01110097 CITY OF CUPERTINO
BUDDING DIVISION PERMIT CONTRACTOR INFORMATION:
` BUILDING ADDRESS: PERMIT NO.
11578 RAINTREE SPRING CT OLD COUNTRY ROOFING 01110097
OWNER'S NAME: APPLICATION SUB DATE
FAN LIN 387 UMBARGER RD #B 11/20/2001
/ HONE: (408) 362-1111 SANITARY NO. CONTROL NO.
1
il)O O ARCHITECT`ENGINEER: BUILDING PERMIT INFO
U LDG ELECT PLUMB MECH
y a i C7 L--.J LJ
LICENSED CONTRACTOR'S DECLARATION
z ln 1 hereby affirm that I am licensed miner provisions of Chapter 9 feco m ose-9 Job Descripti ❑
wt-to with Section 7")of Di,ision3of the Business tuaProfession,Code.anamy'kenu T/O SHAKES, ADD MONIER LIFELITE "CEDARLIT
is in full farce and 12
=tz ¢ Licrosc�}a.� l Lic.n 7 3
3au Dae //!J-] _ SConn.'aDECA
ARCHITECT'S DECLARA ON
-y,O ' 1 undcrntand my plans shall be used as public mconls
i to
iO O Liccmcd Professorial
m OWNER BUILDER DECLARATION
1 hereby¢flim,that 1 am exempt from the Contractor's License Law far the
fiav,
C at< which requires
permit
]BELS,Business and improve,
den voli Caic:Any city amply
ante $11000 ai s G which requires n permit m con s,he Ater.improve,demolish or rtWig any structure Y 11 0 0 0
i3= prior to nsissunnc�ueso rcquirtsvea Ticum for meM1 nofilcasi ed stnlperm tValUa[IOn
mi get
Ihm heir licensed it io m the rov ivisi of Ne dic mitDust.. Rrdl P Low(Chapter9
(e that beds atiirh,5eenon]orarid Divisions In..Business.a Professions Coda '. ?'•• � l'3 OD��4 V4-b�:�U U.+..i!.�,' .i s
or thus tic is csempl tang. m'nnd he basis for IM1e alleged alemption.Any violation
'of Section than five
hundred
danl for a petrnit subjens Ibe npplicmt to a civil pcmtlry
or nor m.re mm five nanarca sonars($slw). 3 0�PN Nis,IE Occupancy Type
❑1,to, he,of m:propeny,or no,employees with wages as their sole compensation.
will daM1c work,and the ode Th h'nm intended or offered for awn(Scaapps too an 6 01 — ROOF TF*R �I P
Business and work.
and the
Calc The Co our
d or law dor aleRon apply en ❑ s eetions
tRIthr of pmpcny Who builds or improve,thereon,and who does such work himself
rough hos awn employeesprovidedbarsuch improvemepn are not lmalwed a .._.. 6.02 -__. ROOF PLYWOOD NAI_L
offered far If,how Ina building at improveIs sow withinyaar of -
completion,meownerbld will have the buNcn or proving that he did not build or 603 — ROOF BATTENS
improve for parpe,enfsale.). 604 - ROOF I_N-PROGRESS
pl:euct die project
p(Secny,am eulusimand mractingwith licensed conuactors to �.a �®
construct me projcm ISec.9014,Busintss and Professtom Cade)The CoOaR�t� ` t ,I
License Law d«x nil apply men owner th pro omm woo builds.r improves]Ircr� '
f. and who contmnse Li such projects with.a camrmol(s)licmsed.pursumt to the
Conunn.rs License law..
❑I amcwmpt under Sec. _ .BS P C far this roa�il B 0 8 2002 �. �';:I .
Own Dam
WORKER-SCOMPF,NSATION DECLARATION 9 N
ee l het<ay affirm mote,penalty of perjury one of the following tledaruions: 1J ILDIN®
O 1 have and will maintain a Ccnificate of Consent or s.Jf-insure for Worker's
Compensation, as provided for by Section 3700 of the L'dor Code, for the
performance of the woa for which this permit is issued.
