01110059 (2) OF
CITY ILDI C DIIVISIONNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO.
11544 EVENING SPRING CT OLD COUNTRY ROOFING 0 110059
OWNER'S NAME: APPLICATION SUB DATE
JJAKAU
KENNETH D 38 UMBARGER RD #B 11/13/2001 ONE SANITARY NO. CONTROL NO.
f
(4)8) 362-1111
O O ARCHITEC 'ENGINEER: BUILDING PERMIT INFO
m- BLDG ELECT PLUMB MECH
I I L__J ___I
z LICENSED CONTRACTOR'S DECLARATION I Job Description
r Z I herehy affirm emt 1 am licensed under provisions of Chapter 9(commencing P
rn 1-m w'im Section 70x0 of Division 3 onhe Business and Profe,siom Code.and my nomo, REROOF
y f= i,in rml rpr< B� 2 '7
!m0 u License Li;c x
0 a u Dam Contractor
a. ARCHITECT'S DECLAIA N
I understand my plans shall be sued as public records
>$
I p C Licensed Profnsi°wl
z
OWNER BUILDER DECLARATION
'Lr a 1 hereby affect that 1 am exempt from the C°sions C s License Law for the
tg< whluwmgrceumPermit t mss.Busmen,and Professionshoar:Any tar or county
e $4800
ye,'t a which its requires a permit re construct.aslier.pplicant
improves demolish,or mash any structure
T1i3x Illhoslissuance.also omen:to he pro,nmose for Craniuch um,
Licensle ae Law
smmmcm
- thatbeOn"n,withSeuantmmepmH,mnsonncCeBasia,,andnmLawmasCor9 Ft. F1oorArea --- -- --.----._. '
"arpni isc s ithsea nlrxn of.O i' 3 nn U ' cs: JProf Code) 366520300 � -- - -"' Valuation--�--------
o m rhd'.exempt That f dth bi r th II g dcx mala Any 'olation kf'} r`�'}'�?,l l`"f'f�s7: £'v'�,x(>'14'4'i s��SG Ir ,
ecT i0ll5b a' licam fora 'T tab en rh It.intro sues - a a
0
Y Y app a 1 app pemlry
or nor m ren weadonm,(ssm) - -__.. -.._. 305-.__..gR ,y�PN"Number— -'--_.--� .. . ' -- _.._"Occupancy"Type..
❑i�muwnertt the t.orm employees were.as their sole compensation, 307 - INSULATION j'' +"list'
proper Y Y emP Y 6 pe
will do the work.and the,wcmr<i,not intended or offered for,ale(Sec*
70oa, 6 01. -..ROOF._TEAR_.OFF_-.—Required
--owner o ana Pri Wion,hose:Tse timer thereon.and law due,not apply melt -- Inspections-----------"-- - -
ownerughhisown emho ployees
or improversuchimprovements
whodoessuch work Motored
602 - ROOF PLYWOOD NAILor through his own employees.provided that such improvements arc nes line yes,or
offered for sale.w however,the builwill
have t m improvement is what he did one year of 603 - ROOF BATTENS
-completion:the ower-builder will Haut the burden of proving that he ria not Wild or ---—...... -------- -
iinproderorpurposenrsale.l. 604 - ROOF IN-PROGRESS "''ITAs.° T`. so•rrK'� "
❑1.as owner of The
- ' popcnY exclusivelycontracting ith licensedcontractors to
construct a(S '7 BfitsvinciXad-P f �Cad )The
Linc sc law does dfaapply roan owner with
prapcny who ce s ...thereon.
Co rano comrazts for such Projects with a comraaogs)licensed pursuam m he
l. ,
Conuactors License taw
❑Ia sempT under Sec' ,B&PCt°nGiircaon
i'
X. Owner
WORKER'S COMPENSATION DECLARATION' �• BUILDING
T '-Ihereb,.Ifm:urder Penaltyrd' jury one of the following declaetions:
I have and will maintain a Cmificute'of Conxnr'io selGinsure for Worker's
•Ff�.>J_ Compensation, as'Provided for by Section'378'of the Labor Cade, for the
pcdomm ser of the work for which his permit is issued. . .
