02060108 CITY rDVOND
IiSIiNPERMIT CONTRACTOR INF0=710N-
BUILDING
TION-BUILDING ADDRESS: PERMIT NO.
11209 STAUFFER LN OLD COUNTRY ROOFING 02060108
OWNER'S NAME: APPLICATION SUB DATE
IGNACIO TEVIS AND CONNIE M 125-B GROBRIC CT 06/18/2002
PHONE: (707) 864-5557 SANITARY NO. CONTROL NO.
O O ARCHITEC(ENGINEER: BUILDING PERMIT INFO
p,— BLDG ELECT PLUMB MECH
a Z ' IJ
8 N
Z Zw LICENSED CONTRSDECLARATION Job Description
°z_° herebya n
rtthalemlittudunderundernprovisions ofChapter 91<ommcrcing REROOF
P,��; with section]000)ofDivision Jof Ne Busin�asand Professions Code.and myli<ense
�a s ^^ul�f`"ndc `. Lim/ / T/0 1 LAYER STD WT TILE, INSTALL 30# FELT'
°�U Dat[ S" cp^atu, & MONIER STD WT TILE ICBG 2656
3a CHITECr'S DEC Tlo
e
Z"o 5 ,/— 1 understand my plans shell be used as public records
c
p O Licensed Professional
°•o LL Oat I am exempt
train
DECLARATION
=' I hereby alarm that 1 vat exempt rmm the Contractor's License Law for the
F Z< following reason,(Section 7011.5,Business and Prolessions Code:Any city or county
f F° which requires a permit to construct.alter,improve.demolish,or repair any structure,
u°'j 3 ec._prior to its issuance,also requires ire applicant for such pcmtit to file a s post statement
that he iq Ocenced punuhmwo the provisions of she Contractors License Law(Chapter 9 SPF $
,t Floor.Are luation
(commrnun8 with Seciion,71i(A)of Division 3 of the Business ani Professions Code)
C'`f 4."4 S•1;:k. 'p. 19 0 fY®
or that he Is exempt therefrom ani Ne basis for the sllejed ctemptinh.Any violation
of section 7031.5 by any oppliam fore pormit ubjecur the applicam toe civil penalty
of not tons:than eve hundred do[ars(S500). t Occupancy Type
❑I,as owner of,hc pro,ert,ser or,employees with wages as their sole compensation.
will do nese a dor:an odestruTie n no,tortou Liceor nse
arc -to,e sale'( ec:- - -- -"will
and Professions Cade:The Commnor's License Law does not apply to an 305 - FRAME Required Inspections" • :r " ,
owner or property Who builds or improves thereon,and who does such work himself 307 - INSULATION
or through his own employee,,provided that such improvemems arc not intended or
"aff red forsac.'If,however'Ne building o _p o tis sold with n one year of - ROOF TEAR OFF
F
_ . . - ... ....{;. .__-_.. .. ...
'completion.the owner-builder will have the burden of proving that he did not build or 603: ••• � "
improve for purpose ofsaleh 602 - ROOF PLYWOOD NAIL
_ r-o .. -'-------- - _... __.. __. _ .... ..__... —.-.... ._.
pl,ieowner orjce propcnyem esdusively<oPrxlisin,Cote:)he Coucmrsto 6'03"'"-'ROOF" BATTENS
Licenser the does
(sea.7oaa,Busters and Profusion tate:)Theves theme, 604 — ROOF IN—PROGRESS ' u' 1.1•.. ^-...
License Law docs not apply wan owner of property who builds or improves thereon,
.and who Commerce,License Low ch.projecu,with.a commdor(s)Jicensed purnaant w Ne _.-... .........