1 have and will maintain Workers Compensmion Insurance,as required by Section
-- 7700 of the Labor Cade.for the performance of than work for which this permit is
issued.My pc turner and Policy number am: "
rAer's Com mon Insurance cam
..
C17RTIRCATION INSURANCE
FROM WOR sy 1 .- t '•s ss,. is-jl�;
COMPENSATION INSURANCE •;' '
..., -(Tris union need not b:completed if the permit is for one hundred dollars ' 1i
(EI00)or less.) _,
. I c<nify that in the p rrormatae of he work fir which this permit id issued,I . .. .. .- •_.•.-.•.- .• — t.I - t 't ~.
;hall ooi employ any'Person in any manner m Is to become subject to the Worker;
Compensation Laws of Califomia.Dam
Applicant
NOTICE TO APPLICANT:If,after making this Certificate orE moo you should
men ` -
become subject to the Workers Compmtom provisions of the labor Code,you must
Q forthwith comply with such provisions or this permit shall be deemed revoked.
. _ - _ ... . .. . _ _.. . - _ - ------ ._. __. _ .-__ ... _
-I' ' •'•''' 'CONSTRUCTION LENDING AGENCY
:o •• that
them
sinc� a )y..for
.th,e.pe,H-.
.r.mance
'of the work fwhi thspermitis ses-(SeW.CivC..Under',Nom -.-- •.•:- e. .. .
I-
t:Z
lender's Address"
„
V0 1 certify that I have read this vpplicirtion and Hale that the above information is
It'F snot 1 agree to comply with all city and county ordinances and state laws relating
O:p t.building construction,and hereby authonzc rcVreocnatives ofthis city to enter upon
the aso,onerlioned property form,pemion proposea. ..
F„ t1 IWc)agree to sine,indemnify and keep harmless the City of CuNnino eoomf
W liabilities,judgments,costs and expenses which may in any way seem:against mid
UZ City in consequence or IM1e griming or this permit. '
SOURCANT UL-An yl�flS AND WILLC PLY N'ffH'ALL NO PoIN
SOURCE REGUTATI(�' \l „/� y'� Issued by: Date
Signamrt o/Applicant lar ' ['Data/• Re-roofs
HAZARDOUS MATERIALS DISCLOSURE
- Will the applicant or Form building occupant stoic in handle hmaMous material Type of Roof -- - -•-- - _ - -- - -
-- as defined by,the Cupertino Municipal Cade.Chapter 9.12.and the Hohn end Safety -
Code.Set:lmn25S32(e)".:. •, T: r I: I ; �'
❑Yea ' .lJ?�t All roofs shall be,inspected prior.to.any roofing material being installed.
Will the appli' nr future building occupant me equipment or devices which If a roof is installed without first obtaining an inspection;I agree to'remove
emit hazaNOYi air mnmminams os'dcfm<d by the Bey Arta Air Quility Management
AnkDisbic I .. all new materials for inspection. Applicant understands and will comply with
(( °Yes .. all non-point source regulations.
'1 hada sod the'hazardoas materials requirements'under'Chapter 6.95 of the
Calif Huldi&Spfin,Cod1:S,ali.r125505.25533andI255341 tandersatiouldirrit
if the building does not Ctionaffily have a Reason.that it y rasp.anbl ty to notify the
scups t of the quire is m h mon be t p'
'oil f Ce fiw¢ f f -
Occupancy
!/ 4 Signature 4Applicant -- Date
Cooper reumonv DoleAll roof coverings to be Class "B" or.better
-. OFFICE
IBuilding Division
' 10300 Tone Avenue
Cupertino,CA 95014-3255
Telephone: (408)777-3228
* CITY OF Fax: (408)777-3333
UPEkTINO
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/" 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: :Ja"� Lt--�
Address: `l S ? /�a-H+� //z.u� s
� r
Reroofing Company Name:��LoC -oQu�v�C� 1�ut �
Applicants Signature: Date: �� ; o/
Joe Antonucci
(Chief Building Official)
6/25/01