have and will maintain Workch Compensation Insurance,as required by Section
](p of rhe Iab°r Cade f rh pofbrmanc -f The work fee which This peman is
uM M Worker, pe r umne andP licy- mbe-
.i
Cam P ror No l.k)t'_1- —
CERTIFICATIONOFEXEMPTIONFROMWORKERS
4'1 t r i a v 9 COMPENSATION INSURANCE \s•
r
r
• (Th xeiamed nothe'completed fh pvmN is for air hundred dollart '. '. [a'" -s 's" },J ins L'kI 7l ii4 j. ._..__ _
i`+t I certify Ih in the peiformaTme of me work for which his . :.s
— -
- - . ' '' miasucdl.t
shall Yemploy Y K any e m t become by heWokrrs
.. -
Compo ton Law fClr Dere', .r e... .
APPlc tri- .:. \,,I + .,. . .—.._ ..
-
r.11 .. - .. .
NOTICE TOAPPLICANP If after kmF h C nifteare of Exe pf ,yin should
subject t rhe Will.Compenxotio p ons of the labor Coda you m .t
war Comply Thsch ror .n or thi
Q o PY p .perm shall tied drc�okcd.s
Q loon
FCthereby
CON STRUCnoLENDING AGENCY
there
*
That rh e oconstructionlending agency for.The Roanvoce
("The orkf hen hspcmit ul lSe 7097 Civ.C. _ s om. .:
S Leedars Narnees-'i+% -
er'sAddrev r : s is pe _
ierrifyrhm 1 he rcatl hu ir
plic.lionard voin,that he lbover.fimitation is "'---
�v+ (Z) n 1 aF:e<to c ply eh all TY id ou rY din a d T T 1 s 1 ung i)C l•l + -
YJ,. mbuild nF art cf dhe eby +h I p e t t fth Tyro
or,open ry Th b ar t ' d ObPcny f pe T d p rye T t , I n
[r LIW) F r d fy ndk phartnl Th Cly fCUPen oegainsr
h 1 b'IT 3 dg m e u M pe s h h 9Y ny'w y ensu gamest .id
V Z. c T r
APPI[44YT UN{>E fTh F SAND WILLc MPLh IVITH ALL ON POINTv'•
SOURCEREGULA of I .i. ' I + ate l�� `Jr- Issued by: Dale
sigoemm orwpp�¢,nVcomrz or 'T� —f/1 �O) Re-roofs
= c Te •
...I li..:..v :'.HAZARDOUS MATERIALS DISCLOSURE's.p: e-J' v :. �
' ^'.Will me upplichm or furore building xcupam giore or haikle nazardous material, Type Of ROOF
as defined byhhe Clipenino Municipal Code;Chapier 9:1],"end The H<ahh and Safety'
Code. yes:.' (al^
All roofs sball;be lnspected.prlor to ariy roo5ng.material.being.rnstalled._.�.__.._....
r`Will the air < i r.,a,"°b'la'g cpm e q p t rd 8 n p r If a-roof tsanstalled without first-obtaining an inspection I agree to remove
th meso o I ane asdf dby Th oyn A Q IT Mna i"
-'"-" ° ` ` r< _ ' ` all new materials for.inSpec[ion. Applicant understands and wilLcorq 3"wnh_-
all non pomf source regulations.
1 h e lt d The h z does mares l rcq rem r tl Chapter a 95 ofrh _ .._.. _
California Health&Safety Cad Secured,25505 25537 and 25531 1 ❑rstand Tn i —
ifheliold'ngem a umN which
most
be, mar T .mY c?po bltyT ufy The' _ �' t'•I a ill- q•,t. - 1, �3
OC apps Tc yf m;r.T,., u tits mbrbe ezp m c< f $'of to of fff ; Q,..
,t ' e� ' * 'r+ V'604 + / ' Signature of Applicant- _.Date
owne uhonim ugenrI- x I All roof coverings to be Class "B" or better
Ir
" OFFICE -
,. '.W: ..;ata.. :mdi ,
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/"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: lC—ely�
Address: PS, C/ G SM G
Reroofing Company Name: 0(r.f'
Applicants Signature: Date: 111115101
i
Joe Antonucci
(Chief Building Official)
6/25/01