01..eLicense law;
- ❑lam exempt under Sect. �' ".BA PCfor this reason
owner - WORKER'S COMPENSATION DECLARATION
5 Iheathy.ffirmunderpemltyofperjuryomeof,N folloingdeclmtions: NOV
❑ I have and will maintain a Cenifcate of Consent to self-insure for Worker's NOV
1 L� 2002
Compensation, as provided for by Section 37W of the Labor Code. for tha
]� performance of the wordd rwhich Nis permit is is sued. ��B��pS5^yy
❑1 have and will maintain.Worker's Compensation Insurance,as required by Section MG
1700 of the'Labor CCdc,for the perfotrmnce of the work for which this pennit'is
.. issued MY Cmr,mrimimihiet eam<r and POLCY numhe� e _ y _...._.�...._ _.�._�..
er C]1RTIFICATIONOFEXEM"1ON OM WORKERSi � ��� t lj..1 , ,Alt js'S yt �I f�s Hr'{{ °w QJ•w`�; II
' CObIPENSA.TION INSURANCE'• 'a= "
''(This iec:lod-need not No cmurdered if the permit is for one hundred dollars -
ISI00)orless.) -
'I c that Ne .
Permit issued,
olemploy arty per:rain' Y a t bton ubJ t ithe Workers'Comok...tomLws of California.Dat
Applicant
,.
I NOTICE TO APPLICANT:If,after making this Cenificatc or Esemption.you Mould
recount,
recomsubject to the Workers Compensation provisions,of the Labor Code,you must
Q 0 forthwith comply with tami
ch provisions or this pert shall a dem
eed revoked.
it . CONSTRUCTIONLENDING AGENCY'
a � 1 hereby affirmthat thememerc is isw cunnmminn lending ugcncy for the performance
W.r of the work for which this'permit iiissucd(Seca09].Civ.C.) _
Lcmlcr'n Name.. -• _.... ,._ __.__ .. .. .__._ _ _ _ _- .-....-.. ..._ __ .. . . .. _ ._..._ .. .\
Z;) Z Lenders Address - t, "r..t ..
V QI certify that 1 have read this arplicariodrmJ state that theab"ve infarmxtian Is
W E. Correct.I agree to comply with.11 city and county ordinances and state laws relating
� O to building construction.and hereby omhorize icpresemsoves of Nis city to enter upon
the b e t sed Cr Ce ty f rop=er p Hi u.
(Wel g 'to a ie -tfy milk p Isf rhe Cly FC porno uga n.a
N Cit ITC. j 06 en t a d expense h yin any y gainst smA
V z City con. q cc of man'F n
APPLICANT DE T S' W COMPLYWITHALLNON-P yr Issuedb (J Date
- sooRGE R :>' Y:
sigmt of APPlim 'anImctor " rot Re-roofs /.
Cod Sect on 35SPO TERIALS DISCLOSURE
AZARDOUS MA
611y. Clic torfuroreNW gat pant.i,10 handle hbarlth senate al Type of Roof. _. ,.. ..._. ....__.. . -._.._.._ ,.
a.
defined by N Cupttt Mp I sJ Chapter9.11 d the Health d Safety
❑Y 1 t/lps�✓� i it"sI i
All roofs shall be Inspected prior to any r ofing,matenal being installed.
With oCpIi to I tar 1, Id g pant use equipmento,de.ce. htrn If a roof is installed without first obt• m an inspection, Ii agree to remove
t h b au cot is d b the Bay Area A' Quality Management
�District' all new materials for _spection, pl pt understands and will comply wi h
°r
all non-point so regulation .
1 bats,read th za ous materials regwr is under Chapter 6.95 or he
/ Jf
California Health fery(,bile.sections 5505 SJJ ani 1553q.l undmtand that
-Il Ne building, em ntlY have aril is my responsibility to notify the
'- --
ci'cupant of t ui,c i tv'which ni 0 prior w o,umc[of a Ce..fie of
G""p""`y. Sig ore of a Dat
• ''' ortiod, - nt - - ate All roof coverings to be Class"B" or better "
OFFICE- - - — -. - -
Building Division
10300 Torre Avenue
,1 Cupertino,CA 95014-3255
4 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 V4"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: C 0,4JA)f �� I 6,'V P1 c.l o
Address: _ I oma? `j S r a (A 4 t;jNc%
Reroofing Company Name: L ` GO A i 00r= l n)G
Applicants Signature: Date: G- / ? - a�
Joe Antonucci
(Chief Building Official)
6/25/01