01090096 (2) ? CITYILDING nmBioNNOPERMIT CONTRACTOR INFORMATION:
BUILDING ADDRESS: PERMIT NO,
11554 EVENING SPRING CT OLD COUNTRY ROOFING 01090096
OWNER'S NAME: APPLICATION SUB DATE
MATTSON 387 UMBARGER RD #B 09/21/2001
HONE: SANITARY NO. CONTROL NO.
(408) 362-1111
�0 0 ARCHITEC iIINGINEER: BUILDING PERMIT INFO
FF BLDG ELECT PLUMB MECH
LICENSED CONTRACTOR'S DECLARATION
•5„? ereb, hapter Job Description
y Ihon7001affimmOmin3oftheedunessauprodsiofssinsCode. ndmmenring SHAKE TO SHINGLE REROOF
:4h`rr wit Seniors 7000)of Division J of the Business vM Professions Cade,end my license
3 ,s in full force mtffe� 2 3
S e < Liams C M
i f a N Data Concacmr
ARCHITECT'
_ C 1 understand my pleas shall be used as public records
i
3 6.82
Licamod Pmfessioml
o•, OWNER-BUILDER DECLARATION
to I hereby M.that I am exempt from the Contractor's License Law for the
t < following mason.(Section 70313.Business and Professions Code:Any city or countyO O
D which requires a permit to com um alar,improve,demolish,or repair any structure3� -Friar to las issuance:alwinstirn the applicant formals parent to flee signed stmormn. _—
thatheis,licempd purivanno the provisionsaf rhe Contractors License Lew(Cwpmr9 v,.,.r }`, g �xyag y 1 y-T Valuation
(commencing with Scotian 7”)of Division 3 of the Business an Q Rrpfaasi...Code) ��tf r f3l'7®'7L:s/.G
or Nei he ii exempt therefrom and the basis for the elldged chem bn.Any violation
of Section 70313 by any applicant fora permit subjects the applicma in e civil pemlry'
'of not marethan five hundred dollars($50T, 3 0 r3ApN ll(t E Occupancy Type
❑L aowner of the ptopwy,or my employees with wages as their sale compensation.
will do the work and the scuctut,is not intended or offered for We ISa.7044.
Busidess and Professions Cade:The Contractor's License Law does not apply to an 601 - ROOF TEMglfjtbt}lnspections
curer of property Who Wilds or improvea thereon.and who does such work himself 602 - _ROOF PLYWOOD NAIL
or tluvugh his own employees.provided that such improvements are,not intended or
offered far sale.If.hawavar.the wilding or improvetnent is sold within one year or 603 - ROOF BATTENS
complw
etion,the owner-wilder will have the Notice of proving that he did not wild or
improve seri pnrpaae err awl,). 604 - ROOF IN-PROGRESS
❑L as ower of Ne property.em exclusively concocting wit licensed commucrs to '
onecuct the Project ISa.7044.Business and Prof iota Cade:)The Cancanor i r ,.
License Law does not apply to an owner of property who Wilds or improves thereon.
and who contracts for such projects with a commons)licensed pursuant to 1M .. _ k ... . ... . ... ..
Contractors Lt..law. .
[IIam mempr udder Sec. B&P C For this reason r "
.. Owner „ r,i.,. Dare
_ WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following decimations:
f ❑ 1 have and will'manumem a'Cenificeu of Contains to self-insure for Worker's
Compensation, as provided for by Session 3700 of the Labor Cade, for the
performance of the work for which this permit is issued;
ILL have and will ouninmin Workers Com amens ion Insurance,si required by Section
1700 of the Labor Code (or the performance of the work for which Mrs permit re
issued My W rke s Compensation Insurance tamer and Policy numbe ^^"
Carne i n, CPO ." PoIlcy No µ1 f/ S/ 3 1y.// .` fl 1 1RED
11iCERTIFICATIONOpEXEMPTIONFRO WORCOMPENSATION INSURANCE(Thiosxtion need nm he camplemtl if Ne permit is(or arm hurtdollen
(SI00)ar less) i L
I cmi(y that in the,perfonnentt of the work for which this paean"issue
shall hot employ any person in any manner,s6 as to become subject to the Workdt
Compensation Laws of California.Due,
Applicant
NOTICE TO APPLICANT:if.after mWho this Certificate of Eumption,you should
O Obecame subject to she Worker.Compensation provisions of the Labor Cod,you must
fooliwidi comply with such provisions err this paimis NNI be domed evoked.
CONSTRUCTIONLFNDMG AGENCY
a I hereby whom Oat
chert ii a smart Sec.
lending agency for the performance s
of the work forme which this permit is iasued(Sec:3037.Civ.C.)
(aa Q I<Mer's Name'"
� z Letider'iAddress' ;
V 1 omify Nat 1 have read this application and state that the above infornsi is
tL,'Ey casco.I agree to comply with ell city and county aotinances end sum Iowa relating
0 U to Wilding construction.and hereby amhm re represedatives o(this city to enter upon
yy rW the abov>maati.oad property for impecrion purposes.
f:.rf IL' (We)agree ser save,indemnify and keep harmless the City of Cupertino against
fA liabilities,judgments,costs and expenses which.may in any way accrue against said
V my in consequence ofthe granting of this permit., '
APPLICANT UNDERSTA ANDWILLCO PLYWITHALLNQN- 0
SOURCEREGUCATI . i " /q Issued by: Date
I�/P/
Sgnaturt of Appbcan o mor ' Dee, Re-roofs
as dell adb She Cu nes Municipal Code.Chapter 9.12.and the Health s Safety Type Of Roof
NA2AR000 MATERIALS DISCLOSURE or URE
'
Will the appllrant or future wilding rrcupant start m SUWIe hamotou
Y pero Pal W and Safety
Cade Section 25532(.)?, t .. s. , - i .' .. I•t \t, i_x t `• .. .
ore: gs�' ;.. All roofs.shall.be inspected prior to any roofing material being installed... _
Will the applicant or future Wilding pent use equpment or devices which If a roof is installed without first obtaining an ins0ection;7'agree to remove
mit haraN commitments as defined by theBey Arm Air Qual sy Management
airmaR❑Y es N all new materials for inspection. Applicant understands and will comply with
all non-point source regulations._ ,
I'have read the heamdous'mMen a requirements under Chapter X6.95 of the
California Health&Safety Cade,Sections 25505,25533 and 25534.1 understand that — /1
if the Wilding does not currently have.tenonLthot it is.,responsibility ser mmif,Oa
ax'apem of the requirement.which must be I prior to issuance df a Cenifime of
aP'"�' �/ / Signature of Appli ant Date
0/
Owner orauthotixed eg , —� Data All roof coverings to be Class "B"or,better
y I OFFICE
i
Building Division
no,C Torre Avenue
ac
Cupertino,CA 95014-3255
Telephone: (408)777-3228
Fax: (408)777-3333
CUPERTINO
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 pxogress 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 1/4"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: � 3
Reroofing Company Name/
Applicants Signature: .0 Date: A., J0
Joe Antonucci
(Chief Building Official)
6/25/01