. a ad expenses whieh mayinany wasacersaF against old
ie
m
City 9 fah g t ,of thi Pe m
UND
WL,IU OV. -LY WITH ALL NO" '(3�
v l✓
Issued by: ate
SOURCE REULATIONSYD
SOURCENT
TIONS.
Re -roofs
Signaturcof ApplicammCmnr or. " gm' ..
' t HAZARDOUS MATERIALS DISCLOSURE
.'Will the nlr fitoom Waldg cent staxorhndl h'Nus masnal
.Type of ROOF ._. .� _ __...._. ... ..,. ..m....,„. .. ,.
-
,pplc
a def 4 by 'heCupertinoMunicipal Cod Chapter 9 l2 d the Health and Safety
'Cod
- a
u N
... .; .art ran
S uan 25532 1 J s 1. L.
I",' f 1Y t l °t �.
S
a
1' 4 ,,. )
roofs sh511 be inspected pnor,to.any material, being installed..
-.1-4 :, :.'
Will meapphc t ter buildingoccup antuse equipment or devices which
_rooffng
If a roof is installed'without first obtaining an inspection;-I'agree to'remove
trait bd wire m t. definedby rh Bay Arc A Quality Mm g m
D
all new materials for inspection Applicant understands and, will comply with
s, ct ��
", oY a
all
non -point source regulations , ,,,
L hive read the hazardous materials requireenm under Chapter 6.95 of the
California Health & Safety Code, Semiuns 25505. 25533 am125534. 1 undeman l Wt
_ - ., . - -, - _ .D 2
if,da, Wilding d no, currend have , r th , t is my responsibility to n l fy t
do up ns of rhe esp rem` t. hath must W t poor to a t a n ate of
'
O`Gara” y
Signature of Applicant Date
All roof coverings to be Class "B" or better
-
Own umhonxe gem Dane.
_ :,... ... ,.. . � ........ . _.....OFFICE -.
r
CITY&O
:UPEkTINO
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 YV 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: /112v� '
Reroofing Company Name: i
Applicants�—• /
�Joe Antonucci
(Chief Building Official)
6/25/01